Risk of histological transformation and therapy-related myelodysplasia/acute myeloid leukaemia in patients receiving radioimmunotherapy for follicular lymphoma

Narendranath Epperla, Anthony Q. Pham, Brian L. Burnette, Gregory A. Wiseman, Thomas Matthew Habermann, William R. Macon, Stephen Maxted Ansell, David J. Inwards, Ivana Micallef, Patrick Bruce Johnston, Svetomir Nenad Markovic, Luis F. Porrata, Joseph P. Colgan, Kay M. Ristow, Grzegorz S Nowakowski, Thomas Elmer Witzig

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Histological transformation (HT) of follicular lymphoma (FL) to an aggressive lymphoma after chemotherapy remains a key issue. The incidence of HT after radioimmunotherapy (RIT) is unknown. This single institution study analysed the risk of HT in FL after treatment with yttrium-90 ibritumomab tiuxetan in 115 consecutive patients treated during 1987-2012. RIT was administered for progressive FL in 111 (97%) patients and as first-line therapy in the remaining 4. 28% (n = 32) had HT, occurring at a median of 60 months from diagnosis and 20 months after RIT. 48% (12/25) of patients who received fludarabine developed HT. The estimated 10-year risk of HT in the fludarabine and non-fludarabine groups was 67% and 26% respectively (P = 0·015). Only prior fludarabine was significantly associated with predicting the risk of HT after RIT. 8% (9/115) of patients developed therapy-related myelodysplastic syndrome/acute myeloid leukaemia (tMDS/AML) at a median of 41·4 months (range, 5-89). The estimated 10-year risk of tMDS/AML in non-fludarabine treated patients (n = 90) versus fludarabine treated (n = 25) was 13% and 29%, respectively. The estimated overall risk of FL undergoing HT at 10 years without fludarabine exposure appears similar to patients reported in the literature that have not received RIT. Patients with prior purine-analogue therapy are at significantly higher risk of HT.

Original languageEnglish (US)
JournalBritish Journal of Haematology
DOIs
StateAccepted/In press - 2017

Fingerprint

Radioimmunotherapy
Follicular Lymphoma
Acute Myeloid Leukemia
Myelodysplastic Syndromes
Therapeutics
Lymphoma
fludarabine
Drug Therapy
Incidence

Keywords

  • Acute myeloid leukaemia
  • Follicular lymphoma
  • Myelodysplastic syndrome
  • Radioimmunotherapy
  • Transformation

ASJC Scopus subject areas

  • Hematology

Cite this

Risk of histological transformation and therapy-related myelodysplasia/acute myeloid leukaemia in patients receiving radioimmunotherapy for follicular lymphoma. / Epperla, Narendranath; Pham, Anthony Q.; Burnette, Brian L.; Wiseman, Gregory A.; Habermann, Thomas Matthew; Macon, William R.; Ansell, Stephen Maxted; Inwards, David J.; Micallef, Ivana; Johnston, Patrick Bruce; Markovic, Svetomir Nenad; Porrata, Luis F.; Colgan, Joseph P.; Ristow, Kay M.; Nowakowski, Grzegorz S; Witzig, Thomas Elmer.

In: British Journal of Haematology, 2017.

Research output: Contribution to journalArticle

@article{1e611afa2e4f47ff81085081302f09b5,
title = "Risk of histological transformation and therapy-related myelodysplasia/acute myeloid leukaemia in patients receiving radioimmunotherapy for follicular lymphoma",
abstract = "Histological transformation (HT) of follicular lymphoma (FL) to an aggressive lymphoma after chemotherapy remains a key issue. The incidence of HT after radioimmunotherapy (RIT) is unknown. This single institution study analysed the risk of HT in FL after treatment with yttrium-90 ibritumomab tiuxetan in 115 consecutive patients treated during 1987-2012. RIT was administered for progressive FL in 111 (97{\%}) patients and as first-line therapy in the remaining 4. 28{\%} (n = 32) had HT, occurring at a median of 60 months from diagnosis and 20 months after RIT. 48{\%} (12/25) of patients who received fludarabine developed HT. The estimated 10-year risk of HT in the fludarabine and non-fludarabine groups was 67{\%} and 26{\%} respectively (P = 0·015). Only prior fludarabine was significantly associated with predicting the risk of HT after RIT. 8{\%} (9/115) of patients developed therapy-related myelodysplastic syndrome/acute myeloid leukaemia (tMDS/AML) at a median of 41·4 months (range, 5-89). The estimated 10-year risk of tMDS/AML in non-fludarabine treated patients (n = 90) versus fludarabine treated (n = 25) was 13{\%} and 29{\%}, respectively. The estimated overall risk of FL undergoing HT at 10 years without fludarabine exposure appears similar to patients reported in the literature that have not received RIT. Patients with prior purine-analogue therapy are at significantly higher risk of HT.",
keywords = "Acute myeloid leukaemia, Follicular lymphoma, Myelodysplastic syndrome, Radioimmunotherapy, Transformation",
author = "Narendranath Epperla and Pham, {Anthony Q.} and Burnette, {Brian L.} and Wiseman, {Gregory A.} and Habermann, {Thomas Matthew} and Macon, {William R.} and Ansell, {Stephen Maxted} and Inwards, {David J.} and Ivana Micallef and Johnston, {Patrick Bruce} and Markovic, {Svetomir Nenad} and Porrata, {Luis F.} and Colgan, {Joseph P.} and Ristow, {Kay M.} and Nowakowski, {Grzegorz S} and Witzig, {Thomas Elmer}",
year = "2017",
doi = "10.1111/bjh.14688",
language = "English (US)",
journal = "British Journal of Haematology",
issn = "0007-1048",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Risk of histological transformation and therapy-related myelodysplasia/acute myeloid leukaemia in patients receiving radioimmunotherapy for follicular lymphoma

