Rituximab and the risk of transformation of follicular lymphoma: a retrospective pooled analysis

Federico, Massimo; Barrigón, María Dolores Caballero; Marcheselli, Luigi; Tarantino, Vittoria; Manni, Martina; Sarkozy, Clémentine; Alonso‐Álvarez, Sara; Wondergem, Mariëlle J.; Cartron, Guillaume; López‐Guillermo, Armando; Issa, Djamila E.; Morschhauser, Franck; Alcoceba, Miguel; Kimby, Eva; Rusconi, Chiara; Chamuleau, Martine E.D.; Holte, Harald; Lockmer, Sandra; Montoto, Silvia; Silva, Maria Gomes da; Aurer, Igor; Zucca, Emanuele; Paszkiewicz‐Kozik, Ewa; Minoia, Carla; Skrypets, Tetiana; Blaker, Yngvild Nuvin; Salles, Gilles; Coiffier, Bertrand

doi:10.1016/s2352-3026(18)30090-5

Cited by 81 publications

(88 citation statements)

References 23 publications

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“…In contrast with recent reports describing a reduced risk of HT in the rituximab era 19 , we were not able to identify significant differences in its incidence among decades, presumably to the relatively small number of this type of event in each of the decades. However, HT rates in the last two decades of the study are superimposable to that reported in the Aristotle study 19 .…”

Section: Discussioncontrasting

confidence: 99%

“…Despite a median OS now approaching 20 years, early progression (progression of disease within 24 months, or POD24), defined as a relapse within the first 2 years of frontline treatment, confers a much poorer prognosis 16 . Likewise, histologic transformation (HT) to a high-grade lymphoma significantly reduces survival 17,18 , although recent studies have suggested that its incidence might be lower in the rituximab era 19 . Some single-center and registry studies have described the changes in survival of FL patients over the last decades and trends in relative survival according to the general population 7,9 .…”

Section: Introductionmentioning

confidence: 99%

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Patterns of change in treatment, response, and outcome in patients with follicular lymphoma over the last four decades: a single-center experience

et al. 2020

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Although the introduction of immunotherapy has improved outcomes for follicular lymphoma (FL) patients, histological transformation (HT) and early relapse still confer a poor prognosis. We sought to describe the patterns of change in treatment, response, and outcome of FL patients at our institution over the last four decades. Seven hundred and twenty-seven patients (389 F/338 M; median age, 57 years) consecutively diagnosed with grade 1-3a FL between 1980 and 2017, categorized into four decades according to the time of diagnosis, constituted the study population. Clinical characteristics, treatment, response, absolute and relative survival, HT, second malignancies (SM), and causes of death were assessed. Median OS for the entire cohort was 17.6 years. From decade 1 to 4, there was an increase in the complete response rate (48 to 70%), progression-free survival (40 to 56% at 5 years), OS (77 to 86% at 5 years), and relative survival ratio (0.83 to 0.94 at 5 years), with no significant differences in the risk of HT or SM. Lymphoma remained the most common cause of death in all four decades. These findings illustrate the overall improvement in outcome for FL patients, but support the need for further research into risk stratification and management.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of change in treatment, response, and outcome in patients with follicular lymphoma over the last four decades: a single-center experience

et al. 2020

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“…Response rate and survival of Group 2 patients were inferior to those of Group 1, supporting that transformation after an overt history of FL has a worse prognosis than transformation at initial diagnosis. Group 2 survival data are similar to those described in the studies conducted in the rituximab era (Link et al, 2013;Guirguis et al, 2014;Federico et al, 2018). We confirm that a shorter interval between FL diagnosis and HT adversely impacts survival (Link et al, 2013).…”

Section: Discussionsupporting

confidence: 80%

Outcome of transformed follicular lymphoma worsens according to the timing of transformation and to the number of previous therapies. A retrospective multicenter study on behalf of Fondazione Italiana Linfomi (FIL)

et al. 2019

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Summary Optimal treatment for transformed follicular lymphoma (tFL) is not fully defined. Clinical characteristics and treatments that impact on post‐transformation outcome of 176 biopsy‐proven tFL were analysed. Transformation occurred at initial diagnosis in 52% (Group 1) and after a FL diagnosis in 48% (Group 2). Five‐year overall survival was 84% for Group 1 and 51% for Group 2 (P < 0·001). In Group 1, 5‐year progression‐free survival was superior after rituximab maintenance compared to observation only (94% vs. 53%, P = 0·024). In Group 2, an inverse trend was found between survival and both a higher number of pre‐transformation treatment lines and a short time‐to‐transformation.

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“…The European ARISTOTLE study also suggested biopsies upon first progression to document histologic transformation in FL occur infrequently. 28 Recently presented retrospective data suggest that after bendamustine-based therapy, rates of POD24 may be lower (9% to 12%), and among those cases, transformation rates were reported in up to three-quarters of patients. 18,19 However, biopsy to document histologic transformation occurred only in small numbers of patients.…”

Section: Case 1 Approach: Do You Recommend a Biopsy?mentioning

confidence: 99%

How I treat early-relapsing follicular lymphoma

Casulo

Barr

2019

Blood

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Follicular lymphoma (FL) is the most frequently occurring indolent non-Hodgkin lymphoma, with generally favorable outcomes but a variable clinical course. Recent studies have elucidated the consistent and reproducible frequency of early disease progression in FL, occurring in ∼20% of patients. Relapse of FL within 24 months of chemoimmunotherapy (POD24) is now established as a robust marker of poor survival, leading to increased risk of death. Currently, there is no established method of identifying patients at risk for early disease progression at the time of their FL diagnosis. However, numerous studies worldwide are investigating clinical, pathologic, and radiographic biomarkers to help predict POD24, thereby improving subsequent outcomes and adapting therapy based on individual risk. There is also a paucity of standardized treatments for patients with POD24, but investigations are ongoing testing novel targeted therapies and autologous stem cell transplantation strategies. This review provides an overview of early-relapsing FL and our approach to patient management based on recent available data.

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Rituximab and the risk of transformation of follicular lymphoma: a retrospective pooled analysis

Cited by 81 publications

References 23 publications

Patterns of change in treatment, response, and outcome in patients with follicular lymphoma over the last four decades: a single-center experience

Patterns of change in treatment, response, and outcome in patients with follicular lymphoma over the last four decades: a single-center experience

Outcome of transformed follicular lymphoma worsens according to the timing of transformation and to the number of previous therapies. A retrospective multicenter study on behalf of Fondazione Italiana Linfomi (FIL)

How I treat early-relapsing follicular lymphoma

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