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Lymphoma > Transformation
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Follicular | Non-Follicular
Indolent lymphomas may convert or transform to
more aggressive lymphomas. The risk ranging from 16% to 60%
depending on the source and definition of transformation.1
Follicular lymphomas, for example, may transform from follicular
lymphoma Grade 1 or 2 to:
* Grade
2 or 3 - a greater proportion of large to small cells
* Diffuse Large B-cell lymphoma - so-called histologic
transformation (HT) to a diffuse pattern
* Aggressive B-cell lymphoma with features of Burkitt
lymphoma, and
* More rarely to lymphoblastoid lymphoma
Jonathan W. Said, M.D. www.nature.com
Transformation of indolent lymphoma to faster growing (aggressive) grade
of the disease is
common during the course of the disease.
"On occasion, patients may experience a
relapse with a more aggressive histology. If the clinical pattern of
relapse suggests that the disease is behaving in a more aggressive
manner, a biopsy should be performed.
Documentation of conversion to
a more aggressive histology requires an appropriate change to
therapy applicable to that histologic type.
Rapid growth or
discordant growth between various disease sites may indicate a
histologic conversion.
Approximately 20% of patients [as of 2005]
with histologic transformation enjoy long-term survival (more than
10 years) after retreatment. - Cancer.gov
What is histologic transformation to DLBCL?
Diffuse and follicular growth pattern.
Click image or go to source: www.med-ed.virginia.edu
The transformation is almost certainly the
result of additional genetic mutations that cause the cells to
divide more rapidly. The diagnosis is based on changes in the
growth of the cells from follicular (nodular) to a diffuse
growth pattern ... resembling de novo DLBCL.
"DLBCL can be classified as de novo, that is,
without a previous history of an indolent lymphoma,
or as secondary transformed DLBCL emanating from an indolent lymphoma most commonly follicular
lymphoma. [The latter commonly referred to as "histologic
transformation to DLBCL"]
The distinction between transformed and de novo DLBCL is based on the morphological
(by appearance) demonstration of a low malignancy grade lymphoma such as follicular lymphoma either
before or simultaneous to the DLBCL.
However, it is not known whether some apparently de novo DLBCL could in fact represent transformed cases
where the component of low-grade malignancy is no longer detectable. The demonstration of a t(14;18)
rearrangement in a significant proportion of de novo DLBCL gives some support for this
hypothesis." 8
What is the risk of histologic transformation
of indolent lymphoma to DLBCL?
The answer is an estimate,
and depends on how you ask the question, the time period, and who you ask:
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The risk of histologic transformation (HT) by 10 years was 28%. 1
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Transformation to more aggressive large cell lymphoma occurs in 25-60% of
pts with FL 4
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Rate of Transform |
at 10 Yr 28%
at 15 Yr 37%
Click chart to enlarge
Source: hememalignancies.com
pdf
CLL and Blast Phase?
TRANSCRIPT: Dr. Wyndham
Wilson, NCI, discusses indolent lymphomas.
Q: Is there any equivalent to a leukemia such as
chronic lymphocytic leukemia (CLL), which for ten years can be sort
of indolent and then move to a devastating blast phase?
A: Yes. But it's a little bit
different. The equivalent for indolent lymphomas is that most of
them have a tendency, some more than others, to undergo histological
transformation to a more aggressive disease. So that reflects
clonal evolution, where a clone that gets additional hits. Once
these things become tumors or become lymphomas, they become
independent of normal regulatory pathways. They have a higher
tendency to accumulate and to survive additional hits. And so what
happens over time is that when our normal cells get genetic hits,
our cells have huge amounts of surveillance pathways to kill those
cells. Those cells die. Otherwise, we would be popping up with
tumors all the time.
