Transformed follicular lymphoma (tFL): consolidation therapy may improve survival.
OBJECTIVE
Retrospective study to evaluate the outcome of patients with transformed follicular lymphoma (tFL) treated with rituximab-containing chemotherapy and consolidation.


METHODS
Patients diagnosed with tFL from 2003 to 2013 treated with consolidation therapy with last follow-up in December 2015 were identified from the institutional lymphoma database and included in this study. Data collected included age, gender, stage, interval to tFL diagnosis, R-IPI score, histological diagnosis and therapy. The treatment algorithm used was stratified for age, performance status (PS) and sibling donor availability using R-chemotherapy induction followed by consolidation with allogeneic stem cell transplant (SCT), autologous SCT, Zevalin or rituximab maintenance (RM). Patients with B-cell lymphoma with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma (BCL-U), with FISH-proven t(14;18) and t(8;14) and their variants were excluded.


RESULTS
Four hundred patients were diagnosed with FL of whom 26 (7%) developed histologically proven tFL. The group was predominantly male (73%) with a median age at transformation of 53 (range 27-72) years and 85% presented with stage III/IV disease. Thirteen (50%) patients presented with de novo tFL and the remainder had previously diagnosed FL, with a median time to transformation of 5.7 (range 1-15) years. The median follow-up time from tFL diagnosis to December 2015 is 8 (range 4-14) years. All patients received immuno-chemotherapy achieving an overall response rate (ORR) of 100%. Fourteen (54%), patients were transplant eligible and based on donor availability, six had an auto-SCT only, five had an allo-SCT only and three had a matched unrelated allo-SCT for a post-auto-SCT relapse. The 12 patients (46%) who were not transplant eligible were consolidated with rituximab maintenance (RM) in nine (35%) and Zevalin in three (11%) cases. The overall survival (OS) and progression-free survival (PFS) for the series at 5 years were, 92 and 73%, respectively.


CONCLUSIONS
This consecutively treated series of 26 patients with tFL have had a better outcome than expected which may be due to the use of rituximab-chemotherapy and a consolidation strategy based on age, PS and availability of a sibling donor.
Haematology Department, St James Hospital, Dublin, Ireland. ezzat.elhassadi@hse.ie.|Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland. ezzat.elhassadi@hse.ie.
E
E
Elhassadi
Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.|Histopathology Department, St. James's Hospital, Dublin, Ireland.
R
R
Flavin
Haematology Department, St James Hospital, Dublin, Ireland.|Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.
P
P
Browne
Haematology Department, St James Hospital, Dublin, Ireland.|Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.
E
E
Conneally
Haematology Department, St James Hospital, Dublin, Ireland.|Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.
P
P
Hayden
Cancer Molecular Diagnostic Department, St. James's Hospital, Dublin, Ireland.
F
F
Quinn
Haematology Department, St James Hospital, Dublin, Ireland.
E
E
Higgins
Haematology Department, St James Hospital, Dublin, Ireland.|Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.
E
E
Vandenberghe
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D060830:Consolidation Chemotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
Rituximab maintenance; Rituximab-chemotherapy; Stem cell transplant; Transformed follicular lymphoma; Zevalin therapy