Bastion Y, Sebban C, Berger F, Felman P, Salles G, Dumontet C, Bryon P A, Coiffier B
Hematology Service, Centre Hospitalier Lyon-Sud, Pierre-Benite, France.
J Clin Oncol. 1997 Apr;15(4):1587-94. doi: 10.1200/JCO.1997.15.4.1587.
To assess the incidence of lymphoma transformation in the natural history of follicular lymphoma (FL) patients and the factors that are predictive of this event.
Two hundred twenty patients with FL treated in our institution between 1975 and 1990, with a median follow-up duration of 9 years, were included in this retrospective analysis.
Transformation was proven by histology in 34 patients or by cytology in 13 patients and was considered as highly probable on clinical arguments in five patients for an overall incidence of 24%. The probability of transformation was 22% at 5 years and 31% at 10 years and tended to plateau after 6 years. Predictive factors for transformation were nonachievement of complete remission (CR) after initial therapy (P < 10(-4), low serum albumin level (< 35 g/L) (P = .001), and beta 2-microglobulin level greater than 3 mg/L (P = .02) at diagnosis. In a multiparametric analysis, only beta 2-microglobulin level retained prognostic significance for freedom-from-transformation (FFT) survival (P = .04). Transformation accounted for 44% of deaths and was associated with a poor outcome, with a median survival time of 7 months.
Transformation is an early event in the course of the disease and is mainly observed in patients with known adverse prognostic factors or those who do not achieve CR after initial treatment. These findings may be useful to select follicular lymphoma patients for intensive therapeutic approaches.
评估滤泡性淋巴瘤（FL）患者自然病程中淋巴瘤转化的发生率以及预测该事件的因素。
本回顾性分析纳入了1975年至1990年间在我院接受治疗的220例FL患者，中位随访时间为9年。
34例患者经组织学证实发生转化，13例经细胞学证实，另有5例根据临床依据高度怀疑发生转化，总体发生率为24%。5年时转化概率为22%，10年时为31%，6年后趋于平稳。转化的预测因素包括初始治疗后未达到完全缓解（CR）（P < 10⁻⁴）、诊断时血清白蛋白水平低（< 35 g/L）（P = 0.001）以及β2-微球蛋白水平大于3 mg/L（P = 0.02）。在多参数分析中，只有β2-微球蛋白水平对无转化（FFT）生存保留预后意义（P = 0.04）。转化占死亡病例的44%，且与不良预后相关，中位生存时间为7个月。
转化是疾病进程中的早期事件，主要见于具有已知不良预后因素的患者或初始治疗后未达到CR的患者。这些发现可能有助于选择滤泡性淋巴瘤患者进行强化治疗。