AU - Epperla, Narendranath

AU - Pham, Anthony Q.

AU - Burnette, Brian L.

AU - Wiseman, Gregory A.

AU - Habermann, Thomas Matthew

AU - Macon, William R.

AU - Ansell, Stephen Maxted

AU - Inwards, David J.

AU - Micallef, Ivana

AU - Johnston, Patrick Bruce

AU - Markovic, Svetomir Nenad

AU - Porrata, Luis F.

AU - Colgan, Joseph P.

AU - Ristow, Kay M.

AU - Nowakowski, Grzegorz S

AU - Witzig, Thomas Elmer

PY - 2017

Y1 - 2017

N2 - Histological transformation (HT) of follicular lymphoma (FL) to an aggressive lymphoma after chemotherapy remains a key issue. The incidence of HT after radioimmunotherapy (RIT) is unknown. This single institution study analysed the risk of HT in FL after treatment with yttrium-90 ibritumomab tiuxetan in 115 consecutive patients treated during 1987-2012. RIT was administered for progressive FL in 111 (97%) patients and as first-line therapy in the remaining 4. 28% (n = 32) had HT, occurring at a median of 60 months from diagnosis and 20 months after RIT. 48% (12/25) of patients who received fludarabine developed HT. The estimated 10-year risk of HT in the fludarabine and non-fludarabine groups was 67% and 26% respectively (P = 0·015). Only prior fludarabine was significantly associated with predicting the risk of HT after RIT. 8% (9/115) of patients developed therapy-related myelodysplastic syndrome/acute myeloid leukaemia (tMDS/AML) at a median of 41·4 months (range, 5-89). The estimated 10-year risk of tMDS/AML in non-fludarabine treated patients (n = 90) versus fludarabine treated (n = 25) was 13% and 29%, respectively. The estimated overall risk of FL undergoing HT at 10 years without fludarabine exposure appears similar to patients reported in the literature that have not received RIT. Patients with prior purine-analogue therapy are at significantly higher risk of HT.

AB - Histological transformation (HT) of follicular lymphoma (FL) to an aggressive lymphoma after chemotherapy remains a key issue. The incidence of HT after radioimmunotherapy (RIT) is unknown. This single institution study analysed the risk of HT in FL after treatment with yttrium-90 ibritumomab tiuxetan in 115 consecutive patients treated during 1987-2012. RIT was administered for progressive FL in 111 (97%) patients and as first-line therapy in the remaining 4. 28% (n = 32) had HT, occurring at a median of 60 months from diagnosis and 20 months after RIT. 48% (12/25) of patients who received fludarabine developed HT. The estimated 10-year risk of HT in the fludarabine and non-fludarabine groups was 67% and 26% respectively (P = 0·015). Only prior fludarabine was significantly associated with predicting the risk of HT after RIT. 8% (9/115) of patients developed therapy-related myelodysplastic syndrome/acute myeloid leukaemia (tMDS/AML) at a median of 41·4 months (range, 5-89). The estimated 10-year risk of tMDS/AML in non-fludarabine treated patients (n = 90) versus fludarabine treated (n = 25) was 13% and 29%, respectively. The estimated overall risk of FL undergoing HT at 10 years without fludarabine exposure appears similar to patients reported in the literature that have not received RIT. Patients with prior purine-analogue therapy are at significantly higher risk of HT.

KW - Acute myeloid leukaemia

KW - Follicular lymphoma

KW - Myelodysplastic syndrome

KW - Radioimmunotherapy

KW - Transformation

UR - http://www.scopus.com/inward/record.url?scp=85018265001&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018265001&partnerID=8YFLogxK

U2 - 10.1111/bjh.14688

DO - 10.1111/bjh.14688

M3 - Article

C2 - 28466487

AN - SCOPUS:85018265001

JO - British Journal of Haematology

JF - British Journal of Haematology

SN - 0007-1048

ER -