Histologic transformation (HT) of indolent non-Hodgkin lymphoma (iNHL) to diffuse large B-cell lymphoma (DLBCL) carries a poor prognosis. Using the Surveillance, Epidemiology, and End Results-17 database, we conducted a population-based study of adult patients with transformed follicular lymphoma (t-FL), marginal zone lymphoma (t-MZL), lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (t-LPL/WM), and de novo DLBCL. Primary outcome was relative survival (RS), and secondary outcomes included overall survival (OS) and lymphoma-specific survival (LSS). Outcomes were modeled using flexible parametric survival models, while multivariable modeling was used to compare RS, OS, and LSS. The incidence of HT was highest in splenic MZL (SMZL, 6.78%) and lowest in extranodal MZL (EMZL, 1.62%). Median follow-up times were similar for patients with de novo DLBCL and transformed indolent lymphomas. The 5-year RS and OS were longer in de novo DLBCL compared to all other transformed iNHL subtypes (68 versus 59%, respectively). For t-FL, early transformation (within 2 years of diagnosis, Hazard ratio [HR] = 1.34) and prior treatment (HR = 1.89) were associated with inferior survival. This association was not observed in other transformed lymphoma subtypes. This is the first comparative study to show that the outcomes of t-LPL/WM were inferior compared to de novo DLBCL and highlights the need to incorporate early experimental therapies in patients with t-FL with early transformation and receipt of prior chemotherapy.
惰性非霍奇金淋巴瘤（iNHL）向弥漫性大B细胞淋巴瘤（DLBCL）的组织学转化（HT）预示不良预后。我们利用监测、流行病学和最终结果-17数据库，对转化性滤泡性淋巴瘤（t-FL）、边缘区淋巴瘤（t-MZL）、淋巴浆细胞淋巴瘤/华氏巨球蛋白血症（t-LPL/WM）以及原发DLBCL的成年患者进行了一项基于人群的研究。主要研究终点为相对生存率（RS），次要终点包括总生存期（OS）和淋巴瘤特异性生存期（LSS）。研究采用灵活参数生存模型进行结局建模，并通过多变量模型比较RS、OS和LSS。HT发生率在脾边缘区淋巴瘤（SMZL）中最高（6.78%），在结外边缘区淋巴瘤（EMZL）中最低（1.62%）。原发DLBCL与转化惰性淋巴瘤患者的中位随访时间相近。与原发DLBCL相比，所有其他转化iNHL亚型的5年RS和OS均较短（分别为68%对59%）。对于t-FL患者，早期转化（诊断后2年内，风险比[HR]=1.34）和既往治疗史（HR=1.89）与较差的生存结局相关，这种关联在其他转化淋巴瘤亚型中未观察到。本研究首次通过对比分析表明，t-LPL/WM的预后较原发DLBCL更差，并强调对于早期转化且接受过化疗的t-FL患者，有必要纳入早期实验性治疗。
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