Because our genetic code probably gets hit
constantly. You know, our body fixes them or the cells commit
suicide through the apoptotic pathway. Tumor cells have a much
higher tendency of, number one, not transcribing their code
correctly. And number two, not committing suicide when the hit
happened. So when you have an indolent process, a chronic process,
that you have for years and years and years, over time it's just
natural that you're going to get clonal evolution. A clone that gets
a hit that gives it a proliferative advantage. And something's going
to pop up. And that's what happens in CLL when it undergoes a
blastic transformation. In any of the lymphomas, they undergo a
large cell transformation. www.cancer.gov
MALT/Marginal Zone:
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Histological grading with clinical relevance in gastric
mucosa-associated lymphoid tissue (MALT) lymphoma. Recent
Results Cancer Res. 2000;156:27-32. Review. PMID:
10802860 | Related
articles
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Transformation of follicular lymphoma: prognostic factors and effect on survival
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Copied from: Abstract No: 1129
Citation: Proc Am Soc Clin Oncol 21: 2002 (abstr 1129)
Author(s): Hillary H Wu, Fredrick B Hagemeister, Mark A Hess, Peter W McLaughlin, Jorge E Romaguera, Maria A Rodriguez, Anas Younes, John T Manning, James D Cox, Martin Muller, Fernando F Cabanillas, M.D. Anderson Cancer Center, Houston, TX; Tuebingen University Medical Center, Tuebingen, Germany.
Abstract: Transformation (TF) of indolent follicular lymphoma (FH) to aggressive lymphoma may be an adverse event. However, few reports define prognostic factors for TF, its definition is unclear, and its effect ill defined.
We reviewed the records of 451 patients with FH sequentially registered from 1985 to 1992 and treated at our center (90.2% on protocols). Data included pathology at diagnosis and relapse, and laboratory and radiographic results.
Pathologic TF was defined as: (1) follicular small cleaved or follicular mixed cell to large cell or pure diffuse lymphoma (2) follicular large to diffuse large cell or (3) any follicular to high-grade lymphoma.
Features studied for impact on risk of TF included attaining CR, LDH, Β2 microglobulin, age, hemoglobin, stage, albumin, B symptoms, and pathology. Survival curves were analyzed for TF and FH relapses.
Results: With a minimum 4.5 and a median 10-years follow-up, 242 (53.4%) developed at least 1 relapse, 40% died, and 56 (12.4%) had TF at any relapse.
Significant factors for TF were lack of initial CR (p=0.008), elevated LDH (p=0.003), and B symptoms (p=0.045).
Median times to TF or FH at first relapse were 32 mo (range 5-114) and 39 mo (7-140). Five-year OS for TF and FH with first relapse were 52% and 82%, but 10-year OS were 46% and 53%.
However, median time to TF at all relapses was 44 mo (range 5-139); median survival after TF was 25 mo compared with 82 mo for FH at all relapses; 29% were alive 10 years after TF, compared with 42% who never had TF on relapses (p=0.0035).
Conclusions: prognostic factors for TF include lack of CR, elevated LDH, and B symptoms. TF is associated with a higher risk of death than FH without TF at first and subsequent relapses; however, time to TF does not affect long term survival
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The Follicular Lymphoma International
Prognostic Index (FLIPI) and the histological
subtype are the most important factors to predict histological
transformation in
follicular lymphoma PDF full
text
Conclusion: FLIPI and histology were the most important
variables predicting HT. Upon HT,
only patients achieving CR (complete response) reached prolonged
survival,
thus emphasizing the need for effective therapies once this
event occurs.
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Background Articles
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Risk and Clinical implications of transformation of follicular lymphoma to
Diffuse Large B-cell Lymphoma jco.org
Purpose: To study the clinical significance of transformation to diffuse large B-cell lymphoma (DLBCL) in
patients with follicular lymphoma (FL).
Patients and Methods: From 1972 to 1999, 325 patients were diagnosed with FL at St Bartholomew’s Hospital (London,
United Kingdom). With a median follow-up of 15 years, progression occurred in 186 patients and
biopsy-proven transformation in 88 of the 325. The overall repeat biopsy rate was 70%.
