Journal of Clinical Oncology, Vol 1, 11-16, Copyright © 1983 by American Society of Clinical Oncology

ARTICLES

Histologic conversion in the non-Hodgkin's lymphomas

B Acker, RT Hoppe, TV Colby, RS Cox, HS Kaplan and SA Rosenberg

Between July 1, 1971 and December 31, 1978, 150 patients with favorable subtypes of non-Hodgkin's lymphoma [nodular poorly differentiated lymphocytic (NLPD), nodular mixed, or diffuse well differentiated lymphocytic] were entered into prospective randomized clinical trials at Stanford University. Treatments included involved field, total lymphoid, or whole body irradiation, single alkylating agent chemotherapy, combination chemotherapy with cyclophosphamide, vincristine and prednisone (CVP) or with cyclophosphamide, vincristine, procarbazine, and prednisone (C-MOPP), or various combinations of chemotherapy and irradiation. The initial complete response rate (CR) was 79%. Among patients who achieved a CR, 31% later relapsed. There were 78 patients who either failed to achieve a CR or achieved a CR and later relapsed. Histologic conversion (change from initially favorable to an unfavorable subtype of non-Hodgkin's lymphoma) was documented in 22/78 patients (28%). However, the actuarial risk for conversion was actually much greater (60% at 8 yr). The median time to documentation of conversion was 51 mo. The most common type of histologic conversion was from NLPD to diffuse histiocytic lymphoma. Documented histologic conversion was often associated with a more aggressive clinical behavior of the lymphoma, and the median survival after conversion was less than 1 yr. However, those patients who achieved a CR after conversion had a more favorable outcome (actuarial survival 75% at 5 yr). No specific risk factors predictive of histologic conversion could be identified.

Related Article

• Follicular Lymphoma Revisited
  Saul A. Rosenberg
  JCO 2008 26: 515-516 [Full Text]

This article has been cited by other articles:

				D. O'Shea, C. O'Riain, C. Taylor, R. Waters, E. Carlotti, F. MacDougall, J. Gribben, A. Rosenwald, G. Ott, L. M. Rimsza, et al. The presence of TP53 mutation at diagnosis of follicular lymphoma identifies a high-risk group of patients with shortened time to disease progression and poorer overall survival Blood, October 15, 2008; 112(8): 3126 - 3129. [Abstract] [Full Text] [PDF]

				R. I. Fisher, M. S. Kaminski, R. L. Wahl, S. J. Knox, A. D. Zelenetz, J. M. Vose, J. P. Leonard, S. Kroll, S. J. Goldsmith, and M. Coleman Tositumomab and Iodine-131 Tositumomab Produces Durable Complete Remissions in a Subset of Heavily Pretreated Patients With Low-Grade and Transformed Non-Hodgkin's Lymphomas J. Clin. Oncol., October 20, 2005; 23(30): 7565 - 7573. [Abstract] [Full Text] [PDF]

				J. P. Leonard, M. Coleman, L. Kostakoglu, A. Chadburn, E. Cesarman, R. R. Furman, M. W. Schuster, R. Niesvizky, D. Muss, J. Fiore, et al. Abbreviated Chemotherapy With Fludarabine Followed by Tositumomab and Iodine I 131 Tositumomab for Untreated Follicular Lymphoma J. Clin. Oncol., August 20, 2005; 23(24): 5696 - 5704. [Abstract] [Full Text] [PDF]

				R. D. Gascoyne Hematopathology Approaches to Diagnosis and Prognosis of Indolent B-Cell Lymphomas Hematology, January 1, 2005; 2005(1): 299 - 306. [Abstract] [Full Text] [PDF]

				I. S. Lossos, A. A. Alizadeh, M. Diehn, R. Warnke, Y. Thorstenson, P. J. Oefner, P. O. Brown, D. Botstein, and R. Levy Transformation of follicular lymphoma to diffuse large-cell lymphoma: Alternative patterns with increased or decreased expression of c-myc and its regulated genes PNAS, June 25, 2002; 99(13): 8886 - 8891. [Abstract] [Full Text] [PDF]

				M. S. Kaminski, A. D. Zelenetz, O. W. Press, M. Saleh, J. Leonard, L. Fehrenbacher, T. A. Lister, R. J. Stagg, G. F. Tidmarsh, S. Kroll, et al. Pivotal Study of Iodine I 131 Tositumomab for Chemotherapy-Refractory Low-Grade or Transformed Low-Grade B-Cell Non-Hodgkin's Lymphomas J. Clin. Oncol., October 1, 2001; 19(19): 3918 - 3928. [Abstract] [Full Text]

				C. D. Williams, C. N. Harrison, T. A. Lister, A. J. Norton, A. K. Blystad, B. Coiffier, G. Taghipour, N. Schmitz, and A. H. Goldstone High-Dose Therapy and Autologous Stem-Cell Support for Chemosensitive Transformed Low-Grade Follicular Non-Hodgkin's Lymphoma: A Case-Matched Study From the European Bone Marrow Transplant Registry J. Clin. Oncol., February 1, 2001; 19(3): 727 - 735. [Abstract] [Full Text] [PDF]

				K. A. Morton, J. Jarboe, and E. M. Burke Gallium-67 Imaging in Lymphoma: Tricks of the Trade J. Nucl. Med. Technol., December 1, 2000; 28(4): 221 - 232. [Abstract] [Full Text] [PDF]

				I. S. Lossos and R. Levy Higher-grade transformation of follicle center lymphoma is associated with somatic mutation of the 5' noncoding regulatory region of the BCL-6 gene Blood, July 15, 2000; 96(2): 635 - 639. [Abstract] [Full Text] [PDF]

				K. S.J. Elenitoba-Johnson, R. D. Gascoyne, M. S. Lim, M. Chhanabai, E. S. Jaffe, and M. Raffeld Homozygous Deletions at Chromosome 9p21 Involving p16 and p15 Are Associated With Histologic Progression in Follicle Center Lymphoma Blood, June 15, 1998; 91(12): 4677 - 4685. [Abstract] [Full Text] [PDF]

				P. R.K. Koduru, K. Raju, V. Vadmal, G. Menezes, S. Shah, M. Susin, J. Kolitz, and J. D. Broome Correlation Between Mutation in P53, p53 Expression, Cytogenetics, Histologic Type, and Survival in Patients With B-Cell Non-Hodgkin's Lymphoma Blood, November 15, 1997; 90(10): 4078 - 4091. [Abstract] [Full Text] [PDF]