Good News for Transformation in FL?

We barely get to catch our breath from ASCO, and we now we have the International Conference on Malignant Lymphoma in Lugano, Switzerland. Lots of good stuff coming out of there for Follicular Lymphoma.

One of those presentations is called "The Risk of Trasformation of Follicular Lymphoma "Transformed" by Rituximab: The ARISTOTLE Study Promoted by the European Lymphoma Institute."

As the title suggests, this very large study showed a much smaller risk of Transformation than previous studies, and it gives the credit to Rituxan (Rituximab/Mabthera).

I assume most of you know what "Transformation" is, since it always seems to be tucked away in our minds somewhere, ready to jump out and scare us when we have a fever or notice a new bump somewhere. But here's a reminder anyway. Follicular Lymphoma is, as a specialist told me long ago, a "genetically unstable" disease. If we are lucky, it take an indolent course, growing slowly and not interfering too much in our lives. But sometimes, it transforms -- it turns into a different kind of cancer, one that is more aggressive. (It usually turns into Diffuse Large B Cell Lymphoma, but it can become other types, too.)

Transformed FL needs to be caught and treated early -- better results come that way. There have been some improvements in the last few years in treating Transformed FL, but it's still a scary idea for most of us. And what makes it scarier is that it seems so common, if you believe the numbers. I have seen some statistics that say up to 50% of FL patients will transform. I've also seen some that say 35%, 30% or 20%. Different studies seem to give us different figures. The good news is that in the 9 years I've been paying attention, the numbers have been trending down. The most recent I have seen say that somewhere between 15% and 20% of FL patients will transform.

That's what makes this study so remarkable. The numbers are sliced up in different ways, but they all show that rate of transformation is under 10%.

This was a retrospective study -- it looks back at patients who were diagnosed with FL between 1997 and 2013. It looked at 7342 patients -- a VERY large number. It defined transformation as the first event after initial therapy; transformation had to be the first reason the patient needed a second treatment. The median time to transformation was 19 months.

Here are the numbers:
The 5 year risk of transformation was 5.5%.
The 10 year risk was 7.2%.

For patients who had Rituxan as part of their treatment, the 10 year risk was 6.2%. For those who didn't have Rituxan, it was 9%.

Breaking it down a little more, for those who did have Rituxan, the 10 year risk was 6% if they only had Rituxan as part of their initial treatment. It was 3.8% if they also had Rituxan Maintenance.

Those are darn good numbers all around, whatever the treatment was. All under 10%, which is a whole lot better than what we've seen, We should be happy about this -- and maybe just a little less worried as patients.

HOWEVER.....

You'll notice the question mark in my title. I do think it's good news, but as a patient, I still have some questions.

One of the things that the researchers point out in the abstract is that the statistics for transformation are hard to pin down because they are really hard to compare to one another. As they say, "the incidence of HT have wavered over the past several decades, due to the adoption of different diagnostic methods, definition of transformation, duration of follow-up, and type of treatment." In other words, the studies are different enough from one another that it's hard to say that the numbers from transformation are getting better because the studies might now be comparing the same things.

In this study, for example, transformation is defined as only the first event after initial therapy. As I read it, that means anyone who watched and waited, and then transformed before they were treated, would not be included here. And anyone who had a second treatment, and then transformed, would also not be included here. So if we're looking for an overall picture of how many transform, then this might not be accurate.

Another important issue that I have seen mentioned in discussing this study -- there is not any connection yet to clinical practice. In other words, don't think that Rituxan Maintenance will keep you from transforming. The researchers don't make that conclusion; they make the broader point that Rituxan (in whatever form) seems to have a positive effect on transformation.

So follow their lead. Worry just a little less about transforming. It might not really be 3.8% or 6%, but it's got to be a lot closer to them than to 50%. And that's pretty nice.