Lymphoma transformation risk in patients with advanced follicular lymphoma

This study investigated the frequency of lymphoma transformation in patients with advanced-stage follicular lymphoma (FL) after treatment with BR (bendamustine, rituximab). This study concluded these patients might be at risk for lymphoma transformation after initial treatment.

FL is the second most common type of non-Hodgkin’s lymphoma. One of the main goals of treatment is to avoid transformation to more aggressive subtypes. The most common transformation is to diffuse large B-cell lymphoma (DLBCL). Approximately 15% of patients with FL experience this type of lymphoma transformation. This tends to be associated with poorer outcomes.

The BR regimen has been widely used as a front-line treatment for FL. Bendamustine (Treanda) is a chemotherapy drug that damages the DNA inside cancer cells. Rituximab (Rituxan) is an immunotherapy that helps the body’s immune system attack cancer cells. How common lymphoma transformation is in patients with FL after treatment with BR is unclear.

This study analyzed the records of 296 patients with FL. 83% of patients had advanced disease (stage 3 – 4). Patients were treated with front-line BR. Patients were followed-up for an average of 3.1 years.

Overall, 92% of all patients were still alive two years later, with 85% alive without any complications from the disease. Within two years, 13% of patients had tumor growth or spread.

76% of patients who had tumor growth or spread also had transformed disease. On average, patients experienced lymphoma transformation at an average of 8.4 months after treatment. After transformation, 40% of patients were still alive two years later. A high level of lactate dehydrogenase (LDH) before treatment was associated with a significantly higher risk of transformation.

This study concluded that patients with advanced-stage FL might be at risk for lymphoma transformation after initial treatment. The authors suggest that patients who had tumor growth or spread after treatment may be at particularly high risk for transformation.

This study looked back in time to analyze data, and the follow-up period was short. This may limit the conclusions that may be drawn from these results. Larger studies with longer follow-up periods are needed to confirm these results.