Results: The risk of histologic transformation (HT) by 10 years was 28%, HT not yet having been observed
after 16.2 years. The risk was higher in patients with advanced stage (P .02), high-risk Follicular
Lymphoma International Prognostic Index (FLIPI; P = .01), and International Prognostic Index (IPI;
P .04) scores at diagnosis.
Expectant management [watchful waiting] (as opposed to treatment being initiated at
diagnosis) also predicted for a higher risk of HT (P .008). Older age (P .005), low hemoglobin
level (P .03), high lactate dehydrogenase (P = .0001), and high-risk FLIPI (P
= .01) or IPI (P= .003) score at the time of first recurrence were associated with the diagnosis of HT in a biopsy
performed at that time.
The median survival from transformation was 1.2 years. Patients with HT had a shorter overall survival (P .0001) and a shorter survival from progression (P
= .0001) than did those in whom it was not diagnosed.
Conclusion: Advanced stage and high-risk FLIPI and IPI scores at diagnosis correlate with an increased risk of
HT. This event strongly influences the outcome of patients with FL by shortening their survival.
There may be a subgroup of patients in whom HT does not occur..
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Transformation of follicular lymphoma: prognostic factors and
effect on survival
Prognostic factors for transformation (TF) include lack of CR,
elevated LDH, and B symptoms.
TF is associated with a higher risk of death than follicular
lymphoma without TF at first and subsequent relapses; however,
time to TF does not affect long term survival
Biology and Management of Histologic Transformation of
Indolent Lymphoma asheducationbook.org
"...chemotherapy is generally of limited
benefit, although a subset of patients are long-term
survivors following high-dose therapy and autologous stem
cell transplantation. The use of radioimmunotherapy and new
agents targeting specific lesions or aberrant pathways may impact
on the management of these aggressive diseases."
Transformation of follicular lymphoma to diffuse large-cell lymphoma:
Alternative patterns with
increased or decreased expression of c- myc and
its regulated genes - SUMC PDF
| PDF-Help | HTML
Histological transformation is a pivotal event in the natural history of cancers, typically coincident with more aggressive clinical behavior. Follicular lymphoma (FL) is often a precursor to a more aggressive lymphoma.
... Transformation to more aggressive large cell lymphoma occurs in 25–60% of patients with FL (3, 4).
Transformation of follicular lymphoma to diffuse large cell
lymphoma is associated
with a heterogeneous set of DNA copy number and gene expression
alterations bloodjournal.org/
"Follicle center lymphoma (FCL) is one of the most common
types of lymphoma, comprising
about 40% of adult non-Hodgkin lymphomas (NHLs) in
Western populations.1
It is
characterized by a relatively indolent clinical course
and long survival, but it is currently incurable.2
FCL transforms to a more aggressive lymphoma in 25%-60% of patients,
an event that represents the outgrowth
of a more malignant subclone.
Transformation is usually
associated with a rapidly progressive clinical course,
refractoriness to treatment, and short survival.2,3
Several secondary genetic abnormalities have been
associated with this histological transformation of FCL,
... However, these alterations are each observed
in only a subset of transformed lymphomas, suggesting
that the process of histological transformation can
occur by multiple different mechanisms."
Indolent, Recurring Non-Hodgkin's Lymphoma Cancer.gov
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The Follicular Lymphoma International Prognostic
Index (FLIPI) and the histological subtype are the most important
factors to predict histological transformation in follicular
lymphoma annonc.oxfordjournals.org
Background: Histological transformation (HT) is a well-known event in patients with follicular lymphoma (FL)
conferring an unfavorable prognosis. The aim of the study was to analyze incidence and risk factors for HT in
a large series of FL patients.
Patients and methods: 276 patients (median age: 54 years; M139/F137) diagnosed with FL (42% grade 1, 51%
2, 7% 3) in a single institution were studied. Initial treatment consisted of combined chemotherapy in most cases.
Median survival was 11.3 years. Main clinic and biological variables were assessed for HT and survival.
