Impact of prior treatment on outcome of transformed follicular lymphoma and relapsed de novo diffuse large B cell lymphoma: a retrospective multicentre analysis

• Published in: Annals of hematology 2015-06, Vol.94 (6), p.981-988
• Main Authors: Lerch, K., Meyer, A. H., Stroux, A., Hirt, C., Keller, U., Viardot, A., Marks, R., Schreiber, S., Pezzutto, A., Scholz, C. W.
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Female; Follow-Up Studies; Hematology; Humans; Lymphoma, Follicular - diagnosis; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - mortality; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - mortality; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Oncology; Original Article; Retrospective Studies; Survival Rate - trends; Treatment Outcome
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-015-2303-5

Transformation of follicular lymphoma (FL) into aggressive disease and relapse of de novo diffuse large B cell lymphoma (DLBCL) are considered highly unfavourable events. However, most published data were acquired when rituximab was not routinely used. We retrospectively analysed 50 patients with transformed FL (tFL) in a multicenter study and compared them to 50 individuals with relapsed DLBCL (rDLBCL) who all obtained rituximab for the treatment of their disease. Our goal was to identify factors that predict a more favourable prognosis. After a median follow-up of 5.4 years from diagnosis, there was no significant difference in median overall survival (OS) from the date of transformation (tFL) or date of the first relapse (rDLBCL) (1.9 versus 3.9 years, P  = .542). Of note, 5-year OS of patients with tFL was 46 %. Follicular lymphoma patients, treatment naïve prior to transformation, fared significantly better than pretreated patients (median not reached versus 1.4 years, P  = .014). Regarding rDLBCL, female gender (13.9 versus 1.8 years, P  = .019) and absence of rituximab prior to the first relapse (14.0 versus 1.8 years, P  = .035) were favourable prognostic factors in a uni- and multivariate analysis. Only a proportion of patients received high-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT), i.e. 38 and 52 % of patients with tFL and rDLBCL, respectively. Our data indicate that a favourable prognosis is conferred by treatment naivety in tFL and by rituximab naivety in rDLBCL. In contrast, we did not find a prognostic impact of HDT-ASCT in our series.