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Annals of Oncology Advance Access published online on August 28, 2006
Annals of Oncology, doi:10.1093/annonc/mdl162
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© 2006 European Society for Medical Oncology
Received April 3, 2006
Revised June 9, 2006
Accepted June 13, 2006

original article

The Follicular Lymphoma International Prognostic Index (FLIPI) and the histological subtype are the most important factors to predict histological transformation in follicular lymphoma

E. Giné 1, S. Montoto 1, F. Bosch 1, L. Arenillas 1, S. Mercadal 1, N. Villamor 1, A. Martínez 1, L. Colomo 1, E. Campo 1, E. Montserrat 1, and A. López-Guillermo 1 *

1 Institute of Hematology and Oncology, Department of Hematology and Hematopathology Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain

* To whom correspondence should be addressed.
A. López-Guillermo, E-mail: alopezg{at}clinic.ub.es


  Abstract

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 {beta}2-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.

Keywords: follicular lymphoma; transformation; FLIPI.
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