Survival Rates of Histological Transformation in Patients With Follicular Lymphoma

Results from the Phase 3 GALLIUM Trial

Histological transformation (HT) in advance-stage follicular lymphoma (FL) was associated with poor overall survival rates, according to findings from the phase 3 GALLIUM trial recently published in Clinical Lymphoma, Myeloma and Leukemia. 

Dr Carla Casulo, MD, Wilmot Cancer Institute, University of Rochester, Rochester, New York, and coauthors stated that although survival of FL has improved after anti-CD20 antibodies were first introduced, it can still “undergo histological transformation (HT) to a more aggressive disease, and a validated model for predicting HT risk is not yet available.” 

In order to assess the risk of HT among patients with advanced-stage FL, Dr Casulo et al aimed to evaluate a primary endpoint of progression-free survival (PFS), as well as secondary endpoints including overall survival, risk factors, and incidence of HT. 

1202 patients with previously untreated, advanced-stage FL were enrolled in this study and assessed for previously mentioned endpoints. HT rates were measured by repeat tumor biopsy at disease progression or relapse. 

Results indicated that out of all patients, 26.2% (n=315) experienced disease progression and 14.6% (n=46) needed a biopsy at the time of first progression, with 40 out of 46 patients having biopsy-confirmed HT. Patients who had HT at the time of first progression had the poorest post-progression survival when compared to those with relapsed FL, and patients with HT experienced relapse earlier than FL relapse. The risk factors for HT were male sex, elevated baseline serum lactate dehydrogenase, and elevated baseline serum β2-microglobulin.

As endpoints were met, Dr Casulo et al concluded, “HT was a low-frequency event associated with poor survival outcomes in the GALLIUM study.” They added, “Further research is required to develop validated prognostic indices for HT risk and guide treatment decisions.”

Source: 

Casulo C, Herold M, Hiddemann W, et al. Risk factors for and outcomes of follicular lymphoma histological transformation at first progression in the GALLIUM study. Clin Lymph, Myel and Leuk. 2023;23(1):40-48. doi:https://doi.org/10.1016/j.clml.2022.09.003