TY - JOUR
T1 - Rates and outcomes of follicular lymphoma transformation in the immunochemotherapy era
T2 - A report from the university of Iowa/mayo clinic specialized program of research excellence molecular epidemiology resource
AU - Link, Brian K.
AU - Maurer, Matthew J.
AU - Nowakowski, Grzegorz S.
AU - Ansell, Stephen M.
AU - MacOn, William R.
AU - Syrbu, Sergei I.
AU - Slager, Susan L.
AU - Thompson, Carrie A.
AU - Inwards, David J.
AU - Johnston, Patrick B.
AU - Colgan, Joseph P.
AU - Witzig, Thomas E.
AU - Habermann, Thomas M.
AU - Cerhan, James R.
N1 - Publisher Copyright:
© 2013 by The American Society of Hematology.
PY - 2013/9/10
Y1 - 2013/9/10
N2 - 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 lt; .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.
AB - 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 lt; .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.
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U2 - 10.1200/JCO.2012.48.3990
DO - 10.1200/JCO.2012.48.3990
M3 - Article
C2 - 23897955
AN - SCOPUS:84891535944
SN - 0732-183X
VL - 31
SP - 3272
EP - 3278
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 26
ER -