Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, 45 Little Britain, EC1A 7BE, London, United Kingdom.
J Clin Oncol. 2011 May 10;29(14):1827-34. doi: 10.1200/JCO.2010.32.7577. Epub 2011 Apr 11.
Histologic transformation (HT) to an aggressive lymphoma is a well-described event in the natural history and clinical course of patients with so-called indolent lymphomas. This phenomenon has been studied most extensively in patients with follicular lymphoma and subsequent transformation to a diffuse large B-cell lymphoma, with little literature on HT in nonfollicular lymphomas. Despite a considerable body of information on the pathologic and molecular events associated with HT, its pathogenesis has remained elusive and the molecular information available has not been translated into clinical advances. It remains unclear if there is already a predisposition to HT and whether this can be detected at the time of diagnosis. The rituximab era has been characterized by a significant improvement in the prognosis of patients with B-cell lymphomas, but HT remains one of the most important challenges in the management of patients with indolent lymphoma, the difficulties starting with the diagnosis and definition of HT and ending with the appropriate management and treatment of the event. Going forward, it is crucial to incorporate HT as a major end point in clinical trials and to include patients with HT as subject of such studies if we are to see meaningful progress in the future.
组织学转化（HT）为侵袭性淋巴瘤是所谓惰性淋巴瘤患者自然病史和临床过程中一个已被充分描述的事件。这一现象在滤泡性淋巴瘤患者中研究得最为广泛，随后转化为弥漫性大 B 细胞淋巴瘤，而非滤泡性淋巴瘤中的 HT 文献很少。尽管已经有大量关于与 HT 相关的病理和分子事件的信息，但它的发病机制仍然难以捉摸，并且可用的分子信息尚未转化为临床进展。目前尚不清楚是否已经存在 HT 的倾向，以及是否可以在诊断时检测到这种倾向。利妥昔单抗时代的特点是 B 细胞淋巴瘤患者的预后有了显著改善，但 HT 仍然是惰性淋巴瘤患者管理中最具挑战性的问题之一，从 HT 的诊断和定义开始，一直到适当的管理和治疗该事件，都存在困难。未来，将 HT 作为临床试验的主要终点纳入其中，并将 HT 患者纳入此类研究的受试者中，如果我们将来要取得有意义的进展，这一点至关重要。
