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Survival of patients with transformed lymphoma in the rituximab era

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Abstract

In the pre-rituximab era, transformation of indolent B-cell lymphoma to diffuse large B-cell lymphoma (DLBCL) was associated with an extremely poor outcome and a median post-transformation survival ranging from 1 to 2 years. We evaluated the impact of rituximab-cyclophosphamide, adriamycin, vincristine, prednisone (R-CHOP) on the survival outcomes of transformed lymphoma compared with de novo DLBCL. Between 2002 and 2010, 317 DLBCL patients who were consecutively diagnosed and treated with R-CHOP were identified at our institution. Patients with transformed lymphoma were included if they had not previously received R-CHOP. Patient characteristics, treatment, and outcome data were retrospectively collected. Sixty patients (19 %) had transformed lymphoma of which 37 (62 %) had transformed from follicular lymphoma, 50 (83 %) were chemotherapy naïve, and 58 (96 %) were rituximab naïve at the time of treatment. With a median follow-up of 31.4 months, 231 patients achieved either complete response or complete response unconfirmed (73 %) with no significant difference between de novo DLBCL (n = 192, 75 %) and the transformed group (n = 39, 65 %) (P = 0.25). Six patients (15 %) relapsed in the transformed group at a median time to relapse of 29.3 months. The 2-year and 5-year overall survivals for all patients were 82 and 72 %, respectively. The overall and progression-free survivals for transformed lymphoma and de novo DLBCL were not statistically different (P = 0.45 and P = 0.38, respectively). With R-CHOP chemotherapy, the prognosis of transformed lymphoma in patients with minimal chemotherapy exposure for indolent disease is similar to that of de novo DLBCL.

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References

  1. Montoto S, Fitzgibbon J (2011) Transformation of indolent B-cell lymphomas. J Clin Oncol 29:1827–1834

    Article  PubMed  Google Scholar 

  2. Lossos IS, Gascoyne RD (2011) Transformation of follicular lymphoma. Best Pract Res Clin Haematol 24:147–163

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Bastion Y, Sebban C, Berger F, Felman P, Salles G, Dumontet C, Bryon PA, Coiffier B (1997) Incidence, predictive factors, and outcome of lymphoma transformation in follicular lymphoma patients. J Clin Oncol 15:1587–1594

    CAS  PubMed  Google Scholar 

  4. Giné E, Montoto S, Bosch F, Arenillas L, Mercadal S, Villamor N, Martínez A, Colomo L, Campo E, Montserrat E, López-Guillermo A (2006) The Follicular Lymphoma International Prognostic Index (FLIPI) and the histological subtype are the most important factors to predict histological transformation in follicular lymphoma. Ann Oncol 17:1539–1545

    Article  PubMed  Google Scholar 

  5. Al-Tourah AJ, Gill KK, Chhanabhai M, Hoskins PJ, Klasa RJ, Savage KJ, Sehn LH, Shenkier TN, Gascoyne RD, Connors JM (2008) Population-based analysis of incidence and outcome of transformed non-Hodgkin's lymphoma. J Clin Oncol 26:5165–5169

    Article  PubMed  Google Scholar 

  6. Montoto S, Davies AJ, Matthews J, Calaminici M, Norton AJ, Amess J, Vinnicombe S, Waters R, Rohatiner AZ, Lister TA (2007) Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma. J Clin Oncol 25:2426–2433

    Article  PubMed  Google Scholar 

  7. Conconi A, Ponzio C, Lobetti-Bodoni C, Motta M, Rancoita PM, Stathis A, Moccia AA, Mazzucchelli L, Bertoni F, Ghielmini M, Cavalli F, Zucca E (2012) Incidence, risk factors and outcome of histological transformation in follicular lymphoma. Br J Haematol 157:188–196

    Article  PubMed  Google Scholar 

  8. Lin P, Mansoor A, Bueso-Ramos C, Hao S, Lai R, Medeiros LJ (2003) Diffuse large B-cell lymphoma occurring in patients with lymphoplasmacytic lymphoma/Waldenström macroglobulinemia. Clinicopathologic features of 12 cases. Am J Clin Pathol 120:246–253

