title: Incidence, risk factors and outcome of histological transformation in follicular lymphoma.
abstract: Histological transformation (HT) into diffuse large B-cell lymphoma (DLBCL) was documented in 37 of the 281 (13%; 95% CI, 9-18) follicular lymphoma (FL) patients treated at our institute from 1979 to 2007. HT occurred at a median of 2·75 years from initial FL diagnosis and HT rate was 15% at 10 years and 26% at 14 years, with a plateau from that point onward. Patients with bulky or extranodal disease, or those diagnosed before 1990 had a significantly higher risk of HT. When initial treatment strategies were taken into account, a reduced HT risk was seen in the patients initially managed with a 'watch and wait' policy, while the risk appeared significantly increased in the small subset of 18 patients initially managed with rituximab plus chemotherapy (P = 0·0005). HT was associated with a significantly shorter cause-specific survival (P = 0·0002). Predictors of survival after HT were the Follicular Lymphoma International Prognostic Index at diagnosis, as well as age and performance status at the time of HT. Our data confirm the adverse clinical outcome of FL after HT. In keeping with previous isolated reports, our findings suggest that there is a subgroup of patients in whom HT may not occur.
authors.affiliation: Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.
authors.forename: Annarita
authors.initials: A
authors.lastname: Conconi
authors.forename: Carlotta
authors.initials: C
authors.lastname: Ponzio
authors.forename: Chiara
authors.initials: C
authors.lastname: Lobetti-Bodoni
authors.forename: Maddalena
authors.initials: M
authors.lastname: Motta
authors.forename: Paola M V
authors.initials: PM
authors.lastname: Rancoita
authors.forename: Anastasios
authors.initials: A
authors.lastname: Stathis
authors.forename: Alden A
authors.initials: AA
authors.lastname: Moccia
authors.forename: Luca
authors.initials: L
authors.lastname: Mazzucchelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Bertoni
authors.forename: Michele
authors.initials: M
authors.lastname: Ghielmini
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008224:Lymphoma, Follicular / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab