Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
Medical Oncology Department, Hospital Universitario La Fe de Valencia, Valencia, Spain.
Hematol Oncol. 2019 Apr;37(2):143-150. doi: 10.1002/hon.2601. Epub 2019 Apr 4.
Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma (NHL) subtype. The histological transformation (HT) of FL is an event considered frequent in the natural history of this tumor. We studied the transformation rates, predictive factors, and treatment characteristics that may impact in the survival of patients with FL and HT. A total of 1074 patients diagnosed with FL were prospectively enrolled from 1990 to 2016 in a Spanish registry. Sixty-four HTs were recorded based on clinical criteria (55%) or histological confirmation (45%). The cumulative incidence rate of transformation at 5 years is 7.3%. The 5-year overall survival (OS) without HT was 85% (95% confidence interval [CI], 70%-90%) vs 66% (95% CI, 51%-76%; P = 0.0012) with HT. Factors associated with HT were elevated lactate dehydrogenase (LDH) (odds ratio [OR] 1.83), intermediate-high Follicular lymphoma international prognostic index (FLIPI) (OR 2.16-OR 3.21), B symptoms (OR 2.46), or Eastern Cooperative Oncology Group (ECOG) 1 (OR 2.35). Treatment options related to HT were "watch and wait" or no rituximab or anthracyclines initially. A 5-year OS for patients treated with chemotherapy before HT was 55% (95% CI, 38%-69%) versus 81% (95% CI, 53%-93%; P = 0.009) for those who had not received it. The HT rate has decreased after the introduction of rituximab, as has been previously described. The timing of this treatment had an impact on the survival of these patients.
滤泡性淋巴瘤（FL）是第二常见的非霍奇金淋巴瘤（NHL）亚型。FL 的组织学转化（HT）被认为是该肿瘤自然史中频繁发生的事件。我们研究了可能影响 FL 和 HT 患者生存的转化率、预测因素和治疗特征。一项前瞻性研究共纳入了 1990 年至 2016 年间在西班牙注册中心诊断为 FL 的 1074 例患者。根据临床标准（55%）或组织学确认（45%）记录了 64 例 HT。5 年转化率的累积发生率为 7.3%。无 HT 的 5 年总生存率（OS）为 85%（95%置信区间[CI]，70%-90%），而 HT 的 5 年 OS 为 66%（95% CI，51%-76%；P=0.0012）。与 HT 相关的因素包括乳酸脱氢酶（LDH）升高（优势比[OR] 1.83）、中高危滤泡性淋巴瘤国际预后指数（FLIPI）（OR 2.16-OR 3.21）、B 症状（OR 2.46）或东部肿瘤协作组（ECOG）1 （OR 2.35）。与 HT 相关的治疗选择是最初“观察等待”或不使用利妥昔单抗或蒽环类药物。在 HT 之前接受化疗的患者 5 年 OS 为 55%（95% CI，38%-69%），而未接受化疗的患者为 81%（95% CI，53%-93%；P=0.009）。正如之前所描述的，利妥昔单抗的引入降低了 HT 率。这种治疗的时机对这些患者的生存有影响。
