Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma (FL) treated with radiotherapy.
Bibliographic record
Abstract
8073 Background: Transformation to aggressive lymphoma is a recognized complication in FL, with an annual risk of approximately 3% (Al-Tourah. JCO. 2008). However, the incidence in limited-stage FL treated with curative intent radiotherapy (RT) is unknown. Methods: We recently reported the outcome of 237 patients (pts) with limited-stage grade 1-3A FL defined as stage I or II, no B symptoms and non-bulky disease < 10cm who were treated with curative intent RT at the British Columbia Cancer Agency (ESMO 2009, Abstract 9202). The 10 and 15-year (y) overall survival (OS) of this cohort was 66% and 46%, respectively. The incidence and outcome of transformation in this cohort was reviewed. Results: With a median follow-up of 7.4 y (range 1.8-23), 34 cases of limited-stage FL underwent transformation to aggressive lymphoma with an overall 10-year risk of 20%. The median time to transformation was 3.6 y (.44-10.23). The majority of cases were histologically confirmed (76%) and were diffuse large B-cell lymphoma (90%). At the time of transformation, the median age of pts was 63.5 y, 47% were male, 24% had B symptoms, 59% had an elevated LDH, 53% had extranodal involvement (most common site bone 50%) and 62% had an IPI of ≥3. In 17 pts (50%), transformation represented the first manifestation of lymphoma relapse. There were no risk factors at diagnosis, including grade of FL, that predicted for future risk of transformation in multivariate analysis (MVA). The 10-year OS in transformed vs. non- transformed pts was 53% vs. 70%, respectively (p=.008). For pts treated with curative intent (n=29), therapy with R-CHOP at the time of transformation improved survival (5-year OS 92% vs. 15%, p=.0067) and was the only factor associated with OS in MVA. (HR .06, p=.006). Conclusions: There is a moderate risk of transformation in limited-stage FL treated with curative intent RT and this represents a major factor impacting outcome in these patients. Treatment with rituximab at the time of transformation appears to improve outcome. Given the absence of clinical variables at the time of diagnosis that predict for future transformation, biologic correlates would aid in identifying patients that may benefit from additional initial therapy. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Allos Therapeutics, Eisai, Genentech, Roche Roche Roche Canada
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".