CLINICAL NEWS
New Insights into Transformed Follicular Lymphoma
from the National LymphoCare Study
Patients with follicular lymphoma
(FL) whose cancer has transformed into diffuse large B-cell
lymphoma (DLBCL) often have
a poor prognosis, with overall survival of just one to two
years. However, the prognosis
of patients whose FL eventually
transforms, or who present with
transformed FL, from the time
of their FL diagnosis, is largely
unknown because this patient
population is largely excluded
from clinical studies.
With the large, prospective, multicenter, observational
National LymphoCare Study
(NLCS), researchers have been
able to detail the disease presentation, treatment patterns, and
clinical outcomes of nearly 2,700
patients with newly diagnosed
FL. Results of the analysis were
recently published in Blood by
Nina D. Wagner-Johnston, MD,
from the Siteman Cancer Center
at Washington University in St.
Louis, Missouri, and colleagues.
“Our study features the
largest series of patients with
transformed FL at the time of
diagnosis and provides a unique
opportunity to learn more about
the clinical behavior of this
population,” Dr. Wagner-Johnston
and colleagues wrote. The study
included a database of 2,652
patients who were diagnosed
with FL within six months of
informed consent and no prior
lymphoma history. Patients were
enrolled between March 2004 and
March 2007 and were subsequently followed from enrollment
through June 2014 or until death,
withdrawal of consent, or loss to
follow-up.
Patients were categorized as
transformed – either suspected
or confirmed – by site investigators, and patient status was
collected quarterly on electronic
case report forms. The study also
included the subset of patients
with transformation at the time of
initial FL diagnosis – a population
that is mostly undocumented in
the literature.
The researchers calculated the
median time to transformation,
progression-free survival (PFS),
and overall survival.
At a median follow-up of 6.8
years, 14.3 percent of patients
(n=379) had pathologically confirmed (5.5%; n=147) or clinically
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suspected (8.7%; n=232) transformation. Twenty-five of the
suspected patients were ultimately
confirmed to have transformed.
“The NLCS database is 4.5- to
10-times larger than all previously described transformed FL
studies,” Dr. Wagner-Johnston
and co-authors wrote, “and the
number of patients with transformations is nearly twice that of the
largest series.”
The following factors determined at diagnosis were associated
with an increased transformation
risk:
• ECOG performance status
>1 (hazard ratio [HR] = 2.12;
95% CI 1.27-3.55)
• Extranodal sites >1 (HR=1.39;
95% CI 1.07-1.81)
• Elevated la