title: Incidence, predictive factors, and outcome of lymphoma transformation in follicular lymphoma patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hematology Service, Centre Hospitalier Lyon-Sud, Pierre-Benite, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bastion
authors.forename: C
authors.initials: C
authors.lastname: Sebban
authors.forename: F
authors.initials: F
authors.lastname: Berger
authors.forename: P
authors.initials: P
authors.lastname: Felman
authors.forename: G
authors.initials: G
authors.lastname: Salles
authors.forename: C
authors.initials: C
authors.lastname: Dumontet
authors.forename: P A
authors.initials: PA
authors.lastname: Bryon
authors.forename: B
authors.initials: B
authors.lastname: Coiffier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002471:Cell Transformation, Neoplastic; D006801:Humans; D015994:Incidence; D008224:Lymphoma, Follicular / Q000097:blood / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome