Risk Factors for and Outcomes of Follicular Lymphoma Histological Transformation at First Progression in the GALLIUM Study
- Author(s)
- Casulo, C; Herold, M; Hiddemann, W; Iyengar, S; Marcus, RE; Seymour, JF; Launonen, A; Knapp, A; Nielsen, TG; Mir, F;
- Details
- Publication Year 2023-01,Volume 23,Issue #1,Page 40-48
- Journal Title
- Clinical Lymphoma, Myeloma & Leukemia
- Publication Type
- Research article
- Abstract
- BACKGROUND: Although advanced‑stage follicular lymphoma (FL) is considered incurable, survival has improved with the introduction of the anti-CD20 antibodies, rituximab (R) and obinutuzumab (G). However, FL can undergo histological transformation (HT) to a more aggressive disease, and a validated model for predicting HT risk is not yet available. PATIENTS AND METHODS: We assessed HT incidence, risk factors and outcomes in the phase III, GALLIUM study evaluating R- or G-chemotherapy in patients with previously untreated, advanced-stage FL (ClinicalTrials.gov NCT01332968). HT rates were assessed by repeat tumour biopsy at disease progression or relapse, at the investigator's discretion. RESULTS: Of 1202 patients enrolled, 315 (26.2%) experienced progressive disease; 46 (14.6%) had a biopsy at first progression, 40 of whom had biopsy-confirmed HT. HT risk factors were male sex (subdistribution hazard ratio [sHR], 2.21; 95% confidence interval [CI], 1.16-4.20), elevated baseline serum lactate dehydrogenase (sHR, 3.97; 95% CI, 2.03-7.76), and elevated baseline serum beta(2)-microglobulin (sHR, 1.96; 95% CI, 1.02-3.79). Patients with HT at first progression had poorer post-progression survival than those with relapsed FL (2-year rate: 55.9% vs. 83.1%). Relapse with HT occurred earlier than FL relapse (median time from randomisation: 0.8 vs. 2.3 years). CONCLUSION: HT was a low-frequency event associated with poor survival outcomes in the GALLIUM study. Male sex and elevated baseline levels of serum LDH and B2M were significant risk factors for HT. Further research is required to develop validated prognostic indices for HT risk and guide treatment decisions.
- Publisher
- Elsevier
- Keywords
- Female; Humans; Male; Antineoplastic Combined Chemotherapy Protocols/adverse effects; *Gallium/therapeutic use; *Lymphoma, Follicular/pathology; Neoplasm Recurrence, Local; Risk Factors; Rituximab/therapeutic use; Follicular lymphoma; GALLIUM study; Histologic transformation; Immunotherapy; Obinutuzumab; Outcomes; Rituximab
- Department(s)
- Clinical Haematology
- PubMed ID
- 36379880
- Publisher's Version
- https://doi.org/10.1016/j.clml.2022.09.003
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-04-04 06:09:38
Last Modified: 2023-04-17 11:53:04