    Article  PubMed  Google Scholar 

  9. Tsimberidou AM, O’Brien S, Khouri I, Giles FJ, Kantarjian HM, Champlin R, Wen S, Do KA, Smith SC, Lerner S, Freireich EJ, Keating MJ (2006) Clinical outcomes and prognostic factors in patients with Richter's syndrome treated with chemotherapy or chemoimmunotherapy with or without stem-cell transplantation. J Clin Oncol 24:2343–2351

    Article  CAS  PubMed  Google Scholar 

  10. Koch P, Probst A, Berdel WE, Willich NA, Reinartz G, Brockmann J, Liersch R, del Valle F, Clasen H, Hirt C, Breitsprecher R, Schmits R, Freund M, Fietkau R, Ketterer P, Freitag EM, Hinkelbein M, Heinecke A, Parwaresch R, Tiemann M (2005) Treatment results in localized primary gastric lymphoma: data of patients registered within the German multicenter study (GIT NHL 02/96). J Clin Oncol 23:7050–7059

    Article  PubMed  Google Scholar 

  11. Yuen AR, Kamel OW, Halpern J, Horning SJ (1995) Long-term survival after histologic transformation of low-grade follicular lymphoma. J Clin Oncol 13:1726–1733

    CAS  PubMed  Google Scholar 

  12. Horning SJ (1993) Natural history of and therapy for the indolent non-Hodgkin's lymphomas. Semin Oncol 20:75–88

    CAS  PubMed  Google Scholar 

  13. Bernstein SH, Burack WR (2009). The incidence, natural history, biology, and treatment of transformed lymphomas. Hematology Am Soc Hematol Educ Program 2009(1):532–541

  14. Pfreundschuh M, Trümper L, Osterborg A, Pettengell R, Trneny M, Imrie K, Ma D, Gill D, Walewski J, Zinzani PL, Stahel R, Kvaloy S, Shpilberg O, Jaeger U, Hansen M, Lehtinen T, López-Guillermo A, Corrado C, Scheliga A, Milpied N, Mendila M, Rashford M, Kuhnt E, Loeffler M, Group, M.I.T (2006) CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 7:379–391

    Article  CAS  PubMed  Google Scholar 

  15. Pfreundschuh M, Schubert J, Ziepert M, Schmits R, Mohren M, Lengfelder E, Reiser M, Nickenig C, Clemens M, Peter N, Bokemeyer C, Eimermacher H, Ho A, Hoffmann M, Mertelsmann R, Trümper L, Balleisen L, Liersch R, Metzner B, Hartmann F, Glass B, Poeschel V, Schmitz N, Ruebe C, Feller AC, Loeffler M, (DSHNHL), G.H.-G.N.-H.L.S.G. (2008) Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 9:105–116

    Article  CAS  PubMed  Google Scholar 

  16. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P, Reyes F, Lederlin P, Gisselbrecht C (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B-cell lymphoma. N Engl J Med 346:235–242

    Article  CAS  PubMed  Google Scholar 

  17. Al-Tourah AJ, Savage KJ, Gill KK, Sehn LH, Shenkier TN, Gascoyne RD, Conners JM (2007) Addition of rituximab to CHOP chemotherapy significantly improves survival of patients with transformed lymphoma. Blood 110: abstr 790

  18. Tan D, Rosenberg SA, Levy R, Lavori P, Tibshirani R, Hoppe RH, Warnke R, Avandi R, Natkunam Y, Yuen A, Horning SJ (2007) Survival in follicular lymphoma: the Stanford experience, 1960–2003. Blood 110: abstr 3428

  19. Fukuhara S, Maruyama D, Miyamoto K-i, Kim S-W, Watanabe T, Kobayashi Y, Taniguchi H, Maeshima AM, Tobinai K (2012) Clinicopathologic analysis of follicular lymphoma (FL) patients with coexisting diffuse large B-cell lymphoma (DLBCL) undergoing rituximab-containing chemotherapy. Blood 120: abstr 3693