Results: 30 of 276 patients (11%) presented HT after a median follow-up of 6.5 years, with a risk of 15% and 22% at
10 and at 15 years, respectively. All HT corresponded to diffuse large B-cell lymphoma (DLBCL). Grade 3 histology,
nodal areas >4, increased LDH and b2-microglobulin, and high-risk IPI and FLIPI were associated with HT.
In multivariate analysis, grade 3 histology and FLIPI retained prognostic significance. Only FLIPI predicted HT
in grade 1–2 patients. 28 patients received salvage treatment for HT, with a CR rate of 52%. Median survival from
transformation was 1.2 years, with 6/13 CR patients being alive >5 years after HT.
Conclusion: FLIPI and histology were the most important variables predicting HT. Upon HT, only patients achieving
CR reached prolonged survival, thus emphasizing the need for effective therapies once this event occurs.
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Genomic imbalances during transformation from follicular lymphoma to diffuse large
B-cell lymphoma
www.nature.com
pdf
Follicular lymphoma is commonly transformed to a more
aggressive diffuse large B-cell lymphoma (DLBCL).
In order to molecularly characterize this histiological
and clinical transformation, comparative genomic hybridization was
applied on 23 follicular lymphoma and 35 transformed DLBCL tumors
from a total of 30 patients.
The results were also compared with our published findings in de
novo DLBCL. Copy number changes were detected in 70% of follicular
lymphoma and in 97% of transformed DLBCL.
In follicular lymphoma, the most common alterations were
þ18q21 (33%), þXq25–26 (28%), þ1q31–32 (23%), and 17p
(23%), whereas transformed DLBCL most frequently exhibited þXq25–26
(36%), þ12q15 (29%), þ7pter-q22 (25%), þ8q21 (21%), and 6q16–21(25%).
Transformed DLBCL showed significantly more alterations as
compared to follicular lymphoma (P¼0.0001), and the alterations
6q16–21 and þ7pter-q22 were only found in transformed DLBCL but
not in follicular lymphoma (P¼0.02).
Alterations involving þ13q22 were significantly less frequent,
whereas 4q13–21 was more common in transformed as compared to de
novo DLBCL (P¼0.01 and P¼0.02, respectively). Clinical
progression from follicular lymphoma to transformed DLBCL is on
the genetic level associated with acquirement of increasing number
of genomic copy number changes, with non-random involvement of
specific target regions.
The findings support diverse genetic background between
transformed and de novo DLBCL.
Modern Pathology (2007) 20,
63–75.
doi:10.1038/modpathol.3800708; published online 29 September 2006
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Higher-grade transformation of follicle center lymphoma is
associated with somatic mutation of the 5' noncoding regulatory
region of the BCL-6 gene bloodjournal.hematologylibrary.org
full
Izidore S. Lossos and
Ronald Levy
Our results show that transformation of FCL to DLBCL
is associated with accumulation of new mutations in the
5' noncoding regulatory region of the BCL-6 gene, that by
deregulation of the BCL-6 gene expression may play a role in lymphoma
transformation.
Genetic Reconstruction of Follicular Lymphoma Evolutions: S
Mutations Studies Suggest Two Progression Patterns, Early Direct
or Late from FL  Stem
Cells
abstracts2view.com
In conclusion, our results suggest that there may be at least two different patterns of progression in FL.
The first could be a direct and rapid evolution from the dominant subclone, explaining the stability of the mutations.
The second, which could potentially happen after many years of clinical remission, could instead be indirect, from a clonally related and often earlier t(14;18) positive subclone probably arising from a different compartment.
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Incidence &
Risk Factors
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Risk and Clinical implications of transformation of follicular lymphoma to
Diffuse Large B-cell Lymphoma (Single Center Experience) jco.org
" From January 1972 to December 1999, 325 patients
with FL were treated at St Bartholomew’s Hospital (London,
United Kingdom; Table 1).
The diagnosis of transformation was made in 88 patients at
a median of 3 years (range, 0.1 to 16.2 years). Among these 88
patients, 14 transformed before initiation of any therapy (two
within 3 months of diagnosis) and 10 during initial therapy. ...
