title: Clinicopathological prognostic indicators in 107 patients with diffuse large B-cell lymphoma transformed from follicular lymphoma.
abstract: Follicular lymphoma (FL) frequently transforms into diffuse large B-cell lymphoma (DLBCL). To clarify the associated clinicopathological prognostic parameters, we examined the correlation of 11 histopathological parameters with progression-free survival (PFS) and overall survival (OS) in 107 consecutive patients who had DLBCL with pre-existing (asynchronous) or synchronous FL. The patients comprised 58 men and 49 women with a median age of 56 years. For DLBCL, the complete response rate was 81%, overall response rate was 88%, and 5-year PFS and OS rates were 55% and 79%, respectively. Immunohistochemical analysis of the DLBCL component revealed the following positivity rates: CD10, 64%; Bcl-2, 83%; Bcl-6, 88%; MUM1, 42%; GCB, 82%; cMyc index ≥80%, 17%; and Ki-67 index ≥90%, 19%. IGH/BCL2 fusion was positive in 57% of DLBCL cases. In univariate analyses, asynchronous FL and DLBCL (24%, P = 0.021), 100% proportion of DLBCL (29%, P = 0.004), Bcl-2 positivity (P = 0.04), and high Ki-67 index (P = 0.003) were significantly correlated with shorter PFS. Asynchronous FL and DLBCL (P = 0.003), 100% proportion of DLBCL (P = 0.001), and high Ki-67 index (P = 0.004) were significantly correlated with shorter OS. In a multivariate analysis, asynchronous FL and DLBCL (P = 0.035) and 100% proportion of DLBCL (P = 0.016) were significantly correlated with shorter OS. Thus, asynchronism and 100% proportion of DLBCL, that is, FL relapsed as pure DLBCL, or FL and DLBCL at different sites, were significant predictors of unfavorable outcome of patients with DLBCL transformed from FL.
authors.affiliation: Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan. akmaeshi@ncc.go.jp
authors.forename: Akiko M
authors.initials: AM
authors.lastname: Maeshima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Suguru
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Dai
authors.initials: D
authors.lastname: Maruyama
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Kensei
authors.initials: K
authors.lastname: Tobinai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsuda
mesh_terms: D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate