Patient selection: follicular lymphoma with Grade 1, 2 or 3a histology (not 3b)
Outcome: histologic transformation (most often diffuse large B-cell lymphoma, DLBCL)
Risk factors for histologic transformation:
(1) histologic grade
(2) ECOG performance status
(3) hemoglobin in g/dL
(4) serum LDH in IU/L relative to the upper limit of normal (ULN)
(5) "B" symptoms (night sweats, weight loss, etc)
(6) FLIPI (Follicular Lymphoma International Prognostic Index) score to treatment
|
Parameter
|
Finding
|
Points
|
|
histologic grade
|
1 or 2
|
0
|
|
|
3a
|
1
|
|
ECOG performance status
|
0 or 1
|
0
|
|
|
2 to 4
|
1
|
|
Hemoglobin
|
>= 12 g/dL
|
0
|
|
|
< 12 g/dL
|
1
|
|
serum LDH
|
<= ULN
|
0
|
|
|
> ULN
|
1
|
|
B symptoms
|
absent
|
0
|
|
|
present
|
1
|
|
FLIPI score
|
<= 2
|
0
|
|
|
> 2
|
1
|
In multivariate analysis ECOG performance and anemia were independently associated with histologic transformation.
number of predictors independently associated with histologic transformation =
= SUM(points for anemia and ECOG)
number of additional predictors =
= SUM(remaining 4 predictors)
Interpretation:
• minimum number of predictors: 0
• maximum number of independently associated predictors: 2
• maximum number of other predictors: 4
• The greater the number of predictors the greater the risk of histologic transformation.
Rebiopsy should be considered if the patient has progression or recurrence in order to detect histologic transformation.