The risk of transformation by 5, 10, and 15 years was 17% (95% CI,13%to 22%),
28% (95%CI,23%to 34%), and 37%(95%CI,30% to 44%), respectively.
Histological Transformation (HT) was not observed after 16.2 years of follow
up, the rate of transformation remaining at 39% from that point onward (Fig 1).
Patients undergoing expectant management at diagnosis (watchful waiting) had a
higher risk of transformation than did those treated immediately (P
.008).
Advanced stage (III to IV) at diagnosis was associated with a higher risk of transformation (P
.02).
Both the FLIPI (P .01) and the IPI (P .04) scores at diagnosis predicted for the risk of
HT
The log-rank test showed a trend for a higher risk of transformation in patients with a high LDH/HBD level at
diagnosis (5-year risk,28% 17%;P.08) and for those with grade 3a FL (38% at 5 years
20% for grade 1 and 10% for grade 2; P .09). "
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The Follicular Lymphoma International Prognostic
Index (FLIPI) and the histological subtype are the most important
factors to predict histological transformation in follicular
lymphoma (Single Center experience) - annonc.oxfordjournals.org
Incidence: "30 of 276 patients (11%) presented HT
after a median follow-up of 6.5 years, with a risk of 15% and 22%
at 10 and at 15 years, respectively. All HT corresponded to
diffuse large B-cell lymphoma (DLBCL). "
Risk factors: "Grade 3 histology, nodal areas >4,
increased LDH and b2-microglobulin, and high-risk IPI and FLIPI
were associated with HT. In multivariate analysis, grade 3
histology and FLIPI retained prognostic significance. Only FLIPI
predicted HT in grade 1–2 patients."
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| Gene-Expression and Immunohistochemical Study of Specific
T-Cell Subsets and Accessory Cell Types in the Transformation and
Prognosis of Follicular Lymphoma. J Clin Oncol. 2007 Jan 2; PMID:
17200149 | Related
articles
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| The International Prognostic Index predicts outcome after
histological transformation of low-grade non-Hodgkin lymphoma.
Leuk Lymphoma. 2006 Sep;47(9):1794-9. PMID:
17064990
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| Molecular pathogenesis of follicular lymphoma: a cross talk
of genetic and immunologic factors. J Clin Oncol. 2005 Sep
10;23(26):6358-63. Review. PMID:
16155020
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| A Proteomic Approach
to Discovery of Candidate Proteins Involved in the Transformation
of Follicular Lymphoma ASH
2005
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| Long-term survival after histologic transformation of
low-grade follicular lymphoma. J Clin Oncol 13 (7): 1726-33, 1995.
PUBMED
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| Transformed
lymphoma: an Achilles' heel of non-Hodgkin's lymphoma.
Bone Marrow Transplant. 2003 Apr;31(7):531-7. Review. PMID:
12692617 | Related
articles
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| Incidence,
predictive factors, and outcome of lymphoma transformation in
follicular lymphoma patients. J Clin Oncol. 1997
Apr;15(4):1587-94. PMID:
9193357 | Related
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| Follicular lymphoma:
prognostic factors for response and survival - Journal of Clinical
Oncology, Vol 4, 1470-1480 abstract
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| International
Prognostic Index (IPI) Predicts Outcome after Histological
Transformation of Low Grade Non-Hodgkin Lymphoma. Reader-friendly
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Long-term survival after histologic transformation of
low-grade follicular lymphoma. J Clin Oncol. 1995
Jul;13(7):1726-33. PMID: 7602362 PubMed
| Related
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Histological
conversion of follicular lymphoma with structural alterations of
t(14;18) and immunoglobin genes. Leukemia. 1995 Oct;9(10):1748-55.
PMID: 7564520 PubMed
| Related
abstracts
"About half of the patients with follicular lymphoma will
develop an aggressive B cell lymphoma with morphological changes
in growth pattern and cellular morphology."
|
| Large-cell transformation of chronic lymphocytic leukemia and
follicular lymphoma during or soon after treatment with
fludarabine- rituximab- containing regimens: natural history- or
therapy-related complication?
