Rates and Outcomes of Follicular Lymphoma Transformation in the Immunochemotherapy Era: A Report From the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource

• Published in: Journal of clinical oncology Vol. 31; no. 26; pp. 3272 - 3278
• Main Authors: LINK, Brian K, MAURER, Matthew J, COLGAN, Joseph P, WITZIG, Thomas E, HABERMANN, Thomas M, CERHAN, James R, NOWAKOWSKI, Grzegorz S, ANSELL, Stephen M, MACON, William R, SYRBU, Sergei I, SLAGER, Susan L, THOMPSON, Carrie A, INWARDS, David J, JOHNSTON, Patrick B
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 10.09.2013
• Subjects: Biological and medical sciences; Hematologic and hematopoietic diseases; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; ORIGINAL REPORTS; Tumors; Iowa; United States; North America; America; Immunochemotherapy; Prognosis; Rate; Resource; B cell neoplasm; Malignant hemopathy; Lymphoid neoplasm; Non Hodgkin lymphoma; Chemotherapy; Cancerology; Research program; Treatment; University; Lymphoproliferative syndrome; Molecular epidemiology; Follicular lymphoma; Evolution; Cancer
• DOI: 10.1200/JCO.2012.48.3990
• ISSN: 0732-183X

Purpose This study sought to characterize transformation incidence and outcome for patients with follicular lymphoma (FL) in a prospective observational series begun after diffusion of rituximab use. Patients and Methods Patients with newly diagnosed FL were prospectively enrolled onto the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource from 2002 to 2009. Patients were actively followed for re-treatment, clinical or pathologic transformation, and death. Risk of transformation was analyzed via time to transformation by using death as a competing risk. Results In all, there were 631 patients with newly diagnosed grade 1 to 3a FL who had a median age at enrollment of 60 years. At a median follow-up of 60 months (range, 11 to 110 months), 79 patients had died, and 60 patients developed transformed lymphoma, of which 51 were biopsy proven. The overall transformation rate at 5 years was 10.7%, with an estimated rate of 2% per year. Increased lactate dehydrogenase was associated with increased risk of transformation. Transformation rate at 5 years was highest in patients who were initially observed and lowest in patients who initially received rituximab monotherapy (14.4% v 3.2%; P = .021). Median overall survival following transformation was 50 months and was superior in patients with transformation greater than 18 months after FL diagnosis compared with patients with earlier transformation (5-year overall survival, 66% v 22%; P < .001). Conclusion Follicular transformation rates in the immunochemotherapy era are similar to risk of death without transformation and may be lower than reported in older series. Post-transformation prognosis is substantially better than described in older series. Initial management strategies may influence the risk of transformation.