{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T20:50:55Z","timestamp":1790974255660,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T00:00:00Z","timestamp":1713312000000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Histological transformation (HT) to diffuse large B\u2010cell lymphoma (DLBCL) is a common complication of follicular lymphoma (FL) and is usually associated with a dismal outcome. However, the survival rate of these patients has improved over the last 20\u2009years with the introduction of rituximab. This study aimed to access the outcome of transformation to DLBCL (t\u2010DLBCL) from FL in a retrospective series that began after the widespread use of rituximab use. In addition, we also compared survival between t\u2010DLBCL and primary DLBCL (p\u2010DLBCL) in the same timeframe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with primary FL and patients with p\u2010DLBCL between 2000 and 2020. Patients who had a subsequent diagnosis of DLBCL at least 2\u2009months after FL diagnosis were identified as t\u2010DLBCL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Finally, we identified 50,332 FL and 95,933 p\u2010DLBCL. With a median follow\u2010up of 119\u2009months, 1631 patients developed t\u2010DLBCL. The median time from FL diagnosis to t\u2010DLBCL was approximately 4\u2009years. The post\u2010transformation survival (PTS) rate at 5\u2009years was 49.6%, with a median PTS of 56\u2009months. Older age, advanced stage, and early transformation were associated with worse PTS. Furthermore, t\u2010DLBCL receiving chemotherapy or combined modality as initial therapy before HT was also associated with worse PTS, while the result was inverse when taking the impact of initial management strategy at HT into account. Taking t\u2010DLBCL and p\u2010DLBCL as a whole, comparable survival was observed between p\u2010DLBCL and t\u2010DLBCL receiving radiation or watch\u2010and\u2010wait as initial therapy prior to HT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The outcome of t\u2010DLBCL in the rituximab era was better than historical series before the rituximab era. Due to the good prognosis, we did not recommend autologous stem cell transplantation for t\u2010DLBCL receiving watch\u2010and\u2010wait or radiation as initial therapy before HT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.7120","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T08:49:45Z","timestamp":1713343785000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Outcomes of the transformation of follicular lymphoma to diffuse large B\u2010cell lymphoma in the rituximab era: A population\u2010based study"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4489-5526","authenticated-orcid":false,"given":"Wenshuai","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Hematology Hainan Hospital of Chinese PLA General Hospital  Sanya 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