AI Summary
This study focused on the histological transformation of follicular lymphoma (FL) to diffuse large B-cell lymphoma, known as HT, within 48 months after FL diagnosis (TOD48). The research showed that early HT, TOD48, was associated with poor survival outcomes. A novel prognostic model called TOD48-FLIPI, combining TOD48 and Follicular Lymphoma International Prognostic Index, was developed and validated for risk stratification in FL patients experiencing HT. The study highlighted the significance of early detection and risk stratification in patients with FL to predict adverse outcomes due to HT.
The population-based retrospective cohort study showed that histological transformation of follicular lymphoma to diffuse large B-cell lymphoma within 48 months after follicular lymphoma diagnosis (TOD48) was associated with poor survival. A novel prognostic model consisting of TOD48 and Follicular Lymphoma International Prognostic Index was proposed and validated for risk stratification.
Abstract
Introduction
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.
Methods
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.
Results
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.
Conclusion
TOD48 was a risk indicator of HT, and the novel prognostic model “TOD48-FLIPI” for HT patients was proposed.