Journal of Clinical Oncology, Vol 15, 1587-1594, Copyright © 1997 by American Society of Clinical Oncology
Incidence, predictive factors, and outcome of lymphoma transformation in follicular lymphoma patients
Y Bastion, C Sebban, F Berger, P Felman, G Salles, C Dumontet, PA Bryon and B Coiffier
Hematology Service, Centre Hospitalier Lyon-Sud, Pierre-Benite, France.
PURPOSE: 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. PATIENTS AND 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. CONCLUSION:
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.
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