title: Rates and outcomes of follicular lymphoma transformation in the immunochemotherapy era: a report from the University of Iowa/MayoClinic Specialized Program of Research Excellence Molecular Epidemiology Resource.
abstract: OBJECTIVE
  This study sought to characterize transformation incidence and outcome for patients with follicular lymphoma (FL) in a prospective observational series begun after diffusion of rituximab use.
  
  
  METHODS
  Patients with newly diagnosed FL were prospectively enrolled onto the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource from 2002 to 2009. Patients were actively followed for re-treatment, clinical or pathologic transformation, and death. Risk of transformation was analyzed via time to transformation by using death as a competing risk.
  
  
  RESULTS
  In all, there were 631 patients with newly diagnosed grade 1 to 3a FL who had a median age at enrollment of 60 years. At a median follow-up of 60 months (range, 11 to 110 months), 79 patients had died, and 60 patients developed transformed lymphoma, of which 51 were biopsy proven. The overall transformation rate at 5 years was 10.7%, with an estimated rate of 2% per year. Increased lactate dehydrogenase was associated with increased risk of transformation. Transformation rate at 5 years was highest in patients who were initially observed and lowest in patients who initially received rituximab monotherapy (14.4% v 3.2%; P = .021). Median overall survival following transformation was 50 months and was superior in patients with transformation greater than 18 months after FL diagnosis compared with patients with earlier transformation (5-year overall survival, 66% v 22%; P < .001).
  
  
  CONCLUSIONS
  Follicular transformation rates in the immunochemotherapy era are similar to risk of death without transformation and may be lower than reported in older series. Post-transformation prognosis is substantially better than described in older series. Initial management strategies may influence the risk of transformation.
authors.affiliation: Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Link
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Maurer
authors.forename: Grzegorz S
authors.initials: GS
authors.lastname: Nowakowski
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: William R
authors.initials: WR
authors.lastname: Macon
authors.forename: Sergei I
authors.initials: SI
authors.lastname: Syrbu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Slager
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Thompson
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Colgan
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002471:Cell Transformation, Neoplastic / Q000187:drug effects* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D007770:L-Lactate Dehydrogenase
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