Eur J Haematol. 2002 Feb;68(2):80-3. PMID: 12038452 PubMed
| Related
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| Prognostic value of chromosomal abnormalities in follicular
lymphoma.
Blood. 1994 Aug 15;84(4):1043-9. PMID: 8049424 PubMed
| Related
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Acute liver failure as initial manifestation of low-grade
non-Hodgkin's lymphoma transformation into large-cell lymphoma.
Leuk Lymphoma. 2001 Jul;42(3):555-9. PMID: 11699425 PubMed
| Related
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| Transformation of follicular lymphoma:
prognostic factors and effect on survival Year: 2002 Abstract No: 1129
"Conclusions: prognostic factors for
Transformation include lack of CR (complete response), elevated LDH, and B
symptoms. Transformation is associated with a higher risk of death than
indolent Follicular without transformation at first and subsequent
relapses; however, time to transformation does not affect long term
survival."
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An autopsy study of histologic progression in non-Hodgkin's
lymphomas. 192 cases from the National Cancer Institute. Cancer.
1983 Aug 1;52(3):393-8. PMID: 6344979 PubMed
| Related
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Diagnosis
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The Tumor Microenvironment Measured by Flow Cytometry
Predicts Overall Survival (OS) and Transformation Risk (TR) in
Follicular Lymphoma. Session Type: Poster Session, Board #584-II
ASH
2006
"The proportion of CD8+ T cells relative to the total T
cells and the number of residual, non-neoplastic B cells were both
predictors of OS. Importantly, both predict, independently of the
IPI, the risk of transformation. These biomarkers are easily
measured and may be used to better stratify patients, choose
initial treatment options and predict transformation risk in
patients with FL."
Majority of Transformed Lymphomas Have High SUVs on PET
Scanning Similar To Diffuse Large B Cell Lymphoma (DLBCL) ASH
2006
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Fine-needle aspiration in non-Hodgkin lymphoma: evaluation of
cell size by cytomorphology and flow cytometry. Am J Clin Pathol.
2002 Jun;117(6):880-8.
PMID: 12047139 PubMed
| Related
abstracts
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Treatment
Considerations
"These data suggest that although outcome after HT is
generally poor, a subset of patients can present prolonged OS.
Moreover, it also stresses that obtaining CR with salvage therapy is a
crucial event, in agreement with previously published
series"
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Zevalin and Transformed disease? ASCO
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The Follicular Lymphoma International Prognostic
Index (FLIPI) and the histological subtype are the most important
factors to predict histological transformation (HT) in follicular
lymphoma (Single Center Experience) annonc.oxfordjournals.org
Surviving HT: Six patients presented prolonged survival over five years after
HT (5.6+, 7+, 9.2+, 11.2+, 15+ and 18.8+ years).
Early stage (I–II) (P = 0.02), ambulatory performance status (£1) (P = 0.028), and intermediate/low or low IPI score (<3)
(P = 0.0046), all at the time of transformation, correlated with longer survival after HT.
In addition, the response to salvage therapy was very important to predict survival after HT (5 years
survival of 43% versus 0% for patients reaching CR (complete
response) versus no CR, respectively; P = 0.0001).
No differences in terms of survival from transformation were seen between the seven patients
who underwent intensification with autologous stem-cell transplantation and those that for a variety of reasons were not
autografted.
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Risk and Clinical implications of [histologic] transformation (HT) of follicular lymphoma to
Diffuse Large B-cell Lymphoma (Single Center Experience) jco.org
Of note, up to six patients have presented prolonged survival
over five years after HT. All of them had achieved CR (complete
response) after salvage therapy, which included an autologous
transplantation in only one case.
These data suggest that although outcome after HT is generally
poor, a subset of patients can present prolonged OS. Moreover, it
also stresses that obtaining CR with salvage therapy is a crucial
event, in agreement with previously published series [14].
