Zhang Xiao-Li, Yu Wen-Juan, Zhu Ya-Nan, Yang Chun-Mei, Xiao Feng, Mai Wen-Yuan
Department of Hematology, Pingdingshan First People's Hospital, Pingdingshan 467000, Henan Province, China,Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China,E-mail：
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Dec;30(6):1772-1778. doi: 10.19746/j.cnki.issn.1009-2137.2022.06.022.
To analyze the clinical manifestations, pathological characteristics, therapeutic effect and prognosis of diffuse large B-cell lymphoma (DLBCL) transformed from follicular lymphoma (FL).
A total of 45 inpatients were eligible for criteria of histologic transformation from FL to DLBCL from January 2010 to January 2021, and their clinical characteristics, diagnosis, treatment and efficacy were collected and analyzed retrospectively.
Among the 45 patients, transformation occurred at diagnosis in 27 cases, during " watch and wait " phase in 7 cases and after treatment of FL in 11 cases. The median age was 56 years old (ranged from 27 to 76 years), with 23 male and 22 female. The transformations were observed in 8 cases with low-grade and 37 cases with high-grade FL. Extranodal involvement was present in 26 cases, including bone marrow infiltration in 16 cases. There were 17 cases with anemia and 32 cases met the GELF criteria of high tumor burden. B symptoms were present in 12 cases. There were 38 cases with Ki-67≥50%. The germinal center B-cell-like (GCB) subtype of DLBCL was observed in 43 cases. Efficacy was evaluated in 45 cases. The OR, CR and PR rate were 80.0%, 60.0% and 20.0%, respectively. The OR,CR rate of patients received R-CHOP was higher than those of patients received other regimens (86.11% vs 55.55%, =0.063; 66.67% vs 33.33%, =0.126), but there was no significant statistical difference. The early transformation (at diagnosis) group showed the highest OR rate (85.18%) and CR rate (74.07%). The median follow-up time of all patients was 26 (4-120) months, and the median PFS (2-120 months) and median OS (5-120 months) had not yet reached. The 3-year PFS and OS were 55% and 70%, respectively. In univariate analysis, factors affecting PFS includ OR rate and POD24, and factors affecting OS includ IPI score, OR rate, POD24, B symptoms and anemia (<0.05).Multivariant analysis indicated that OR rate and POD24 were the independent prognostic factors for PFS (<0.05) and IPI score was an independent prognostic factor for OS (<0.05).
The OR and CR rates are higher in early transformation group of patients with DLBCL transformed from FL. Patients with anemia, B symptoms, POD24, and high-risk score have poor prognosis. IPI score is the independent prognosis factor for OS.
分析滤泡性淋巴瘤（FL）转化为弥漫性大B细胞淋巴瘤（DLBCL）的临床表现、病理特征、治疗效果及预后。
回顾性收集并分析2010年1月至2021年1月期间符合从FL组织学转化为DLBCL标准的45例住院患者的临床特征、诊断、治疗及疗效。
45例患者中，27例在诊断时发生转化，7例在“观察等待”阶段发生转化，11例在FL治疗后发生转化。中位年龄为56岁（27至76岁），男性23例，女性22例。8例低级别FL和37例高级别FL发生转化。26例有结外受累，其中16例有骨髓浸润。17例有贫血，32例符合高肿瘤负荷的GELF标准。12例有B症状。38例Ki-67≥50%。43例为DLBCL生发中心B细胞样（GCB）亚型。45例患者进行了疗效评估。客观缓解（OR）率、完全缓解（CR）率和部分缓解（PR）率分别为80.0%、60.0%和20.0%。接受R-CHOP方案治疗患者的OR、CR率高于接受其他方案治疗的患者（86.11%对55.55%，P=0.063；66.67%对33.33%，P=0.126），但无显著统计学差异。早期转化（诊断时）组的OR率（85.18%）和CR率（74.07%）最高。所有患者的中位随访时间为26（4至120）个月，中位无进展生存期（PFS，2至120个月）和中位总生存期（OS，5至120个月）尚未达到。3年PFS和OS分别为55%和70%。单因素分析显示，影响PFS的因素包括OR率和POD24，影响OS的因素包括国际预后指数（IPI）评分、OR率、POD24、B症状和贫血（P<0.05）。多因素分析表明，OR率和POD24是PFS的独立预后因素（P<0.05），IPI评分是OS的独立预后因素（P<0.05）。
FL转化为DLBCL患者的早期转化组OR和CR率较高。有贫血、B症状、POD24及高危评分的患者预后较差。IPI评分是OS的独立预后因素。