    Google Scholar 

  20. Ghesquières H, Berger F, Felman P, Callet-Bauchu E, Bryon PA, Traverse-Glehen A, Thieblemont C, Baseggio L, Michallet AS, Coiffier B, Salles G (2006) Clinicopathologic characteristics and outcome of diffuse large B-cell lymphomas presenting with an associated low-grade component at diagnosis. J Clin Oncol 24:5234–5241

    Article  PubMed  Google Scholar 

  21. Hubbard SM, Chabner BA, DeVita VT, Simon R, Berard CW, Jones RB, Garvin AJ, Canellos GP, Osborne CK, Young RC (1982) Histologic progression in non-Hodgkin's lymphoma. Blood 59:258–264

    CAS  PubMed  Google Scholar 

  22. Oviatt DL, Cousar JB, Collins RD, Flexner JM, Stein RS (1984) Malignant lymphomas of follicular center cell origin in humans. V. Incidence, clinical features, and prognostic implications of transformation of small cleaved cell nodular lymphoma. Cancer 53:1109–1114

    Article  CAS  PubMed  Google Scholar 

  23. Tan D, Rosenberg SA, Lavori P, Hoppe LR, Warnke R, Avandi R, Natkunam Y, Yuen A, Horning SJ (2008) Improved prognosis after histologic transformation (HT) of follicular lymphoma (FL): the Stanford experience 1960-2003. Annals of Oncology 19 (suppl 4): abstr 089

    Google Scholar 

  24. Salles G, Seymour JF, Offner F, López-Guillermo A, Belada D, Xerri L, Feugier P, Bouabdallah R, Catalano JV, Brice P, Caballero D, Haioun C, Pedersen LM, Delmer A, Simpson D, Leppa S, Soubeyran P, Hagenbeek A, Casasnovas O, Intragumtornchai T, Fermé C, da Silva MG, Sebban C, Lister A, Estell JA, Milone G, Sonet A, Mendila M, Coiffier B, Tilly H (2011) Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial. Lancet 377:42–51

    Article  CAS  PubMed  Google Scholar 

  25. Villa D, Crump M, Panzarella T, Savage KJ, Toze CL, Stewart DA, Macdonald DA, Buckstein R, Lee C, Alzahrani M, Rubinger M, Foley R, Xenocostas A, Sabloff M, Muccilli A, Chua N, Couture F, Larouche JF, Cohen S, Connors JM, Ambler K, Al-Tourah A, Ramadan KM, Kuruvilla J (2013) Autologous and allogeneic stem-cell transplantation for transformed follicular lymphoma: a report of the Canadian blood and marrow transplant group. J Clin Oncol 31:1164–1171

    Article  CAS  PubMed  Google Scholar 

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Author contribution

HG designed the research study, performed the research, collected, analyzed, and interpreted the data, and wrote the manuscript; RB designed the research study, supervised the research, analyzed, and interpreted the data, and wrote the manuscript; MC, EP, DS, NB, and KI analyzed, interpreted the data, and wrote the manuscript; LZ performed statistical analysis and wrote the manuscript. All authors approved the submitted version of the manuscript.

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The authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada

    Hany R. Guirguis, Matthew C. Cheung, Eugenia Piliotis, David Spaner, Neil L. Berinstein, Kevin Imrie, Liying Zhang & Rena Buckstein

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  1. Hany R. Guirguis
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  2. Matthew C. Cheung
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  3. Eugenia Piliotis
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  8. Rena Buckstein
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Correspondence to Rena Buckstein.

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Guirguis, H.R., Cheung, M.C., Piliotis, E. et al. Survival of patients with transformed lymphoma in the rituximab era. Ann Hematol 93, 1007–1014 (2014). https://doi.org/10.1007/s00277-013-1991-y

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  • DOI: https://doi.org/10.1007/s00277-013-1991-y

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