The most recent issue of Blood journal includes research on Transformed Follicular Lymphoma ("Cell-of-Origin of Transformed Follicular Lymphoma"). As the abstract says, we really don't know a whole lot about transformation -- not enough to predict who might transform. This article describes research that attempts to change all of that.
The researchers looked at samples from FL patients that had transformed, and some that had not, including some that they had samples from before and after their transformation. This allowed them to see changes in the cells, so they could determine what was different after transformation. They looked for known biomarkers -- elements of the cell that are present that signal something important.
What they found was that the biomarker IRF4 was a "predictor of early transformation." IRF4 stands for Interferon Regulatory Factor 4. The gene related to IRF4 does what its name says -- it helps regulate interferons, which are very cool signaling devices in cells. When a cell is attacked by an outsider, it releases interferons, which let other cells know that they should put up their defenses. When there is a problem with IRFs, interferons stop doing their jobs, and attackers are allowed to run wild.
So if there's a problem with an IRF, the body isn't stopping out-of-control cells from growing. Makes sense that it would play a role in transformation.
The research made several other important discoveries as well, including "composite histology predicting favorable prognosis." The abstract doesn't provide any more detail, and I haven't read the entire article, but composite histology indicates two types of cells. I assume this means both Follicular cells and transformed cells, and having both (rather than only transformed) is better news for a patient.
It will be interesting to see where research goes from here. There's plenty of work being done on targeting translocated genes like IRF4, and stopping whatever process it is allowing to happen. IRF4 is a "known biomarker" (and has been known for quite a while), so I'm guessing there is research already being done. Looking forward to seeing how it relates to transformed Follicualr Lymphoma in particular.