Originally published as JCO Early Release 10.1200/JCO.2008.16.0283 on October 6 2008

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Population-Based Analysis of Incidence and Outcome of Transformed Non-Hodgkin's Lymphoma

Abdulwahab J. Al-Tourah, Karamjit K. Gill, Mukesh Chhanabhai, Paul J. Hoskins, Richard J. Klasa, Kerry J. Savage, Laurie H. Sehn, Tamara N. Shenkier, Randy D. Gascoyne, Joseph M. Connors

From the Division of Medical Oncology, Fraser Valley and Vancouver Cancer Centers; and the Departments of Pathology and Biostatistics, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada

Corresponding author: Abdulwahab J. Al-Tourah, MB, BcH, FRCPC, British Columbia Cancer Agency, 13750 96th Ave, Surrey, British Columbia, Canada; e-mail: aaltoura{at}bccancer.bc.ca

Purpose To assess the incidence and predictive factors for development of transformed lymphoma in a population-based series of patients with follicular lymphoma (FL).

Patients and Methods The Lymphoid Cancer Database was used to identify patients with FL diagnosed and treated in the province of British Columbia, Canada. Transformed lymphoma was defined as the development of aggressive non-Hodgkin's lymphoma (NHL) in patients with FL. Factors present at the time of initial diagnosis of indolent NHL and at transformation were analyzed for their impact on risk of transformation and subsequent outcome.

Results Between 1986 and 2001, 600 patients with newly diagnosed FL met the inclusion criteria. With a median follow-up of 109 months (range, 10 to 244), 170 (28%) developed transformation, 107 (63%) based on biopsy confirmation. The annual risk of transformation was 3% continuously through 15 years. A multivariate analysis of clinical factors at diagnosis identified advanced stage as the only predictor of future transformation. The median post-transformation survival was 1.7 years. The 5-year survival was superior for patients with limited extent transformation compared with those with advanced cases (66% v 19%, P < .0001). Patients with transformation based on clinical versus histological criteria had an identical median survival of 1.8 years (P = .2).

Conclusion The annual risk of transformation of FL is 3% continuing without plateau beyond 15 years. Advanced stage at diagnosis is predictive of future transformation. Clinically diagnosed transformation has an equal impact on outcome as biopsy proven transformation.

published online ahead of print atwww.jco.org on October 6, 2008

Support for this project was provided in part by the Turner Family Outcomes Unit fund; the Mary Toye Memorial fund; the Terry Fox Foundation; Genome Canada; and the Centre for Lymphoid Cancer of the British Columbia Cancer Agency.

Presented in part at the meeting of the American Society of Hematology in December 2004, San Diego, CA, and the 9th International Conference on Malignant Lymphoma, June 2005, Lugano, Switzerland.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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