Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS)

Abstract

Key Points• The median posttransformation survival of 5 years suggests improved outcomes for transformed FL in the modern era.• Five-year progression-free and overall survival (66% and 88%) are favorable for patients with evidence of transformation at diagnosis.We assessed the incidence, prognostic features, and outcomes associated with transformation of follicular lymphoma (FL) among 2652 evaluable patients prospectively enrolled in the National LymphoCare Study. At a median follow-up of 6. , 83-86). The median overall survival posttransformation was 5 years. Forty-seven patients with evidence of transformation at the time of diagnosis shared similar prognostic factors and survival rates to those without transformation. Improved outcomes for transformation in the modern era are suggested by this observational study. This trial is registered at www.clinicaltrials.gov as #NCT00097565. (Blood. 2015;126(7):851-857)

Is watch and wait still acceptable for patients with low-grade follicular lymphoma?

“…28 A number of groups have more recently reported on the rate of histologic transformation, and a consensus emerged that the rate was not clearly affected by type of treatment. 29 Recent estimates suggest that the rate of histologic transformation may be 2% to 3% per year. [29][30][31] However, the explanation for the lower incidence remains unclear.…”

Autologous Stem Cell Transplantation for Transformed Lymphoma: Single-Center Experience

“…The OS at five years was 50%, and the data demonstrate that patients with synchronous transformation of FL had outcomes comparable to FL without transformation (five-year OS of 88%). 2 The NCCN study observed that younger chemotherapy-naive or rituximab-naive patients had a favorable outcome without transplantation with the five-year OS of 80%.…”

“…In the past decade, the median overall survival (OS) has improved from one year to approximately five years. 2 New modalities of therapy and earlier diagnosis of histological transformation (HT) could be the attributing factors. Due to the aggressive nature of transformed lymphomas (TLs), many centers offer high-dose chemotherapy and autologous stem cell transplantation (HD-ASCT) to eligible patients with chemotherapy-sensitive disease.…”

“…5 The National LymphoCare Study confirmed that the incidence of transformation in the current era remains the same despite the use of chemoimmunotherapy. 2 The gold standard for the diagnosis of HT is documentation by biopsy. The yield is enhanced by positron emission tomography scan (PET) assessment.…”

Axicabtagene ciloleucel, a first-in-class CAR T cell therapy for aggressive NHL

“…First-line treatment for patients with DLBCL, PMBCL, or TFL generally consists of combination therapy with rituximab and chemotherapy [13,19,20]. Most new cases of DLBCL are cured with standard of care frontline therapy, but 10-15% of patients experience primary refractory disease and 20-30% of patients who do respond to front-line treatment will relapse [13].…”