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Transformed follicular lymphoma in the rituximab era: A report from the S panish L ymphoma O ncology G roup
Author(s) -
Méndez Miriam,
Torrente Maria,
SánchezBeato Margarita,
GonzálezRincón Julia,
Royuela Ana,
GómezCodina José,
CruzMerino Luis,
Rueda Antonio,
Llanos Marta,
Quero Cristina,
RodríguezAbreu Delvys,
Gumá Josep,
Monsalvo Silvia,
Sabin Pilar,
Provencio Mariano
Publication year - 2019
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2601
Subject(s) - medicine , rituximab , follicular lymphoma , lymphoma , gastroenterology , confidence interval , odds ratio , international prognostic index , oncology
Follicular lymphoma (FL) is the second most common non‐Hodgkin lymphoma (NHL) subtype. The histological transformation (HT) of FL is an event considered frequent in the natural history of this tumor. We studied the transformation rates, predictive factors, and treatment characteristics that may impact in the survival of patients with FL and HT. A total of 1074 patients diagnosed with FL were prospectively enrolled from 1990 to 2016 in a Spanish registry. Sixty‐four HTs were recorded based on clinical criteria (55%) or histological confirmation (45%). The cumulative incidence rate of transformation at 5 years is 7.3%. The 5‐year overall survival (OS) without HT was 85% (95% confidence interval [CI], 70%‐90%) vs 66% (95% CI, 51%‐76%; P = 0.0012) with HT. Factors associated with HT were elevated lactate dehydrogenase (LDH) (odds ratio [OR] 1.83), intermediate‐high Follicular lymphoma international prognostic index (FLIPI) (OR 2.16‐OR 3.21), B symptoms (OR 2.46), or Eastern Cooperative Oncology Group (ECOG) 1 (OR 2.35). Treatment options related to HT were “watch and wait” or no rituximab or anthracyclines initially. A 5‐year OS for patients treated with chemotherapy before HT was 55% (95% CI, 38%‐69%) versus 81% (95% CI, 53%‐93%; P = 0.009) for those who had not received it. The HT rate has decreased after the introduction of rituximab, as has been previously described. The timing of this treatment had an impact on the survival of these patients.