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Risk of, and survival following, histological transformation in follicular lymphoma in the rituximab era. A retrospective multicentre study by the Spanish GELTAMO group
Author(s) -
AlonsoÁlvarez Sara,
Magnano Laura,
Alcoceba Miguel,
AndradeCampos Marcio,
EspinosaLara Natalia,
Rodríguez Guillermo,
Mercadal Santiago,
Carro Itziar,
Sancho Juan M.,
Moreno Miriam,
Salar Antonio,
GarcíaPallarols Francesc,
Arranz Reyes,
Cannata Jimena,
Terol María José,
Teruel Ana I.,
Rodríguez Antonia,
JiménezUbieto Ana,
González de Villambrosia Sonia,
Bello José L.,
López Lourdes,
Monsalvo Silvia,
Novelli Silvana,
Cabo Erik,
Infante María S.,
Pardal Emilia,
GarcíaÁlvarez María,
Delgado Julio,
González Marcos,
Martín Alejandro,
LópezGuillermo Armando,
Caballero María D.
Publication year - 2017
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14831
Subject(s) - medicine , hazard ratio , rituximab , follicular lymphoma , international prognostic index , cumulative incidence , retrospective cohort study , confidence interval , autologous stem cell transplantation , gastroenterology , surgery , transplantation , oncology , lymphoma
Summary The diagnostic criteria for follicular lymphoma ( FL ) transformation vary among the largest series, which commonly exclude histologically‐documented transformation ( HT ) mandatorily. The aims of this retrospective observational multicentre study by the Spanish Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea, which recruited 1734 patients (800 males/934 females; median age 59 years), diagnosed with FL grades 1–3A, were, (i) the cumulative incidence of HT ( CI ‐ HT ); (ii) risk factors associated with HT ; and (iii) the role of treatment and response on survival following transformation ( SFT ). With a median follow‐up of 6·2 years, 106 patients developed HT . Ten‐year CI ‐ HT was 8%. Considering these 106 patients who developed HT , median time to transformation was 2·5 years. High‐risk FL International Prognostic Index [Hazard ratio ( HR ) 2·6, 95% confidence interval ( CI ): 1·5–4·5] and non‐response to first‐line therapy ( HR 2·9, 95% CI : 1·3–6·8) were associated with HT . Seventy out of the 106 patients died (5‐year SFT , 26%). Response to HT first‐line therapy ( HR 5·3, 95% CI : 2·4–12·0), autologous stem cell transplantation ( HR 3·9, 95% CI : 1·5–10·1), and revised International Prognostic Index ( HR 2·2, 95% CI : 1·1–4·2) were significantly associated with SFT . Response to treatment and HT were the variables most significantly associated with survival in the rituximab era. Better therapies are needed to improve response. Inclusion of HT in clinical trials with new agents is mandatory.