Division of Hematology & Oncology, NYU Grossman Long Island School of Medicine, New York, NY, USA.
Department of Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt.
Blood Cancer J. 2024 Nov 29;14(1):212. doi: 10.1038/s41408-024-01194-5.
Histologic transformation (HT) of indolent non-Hodgkin lymphoma (iNHL) to diffuse large B-cell lymphoma (DLBCL) carries a poor prognosis. Using the Surveillance, Epidemiology, and End Results-17 database, we conducted a population-based study of adult patients with transformed follicular lymphoma (t-FL), marginal zone lymphoma (t-MZL), lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (t-LPL/WM), and de novo DLBCL. Primary outcome was relative survival (RS), and secondary outcomes included overall survival (OS) and lymphoma-specific survival (LSS). Outcomes were modeled using flexible parametric survival models, while multivariable modeling was used to compare RS, OS, and LSS. The incidence of HT was highest in splenic MZL (SMZL, 6.78%) and lowest in extranodal MZL (EMZL, 1.62%). Median follow-up times were similar for patients with de novo DLBCL and transformed indolent lymphomas. The 5-year RS and OS were longer in de novo DLBCL compared to all other transformed iNHL subtypes (68 versus 59%, respectively). For t-FL, early transformation (within 2 years of diagnosis, Hazard ratio [HR] = 1.34) and prior treatment (HR = 1.89) were associated with inferior survival. This association was not observed in other transformed lymphoma subtypes. This is the first comparative study to show that the outcomes of t-LPL/WM were inferior compared to de novo DLBCL and highlights the need to incorporate early experimental therapies in patients with t-FL with early transformation and receipt of prior chemotherapy.
惰性非霍奇金淋巴瘤（iNHL）向弥漫性大 B 细胞淋巴瘤（DLBCL）的组织学转化（HT）预后不良。我们利用监测、流行病学和最终结果-17 数据库，对转化滤泡性淋巴瘤（t-FL）、边缘区淋巴瘤（t-MZL）、淋巴浆细胞淋巴瘤/华氏巨球蛋白血症（t-LPL/WM）和新诊断的 DLBCL 成年患者进行了一项基于人群的研究。主要结局是相对生存率（RS），次要结局包括总生存率（OS）和淋巴瘤特异性生存率（LSS）。采用灵活的参数生存模型对结果进行建模，同时采用多变量模型比较 RS、OS 和 LSS。HT 的发生率在脾边缘区淋巴瘤（SMZL，6.78%）最高，结外边缘区淋巴瘤（EMZL，1.62%）最低。新发 DLBCL 患者和转化惰性淋巴瘤患者的中位随访时间相似。与所有其他转化惰性 NHL 亚型相比，新发 DLBCL 的 5 年 RS 和 OS 更长（分别为 68%和 59%）。对于 t-FL，早期转化（诊断后 2 年内，HR=1.34）和先前治疗（HR=1.89）与生存不良相关。在其他转化淋巴瘤亚型中未观察到这种相关性。这是第一项比较研究，表明 t-LPL/WM 的结局比新诊断的 DLBCL 差，并强调需要在早期转化和接受先前化疗的 t-FL 患者中纳入早期实验性治疗。
