Early histological transformation of follicular lymphoma to diffuse large B-cell lymphoma indicating adverse survival: A population-based analysis and validation.

in Cancer by Zi-Hua Li, Min-Yue Zhang, Massimo Federico, Monica Civallero, Martina Manni, Sara Alonso-Alvarez, Jian Hou, Hong-Hui Huang

TLDR

  • The study looked at how the transformation of a type of cancer called follicular lymphoma to a different type of cancer called diffuse large B-cell lymphoma affects the prognosis of patients. The study found that patients who underwent this transformation had worse outcomes than those who did not. The study also identified risk factors for early transformation, such as older age and B symptoms at diagnosis. The study developed a new way to predict which patients are at high risk of transformation and can help doctors develop personalized treatment plans.

Abstract

The histological transformation (HT) of follicular lymphoma (FL) is a crucial biological event. The study aimed to evaluate the incidence, clinicial characteristics, prognosis and impact of HT time on survival of FL transforming to diffuse large B-cell lymphoma in population-based large-scale cohorts. A retrospective cohort study of FL with HT was performed in the Surveillance, Epidemiology, and End Results database. The Hematological Malignancy Research Network FL cohort and Aristotle study FL cohort were used to assess the external validity. Among 44,127 FL cases from the Surveillance, Epidemiology, and End Results database, 1311 cases were pathology-proven recorded to transform to diffuse large B-cell lymphoma. The cumulative rates of HT at 5, 10, and 15 years after FL diagnosis were estimated to be 1.19%, 2.93%, and 5.01%, respectively. Significantly worse overall survival and cancer-specific survival were exhibited in patients with HT than those without HT. Early HT (transformation of FL within 48 months after FL diagnosis [TOD48]) was an independent predictor for adverse overall survival of HT patients, regardless of treatment modalities before transformation. The adverse prognostic effect of TOD48 was validated in the Hematological Malignancy Research Network cohort and Aristotle study cohort. Older age (>75 years) and B symptoms within FL at diagnosis were the independent risk factors of TOD48. Furthermore, a novel prognostic model combining TOD48 with Follicular Lymphoma International Prognostic Index (TOD48-FLIPI) was constructed and validated for risk stratification. TOD48 was a risk indicator of HT, and the novel prognostic model "TOD48-FLIPI" for HT patients was proposed.

Overview

  • The study aimed to evaluate the incidence, clinical characteristics, prognosis, and impact of histological transformation (HT) time on survival of follicular lymphoma (FL) transforming to diffuse large B-cell lymphoma in population-based large-scale cohorts. A retrospective cohort study of FL with HT was performed in the Surveillance, Epidemiology, and End Results database. The Hematological Malignancy Research Network FL cohort and Aristotle study FL cohort were used to assess the external validity. The study used a retrospective cohort design, and the primary objective was to evaluate the prognosis of FL patients who underwent histological transformation to diffuse large B-cell lymphoma. The study included 44,127 FL cases from the Surveillance, Epidemiology, and End Results database, and the outcomes were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression. The study aimed to answer the question of how the histological transformation of follicular lymphoma affects the prognosis of patients and identify risk factors for early histological transformation.

Comparative Analysis & Findings

  • The study compared the outcomes observed under different experimental conditions or interventions detailed in the study. The study found that the cumulative rates of histological transformation at 5, 10, and 15 years after follicular lymphoma diagnosis were 1.19%, 2.93%, and 5.01%, respectively. The study also found that significantly worse overall survival and cancer-specific survival were exhibited in patients with histological transformation than those without histological transformation. Early histological transformation (transformation of follicular lymphoma within 48 months after follicular lymphoma diagnosis [TOD48]) was an independent predictor for adverse overall survival of histological transformation patients, regardless of treatment modalities before transformation. The adverse prognostic effect of TOD48 was validated in the Hematological Malignancy Research Network cohort and Aristotle study cohort. Older age (>75 years) and B symptoms within follicular lymphoma at diagnosis were the independent risk factors of TOD48. Furthermore, a novel prognostic model combining TOD48 with Follicular Lymphoma International Prognostic Index (TOD48-FLIPI) was constructed and validated for risk stratification. The study found that histological transformation of follicular lymphoma is associated with worse prognosis and identified risk factors for early histological transformation.

Implications and Future Directions

  • The study's findings have significant implications for the field of research or clinical practice. The study identified risk factors for early histological transformation and developed a novel prognostic model for risk stratification. The study's findings can be used to identify patients who are at high risk of histological transformation and to develop personalized treatment plans. The study's limitations include the retrospective design, which may introduce bias, and the limited external validation. Future research should address these limitations and validate the study's findings in prospective studies. Future research should also explore the impact of different treatment modalities on the prognosis of histological transformation patients and develop novel treatment strategies for this population.
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