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Meet the Professors - a provocative discussion among experts
regarding first treatment options for
advanced follicular lymphoma, including indications of
transformation meettheprofessors.com
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| High-dose therapy and autologous stem-cell support for
chemosensitive transformed low-grade follicular non-Hodgkin's
lymphoma: a case-matched study from the European Bone Marrow
Transplant Registry. J Clin Oncol 19 (3): 727-35, 2001. PUBMED
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Deregulation of the Insulin-Like Growth Factor Type 1
Receptor (IGF-1R) in Transformed Follicular Lymphomas:
Implications for Novel Therapy.
ASH
2006
The take-home point is that insulin-like growth factor receptors were found to be expressed on transformed FL cells, but not the FL cells of origin. Antibodies to target these receptors are under development for other cancers providing the opportunity and rationale to test these antibodies on transformed fNHL.
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Autotransplants
for histologically transformed follicular non-Hodgkin's
lymphoma related
abstracts
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Aggressive NHL: Oncology Board Review Manual yr
2000 PDF
| PDF-Help
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Overview Aggressive Non-Hodgkin's Lymphomas Lymphoma
InfoNet
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High-dose therapy with
autologous haematopoietic support in patients with transformed
follicular lymphoma: a study of 27 patients from a single centre.
Ann Oncol. 1998 Aug;9(8):865-9. PMID: 9789609 PubMed
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Autologous peripheral
blood progenitor cell transplantation for transformed diffuse
large-cell lymphoma. Clin Lymphoma. 2000 Dec;1(3):226-31;
discussion 232-3.
PMID: 11707835 PubMed
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Autologous bone marrow
transplantation after histologic transformation of indolent B cell
malignancies. Biol Blood Marrow Transplant. 1999;5(4):262-8.
PMID: 10465106 PubMed
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Rituximab-EPOCH - an Effective Salvage Regime for Relapsed,
Refractory, or Transformed B-Cell Lymphoma. Results of a Phase II
Study. Year: 2001 Abstract No: 1157
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Treatment
of Intermediate-and High-Grade Non-Hodgkin's Lymphoma
U-M Comprehensive Cancer Center
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The Follicular Lymphoma International Prognostic
Index (FLIPI) and the histological subtype are the most important
factors to predict histological transformation in follicular
lymphoma PDF full text
Conclusion: FLIPI and histology were the most important
variables predicting HT. Upon HT, only patients achieving CR
(complete response) reached prolonged survival, thus emphasizing
the need for effective therapies once this event occurs.
|
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Transformation from follicular to
Diffuse Large Cell Lymphoma
(DLCL)
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"Some cases of DLBCL may arise from follicular lymphoma
(an indolent lymphoma) or from chronic lymphocytic leukemia. The
latter is known as a Richter’s transformation. Both of
these transformations are generally associated with worse short-
and long-term outcomes after therapy." - Aggressive NHL: Oncology Board Review Manual yr
2000 PDF
| PDF-help
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p53 mutations are associated with histologic transformation of
follicular lymphoma. Blood. 1993 Oct 15;82(8):2289-95. PMID:
8400281 PubMed
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| Transformation of follicular lymphoma to diffuse large-cell
lymphoma: alternative patterns with increased or decreased
expression of c-myc and its regulated genes. Proc Natl Acad Sci U
S A. 2002 Jun 25;99(13):8886-91.
PMID: 12077300 PubMed
| PDF |
PDF-help
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Non-follicular
Transformations
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Progression of follicular large cell lymphoma to
Burkitt's lymphoma.
PubMed
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Primary digestive Richter's syndrome. Mod Pathol.
2001 May;14(5):452-7.
PMID: 11353056 PubMed |
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Progression to large B-cell lymphoma in splenic
marginal zone lymphoma: a description of a series of 12 cases. Am
J Surg Pathol. 2001 Oct;25(10):1268-76.
PMID: 11688461 PubMed
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Richter’s transformation (DLBCL) can arise from
CLL - Aggressive NHL: Oncology Board Review Manual yr
2000 PDF
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