Recommendation ID

Factors predicting outcomes for people with high-grade transformation of follicular lymphoma:- In people with high-grade transformation of follicular lymphoma, which biological and clinical factors predict good outcomes with immunochemotherapy alone?

Any explanatory notes
(if applicable)

Why this is important:- Before rituximab, it was accepted that high-grade transformation of follicular lymphoma to diffuse large B-cell lymphoma portended a poor prognosis. Recent data suggest that although transformation remains an important clinical event, outcomes have improved. It is unclear which people are likely to do well with conventional treatment (such as R-CHOP) and which people may benefit from intensive treatment with, for example, high-dose therapy and autologous stem cell transplantation. Many factors are likely to influence outcome, including clinical factors (such as age, stage at transformation and extranodal involvement at  ransformation), radiological findings (such as early improvement of disease identified using an interim FDG-PET-CT scan) and molecular factors (such as certain driver mutations present at transformation, the presence of MYC translocation and response of circulating tumour DNA to treatment). A better understanding of which factors are associated with high-risk or low-risk disease would enable therapy to be tailored to the person's needs, reducing unnecessary toxicity for people at low risk and reserving intensive therapy for people at high risk. Outcomes of interest include progression-free survival and overall survival in subgroups defined by clinical factors, radiological findings and molecular analyses.

Source guidance details

Comes from guidance
Non-Hodgkin’s lymphoma: diagnosis and management
Date issued
July 2016

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/07/2016