The incidence of biopsy-proven transformation in follicular lymphoma in the rituximab era. A retrospective analysis from the Czech Lymphoma Study Group (CLSG) database
Language English Country Germany Media print-electronic
Document type Journal Article
PubMed
29318369
DOI
10.1007/s00277-017-3218-0
PII: 10.1007/s00277-017-3218-0
Knihovny.cz E-resources
- Keywords
- Follicular lymphoma, Rituximab, Transformation,
- MeSH
- Survival Analysis MeSH
- Anthracyclines adverse effects therapeutic use MeSH
- Biopsy MeSH
- Adult MeSH
- Lymphoma, Follicular drug therapy epidemiology pathology prevention & control MeSH
- Incidence MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Cell Transformation, Neoplastic drug effects pathology MeSH
- Follow-Up Studies MeSH
- Antineoplastic Agents, Immunological adverse effects therapeutic use MeSH
- Antineoplastic Combined Chemotherapy Protocols adverse effects therapeutic use MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Rituximab adverse effects therapeutic use MeSH
- Secondary Prevention MeSH
- Aged MeSH
- Maintenance Chemotherapy adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic epidemiology MeSH
- Names of Substances
- Anthracyclines MeSH
- Antineoplastic Agents, Immunological MeSH
- Rituximab MeSH
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.
Department of Clinical Hematology Teaching Hospital Ostrava Ostrava Czech Republic
Department of Oncology Hospital Ceske Budejovice Ceske Budejovice Czech Republic
Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
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