Transformation Research

Another abstract from the ASH conference. The name of this session is "Risk Factors for Early Transformation of Follicular Lymphoma (FL): Report From the National LymphoCare Study (NLCS)." The LymphoCare Study is a very large study of lymphoma patients, attempting to gather information about what those patients have done and have gone through in the past (as opposed to a clinical trial, where the patients would be part of a controlled experiment). This paper looks at Follicular NHL patients, and tries to determine if there is a connection between various factors and the risk of fNHL patients transforming to a more aggressive form of NHL.

The researchers looked at 2,734 fNHL patients, and looked at previous research that tried to determine if particular practices would increase the chances of transformation. [Just a reminder: about 30% of fNHL patients will have their slow-growing lymphoma change into a fast-growing lymphoma at some point; the process is known as "transformation." It's a great fear of fNHL patients -- maybe our biggest fear.] Previous research has suggested that watching and waiting increases the risk of transformation; the use of R-CHOP decreases the risk; and there is no difference in risk in using Rituxin as a first treatment as opposed to a second or later treatment.


Of the 2,734 patients, they found that 139 patients had transformed during the study.


As for watching and waiting, they found no difference in the risk of transformation between the 481 W&Wers and the 2253 who had received some kind of initial treatment. (Woo hoo!)


As for the R-CHOP (or other anthracycline-based treatment): 944 patients received R-CHOP as an initial treatment, and the risk was "not statistically different (although a trend exists)" compared to those who didn't receive that treatment.


It seems pretty rare to me that people are not given Rituxin as part of their treatment (R-CVP, R-CHOP, etc), given what we know about how much the addition of Rituxin improves the effectiveness of other treatments, but 450 patients in the study did not receive Rituxin as part of their treatment, and had a higher risk of transformation than the 1803 who did receive it.

So they seem to have overturned a few assumptions about what we have known (or thought) about fNHL and transformation.

The authors caution that their information will be even better with a longer follow-up, and they also caution that this kind of "looking back" doesn't necessarily tell the whole story. They also suggest looking at an article from a couple of years ago called "Transformation of follicular lymphoma to diffuse large B-cell lymphoma proceeds by distinct oncogenic mechanisms," which suggests that....well, I'm not sure what it suggests, because it's really technical. But it seems to look at the kind of genetic pathways that allow transformation to take place, and says that there are two different mechanisms that lead to transformation.

My guess (and, hey, my one semester as a pre-med major allows me to make this guess) is that more research on the microenvironment of transformed cells will lead us to some answers about transformation risk. We'll be able to look at individual markers on the cells and say, "Whoa -- gotta watch this one." Pure speculation on my part, but I'm guessing that individual treatments don't have a huge effect on transformation.

We'll know more at some point, I guess -- hopefully soon -- but for now, it's nice to know that there is at least some path for fNHL patients to follow, based on this research. Watch and wait if you must, stick with anthracycline if it does happen, and make sure to chase it with a shot of Rituxin (call it a "B-Cell Boilermaker," or an "Antibody-tini," or something cute like that.....).