INCIDENCE OF TRANSFORMATION IN FOLLICULAR LYMPHOMA: MULTICENTRE RETROSPECTIVE ANALYSIS OF THE SPANISH GROUP OF LYMPHOMA AND AUTOLOGOUS STEM-CELL TRANSPLANTATION (GELTAMO)
Author(s): ,
Sara Alonso
Affiliations:
hematologia,HOSPITAL UNIVERSITARIO DE SALAMANCA,salamanca,Spain
,
Miguel Alcoceba*
Affiliations:
hematologia,HOSPITAL UNIVERSITARIO DE SALAMANCA,salamanca,Spain
,
Laura Magnano*
Affiliations:
hematologia,Hospital Clinic,Barcelona,Spain
,
Maria Garcia-Alvarez
Affiliations:
hematologia,HOSPITAL UNIVERSITARIO DE SALAMANCA,salamanca,Spain
,
Marcio Andrade
Affiliations:
hematologia,Hospital Miguel Sevet,Zaragoza,Spain
,
Guillermo Rodriguez
Affiliations:
hematologia,Hospital Virgen del Rocio,Sevilla,Spain
,
Francesc García-Pasarolls
Affiliations:
hematologia,Hospital del Mar,Barcelona,Spain
,
Antonio Salar
Affiliations:
hematologia,Hospital del Mar,Barcelona,Spain
,
Maria Jose Terol
Affiliations:
hematologia,Hospital Clinico de Valencia,Valencia,Spain
,
Esther Vega
Affiliations:
hematologia,Hospital 12 de Octubre,Madrid,Spain
,
Carlos Grande
Affiliations:
hematologia,Hospital 12 de Octubre,Madrid,Spain
,
Emilia Pardal
Affiliations:
hematologia,Hospital Virgen del Puerto,Plasencia,Spain
,
Alejandro Martin
Affiliations:
hematologia,HOSPITAL UNIVERSITARIO DE SALAMANCA,salamanca,Spain
,
Armando Lopez-Guillermo ‡
Affiliations:
hematologia,Hospital Clinic,Barcelona,Spain
Dolores Caballero‡
Affiliations:
hematologia,HOSPITAL UNIVERSITARIO DE SALAMANCA,salamanca,Spain
EHA Learning Center. Alcoceba M. Jun 13, 2015; 100823
Disclosure(s): HOSPITAL UNIVERSITARIO DE SALAMANCA
Dr. Miguel Alcoceba
Dr. Miguel Alcoceba

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Abstract
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Abstract: P682

Type: Poster Presentation

Presentation during EHA20: From 13.06.2015 17:15 to 13.06.2015 18:45

Location: Poster area (Hall C)

Background

Follicular lymphoma (FL) may, over time, transform into an aggressive lymphoma, usually diffuse large B-cell lymphoma (DLBCL). Transformed follicular lymphomas (tFL) have a worse prognosis due to poorer response to treatment than primary DLBCL. The incidence of transformation is estimated in ~3% per year, although it varies largely between different studies (24%>70% overall). These differences are mainly due to different criteria to define tFL, to lack of evidence of tFL by biopsy, absence of clonality studies discarding secondary de novo NHL, studies performed in the pre-Rituximab era, or different follow-up times among studies. With all this pitfalls, the actual incidence of transformation remains an open question.



Aims
The aim of the present study is to analyse the incidence and prognostic impact of transformation in patients with FL in a large retrospective series of the Spanish group of Lymphomas (GELTAMO).

Methods

A total of 1096 patients (grade I, II, and IIIa) from 8 Spanish centres diagnosed of FL between 2000 and 2010 were included in the study. Data were obtained from the database of centres willing to participate in this study. True tFL (FL to DLBCL) were recorded. Composite FL+DLBCL, discordant tFL (FL in bone marrow and DLBCL in adenopathy or viceversa), and downgrading tFL (DLBCL at diagnosis and relapse of FL) were excluded from the preliminary analysis. This study was approved by the Salamanca University Hospital Ethic Committee.



Results

Seventy-one patients (median follow up of 6 years) were transformed to DLBCL (6,5%). Cumulative incidence of transformation at 5, 10, and 15 years was of 5%, 8%, and 14%, respectively. Median time to transformation was 30 months, ranged 3-150. Considering survival from diagnosis of FL, tFL patients had a shorter OS than non-transformed (20% vs. 68%, p<0,0001). Most of the tFL patients (92%) have previously received treatment for FL, 56% of them with Rituximab. Median number of treatment lines before transformation was 2 (1-6). Patients receiving Rituximab as first line therapy showed decreased time to transformation at 15 years (10% vs 19%, p=0.025). Other factors influencing risk of tFL included no response to first line therapy, age at diagnosis >60 years, FLIPI, and Ann Arbor stage. Consolidation therapy with autologous transplant for tFL showed an increase in OS (67% vs. 8%, p=0.001). However, these results should be confirmed in prospective studies.



Summary

High risk FLIPI, Ann Arbor stage III-IV, age >60 years, not use of Rituximab in first line therapy, and response to first line have shown to predispose to a higher risk of transformation. Autologous transplantation could have a benefit in terms of OS in transformed patients. Effort should be made in order to clarify criteria for transformation, and biological studies on tumoral samples at diagnosis and at transformation will help to determine pathogenesis of transformation in helping to design clinical trials with new molecules based on molecular characteristics of transformation.

* Equal contribution; Equal senior contribution



Keyword(s): Follicular lymphoma, Transformation

Session topic: Indolent Non-Hodgkin lymphoma - Clinical
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