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The incidence of biopsy-proven transformation in follicular lymphoma in the rituximab era. A retrospective analysis from the Czech Lymphoma Study Group (CLSG) database

A. Janikova, Z. Bortlicek, V. Campr, N. Kopalova, K. Benesova, M. Hamouzova, D. Belada, V. Prochazka, R. Pytlik, S. Vokurka, J. Pirnos, J. Duras, H. Mocikova, J. Mayer, M. Trneny,

. 2018 ; 97 (4) : 669-678. [pub] 20180109

Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc18010206

Grant support
NV16-31092A MZ0 CEP Register

The aim of this study is to assess the incidence, risk factors, and outcome of biopsy-proven transformation in follicular lymphoma (FL) patients in the rituximab era. Transformation was analyzed in 1233 patients with initially diagnosed FL grades 1-3A, identified between 2002 and 2012 in the prospectively maintained Czech Lymphoma Study Group database. Only patients with histologically proven transformation (HT) were included. HT occurred in 58 cases at a median of 3.0 years from the initial FL diagnosis; the HT rate was 4% at 5 years. Transformation occurred most frequently at the first relapse (84% patients). Median OS from the HT was 2.5 years (95% CI 0.4-4.6) and 6-year OS with HT was shorter compared to all FLs (60 vs. 83.9%; 95% CI). A bulky tumor (≥ 10 cm), increased lactate dehydrogenase, age ≥ 60 years, and International Prognostic Index (intermediate/high risk), but not Follicular Lymphoma International Prognostic Index, were associated with transformation (p < 0.05). In the first line, 70% of patients received rituximab (including 36% rituximab maintenance), 57% CHOP-like regimens, and 2.6% of patients were treated with fludarabine-based therapy, whereas 11% of patients were watched only. The patients treated with R-CHOP in the first line (n = 591) showed the transformation rate at 5 years of 4.23% (95% CI 2.52-5.93); subsequent rituximab maintenance (n = 276) vs. observation (n = 153) was associated with a lower transformation rate (p.033; HR 3.29; CI 1.10-9.82). The transformation rate seems to be lower than in previous series, which may be influenced by broad use of rituximab, but prognosis of HT developed during therapy continues to be poor.

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$a The aim of this study is to assess the incidence, risk factors, and outcome of biopsy-proven transformation in follicular lymphoma (FL) patients in the rituximab era. Transformation was analyzed in 1233 patients with initially diagnosed FL grades 1-3A, identified between 2002 and 2012 in the prospectively maintained Czech Lymphoma Study Group database. Only patients with histologically proven transformation (HT) were included. HT occurred in 58 cases at a median of 3.0 years from the initial FL diagnosis; the HT rate was 4% at 5 years. Transformation occurred most frequently at the first relapse (84% patients). Median OS from the HT was 2.5 years (95% CI 0.4-4.6) and 6-year OS with HT was shorter compared to all FLs (60 vs. 83.9%; 95% CI). A bulky tumor (≥ 10 cm), increased lactate dehydrogenase, age ≥ 60 years, and International Prognostic Index (intermediate/high risk), but not Follicular Lymphoma International Prognostic Index, were associated with transformation (p < 0.05). In the first line, 70% of patients received rituximab (including 36% rituximab maintenance), 57% CHOP-like regimens, and 2.6% of patients were treated with fludarabine-based therapy, whereas 11% of patients were watched only. The patients treated with R-CHOP in the first line (n = 591) showed the transformation rate at 5 years of 4.23% (95% CI 2.52-5.93); subsequent rituximab maintenance (n = 276) vs. observation (n = 153) was associated with a lower transformation rate (p.033; HR 3.29; CI 1.10-9.82). The transformation rate seems to be lower than in previous series, which may be influenced by broad use of rituximab, but prognosis of HT developed during therapy continues to be poor.
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$a Bortlicek, Zbynek $u Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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$a Campr, Vit $u Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Faculty Hospital in Motol, Prague, Czech Republic.
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$a Kopálová, Nataša $u Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic. $7 xx0331481
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$a Benesova, Katerina $u 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic.
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$a Hamouzova, Michaela $u 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic.
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$a Belada, David $u 4th Department of Internal Medicine-Hematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic.
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$a Prochazka, Vit $u Department of Hemato-oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic.
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$a Pytlik, Robert $u 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic.
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$a Vokurka, Samuel $u Department of Hemato-oncology, Charles University and University Hospital Pilsen, Pilsen, Czech Republic.
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$a Pirnos, Jan $u Department of Oncology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic.
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$a Duras, Juraj $u Department of Clinical Hematology, Teaching Hospital Ostrava, Ostrava, Czech Republic.
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$a Mayer, Jiri $u Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic.
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