{"title":"FOLLICULAR LYMPHOMA TRANSFORMATION: REAL-WORLD ANALYSIS INCLUDING EFFECT OF RITUXIMAB/OBINUTUZUMAB","authors":"D. Shpitzer, C. Perry, I. Avivi","doi":"10.1002/hon.70094_226","DOIUrl":null,"url":null,"abstract":"<p><b>Background</b>: Follicular lymphoma (FL) carries a 2–3% annual risk of transformation to aggressive lymphoma. While most studies focus on transformed FL (T-FL) in previously treated patients (pts), limited data exist on transformation without prior therapy. Additionally, the impact of Obinutuzumab (O) versus Rituximab (R) on T-FL risk is not well documented.</p><p><b>Aims</b>: To provide real-world data (RWD) on FL pts with and without prior anti-FL therapy exposure who developed T-FL, investigating risk factors, treatment patterns, and outcomes.</p><p><b>Methods</b>: We retrospectively reviewed electronic medical records of 1145 FL pts, diagnosed between 2010–2023, age ≥ 18 years, and recorded within Maccabi Healthcare Services. T-FL was defined as a subsequent diagnosis of diffuse large B-cell lymphoma (DLCL) without prior DLCL history. We analyzed transformation risk factors, impact of comorbidities, treatment regimens, and overall survival (OS).</p><p><b>Results</b>: Of 1145 FL pts, 9% (<i>n</i> = 104) developed T-FL over a median follow-up of 71 months (m), reflecting a 1.43% annual transformation rate. Median time to transformation was 42 m. No significant differences were found in age (63 vs. 61 years, <i>p</i> = 0.1) or gender (males 48% vs. 47%, <i>p</i> = 0.8) between T-FL and non-T-FL pts. Charlson Comorbidity Index (CCI) was higher in T-FL pts (median 4 vs. 3, <i>p</i> = 0.005).</p><p>Among 103 T-FL cases, 47% (<i>n</i> = 49) were treatment-naïve, and 53% (<i>n</i> = 54) had prior therapy (26 at diagnosis, 28 after watch-and-wait or local radiotherapy). Median treatment lines among treated pts was 1 (range 1–3). First-line regimens included R-CHOP/CVP (33%, <i>n</i> = 213, predominantly CHOP), R-bendamustine (B) (28%, <i>n</i> = 181), R-monotherapy (11%, <i>n</i> = 71), OB (20%, <i>n</i> = 133), and O-CHOP/CVP (9%, <i>n</i> = 57).</p><p>Median time from initiation of first-line therapy to T-FL in previously treated pts was 23 m, with no significant difference between those treated at diagnosis and those initially managed with watch-and-wait (24 vs. 21 m, <i>p</i> = 0.08). Multivariate analysis revealed that O- vs. R-based regimens (HR 0.43, <i>p</i> = 0.025) and maintenance therapy (HR 0.41, <i>p</i> < 0.001) were associated with reduced transformation risk, whereas B-containing regimens were linked to an increased risk of T-FL (HR 1.52, <i>p</i> = 0.017).</p><p>Median OS from FL diagnosis was shorter in T-FL pts (154 m vs. not reached, <i>p</i> < 0.001), with a median OS since T-FL of 125 m. Previously treated T-FL pts had shorter OS than treatment-naïve pts (34.6 m vs. not reached, <i>p</i> = 0.001). Prior anti-FL therapy (HR 2.23, <i>p</i> < 0.001), male gender (HR 1.77, <i>p</i> = 0.006), and older age at transformation (HR 1.03, <i>p</i> = 0.02) were linked to shorter OS.</p><p><b>Conclusions</b>: Our RWD on T-FL demonstrates several key findings: O-based regimens significantly reduce transformation risk in FL; B-containing regimens are associated with increased T-FL incidence, and patients developing T-FL without prior anti-FL therapy have markedly improved OS. These findings highlight the need for tailored strategies to reduce transformation risk and optimize FL outcomes.</p><p><b>Keyword:</b> indolent non-Hodgkin lymphoma</p><p>No potential sources of conflict of interest.</p>","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70094_226","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hematological Oncology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hon.70094_226","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Follicular lymphoma (FL) carries a 2–3% annual risk of transformation to aggressive lymphoma. While most studies focus on transformed FL (T-FL) in previously treated patients (pts), limited data exist on transformation without prior therapy. Additionally, the impact of Obinutuzumab (O) versus Rituximab (R) on T-FL risk is not well documented.
Aims: To provide real-world data (RWD) on FL pts with and without prior anti-FL therapy exposure who developed T-FL, investigating risk factors, treatment patterns, and outcomes.
Methods: We retrospectively reviewed electronic medical records of 1145 FL pts, diagnosed between 2010–2023, age ≥ 18 years, and recorded within Maccabi Healthcare Services. T-FL was defined as a subsequent diagnosis of diffuse large B-cell lymphoma (DLCL) without prior DLCL history. We analyzed transformation risk factors, impact of comorbidities, treatment regimens, and overall survival (OS).
Results: Of 1145 FL pts, 9% (n = 104) developed T-FL over a median follow-up of 71 months (m), reflecting a 1.43% annual transformation rate. Median time to transformation was 42 m. No significant differences were found in age (63 vs. 61 years, p = 0.1) or gender (males 48% vs. 47%, p = 0.8) between T-FL and non-T-FL pts. Charlson Comorbidity Index (CCI) was higher in T-FL pts (median 4 vs. 3, p = 0.005).
Among 103 T-FL cases, 47% (n = 49) were treatment-naïve, and 53% (n = 54) had prior therapy (26 at diagnosis, 28 after watch-and-wait or local radiotherapy). Median treatment lines among treated pts was 1 (range 1–3). First-line regimens included R-CHOP/CVP (33%, n = 213, predominantly CHOP), R-bendamustine (B) (28%, n = 181), R-monotherapy (11%, n = 71), OB (20%, n = 133), and O-CHOP/CVP (9%, n = 57).
Median time from initiation of first-line therapy to T-FL in previously treated pts was 23 m, with no significant difference between those treated at diagnosis and those initially managed with watch-and-wait (24 vs. 21 m, p = 0.08). Multivariate analysis revealed that O- vs. R-based regimens (HR 0.43, p = 0.025) and maintenance therapy (HR 0.41, p < 0.001) were associated with reduced transformation risk, whereas B-containing regimens were linked to an increased risk of T-FL (HR 1.52, p = 0.017).
Median OS from FL diagnosis was shorter in T-FL pts (154 m vs. not reached, p < 0.001), with a median OS since T-FL of 125 m. Previously treated T-FL pts had shorter OS than treatment-naïve pts (34.6 m vs. not reached, p = 0.001). Prior anti-FL therapy (HR 2.23, p < 0.001), male gender (HR 1.77, p = 0.006), and older age at transformation (HR 1.03, p = 0.02) were linked to shorter OS.
Conclusions: Our RWD on T-FL demonstrates several key findings: O-based regimens significantly reduce transformation risk in FL; B-containing regimens are associated with increased T-FL incidence, and patients developing T-FL without prior anti-FL therapy have markedly improved OS. These findings highlight the need for tailored strategies to reduce transformation risk and optimize FL outcomes.
期刊介绍：
Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged:
-Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders
-Diagnostic investigations, including imaging and laboratory assays
-Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases
-Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies
-Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems.
Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
