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| |  ICML: Prognostic Factors for Relapse and Transformation of Indolent Follicular Lymphoma By Claudia Orellana and Tim Allmark LUGANO, SWITZERLAND -- June 16, 2002 -- In a retrospective analysis, researchers from the United States have identified factors that predict relapse and transformation in patients with follicular lymphoma. Their findings were presented here Thursday at the 8th International Conference of Malignant Lymphoma (ICML). Frequent relapses and transformation to aggressive lymphoma are common in indolent follicular lymphoma. A knowledge of prognostic factors for relapse and transformation is important for designing therapy. Records of 451 patients with follicular lymphoma registered at the M.D. Anderson Cancer Center, University of Texas, Houston, between 1985 and 1992 were reviewed, including pathological analyses at times of diagnosis and relapse, laboratory and radiographic results. Median follow-up was 10 years (with a minimum of 4.5 years). During follow-up, 40 percent of patients died, 53.3 percent developed at least one relapse, and 12.4 percent had transformation at any relapse. Transformation was defined by follicular small cleaved or follicular mixed cell to large cell or pure diffuse lymphoma, follicular large cell to diffuse large cell, or any follicular to high-grade lymphoma. Significant negative factors for relapse included age older than 60, ß2 microglobulin levels higher than 3 mg/dL, lactate dehydrogenase (LDH) levels higher than upper normal limits, hemoglobin levels lower than 12 mg/dL for women and lower than 14 for men, disease stage IV, and lack of complete response. Significant factors for TF were lack of initial complete response, elevated LDH and presence of B symptoms at time of diagnosis, "so the major factors resulted to be predictive for both transformation and relapse," said Hillary Wu, first author of the study, adding that "it looks like the later the transformation with each progression episode the higher proportion they occur and also the faster speed they occur." The researchers found that survival times were heavily affected by transformation. Survival times from transformation at any relapse were 25 months compared with 82 months for indolent histology at all relapses. Of patients with transformation, 29 percent had 10-year overall survival compared with 42 percent of patients who had never transformed. "We have also found that it doesn’t matter when you transform. If you transform early or you transform later, your long-term survival time is exactly the same. To me it is fascinating that early transformers do just as poorly as do late transformers," said researcher Dr. Frederick Hagemeister. "What this all might mean is that transformation actually accounts for a lot of the adverse prognostic factors that we commonly think of as being important for progression relationships."
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