{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T20:50:24Z","timestamp":1789159824955,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T00:00:00Z","timestamp":1554336000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hematological Oncology"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Follicular lymphoma (FL) is the second most common non\u2010Hodgkin lymphoma (NHL) subtype. The histological transformation (HT) of FL is an event considered frequent in the natural history of this tumor. We studied the transformation rates, predictive factors, and treatment characteristics that may impact in the survival of patients with FL and HT. A total of 1074 patients diagnosed with FL were prospectively enrolled from 1990 to 2016 in a Spanish registry. Sixty\u2010four HTs were recorded based on clinical criteria (55%) or histological confirmation (45%). The cumulative incidence rate of transformation at 5\u00a0years is 7.3%. The 5\u2010year overall survival (OS) without HT was 85% (95% confidence interval [CI], 70%\u201090%) vs 66% (95% CI, 51%\u201076%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0012) with HT. Factors associated with HT were elevated lactate dehydrogenase (LDH) (odds ratio [OR] 1.83), intermediate\u2010high Follicular lymphoma international prognostic index (FLIPI) (OR 2.16\u2010OR 3.21), B symptoms (OR 2.46), or Eastern Cooperative Oncology Group (ECOG) 1 (OR 2.35). Treatment options related to HT were \u201cwatch and wait\u201d or no rituximab or anthracyclines initially. A 5\u2010year OS for patients treated with chemotherapy before HT was 55% (95% CI, 38%\u201069%) versus 81% (95% CI, 53%\u201093%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.009) for those who had not received it. The HT rate has decreased after the introduction of rituximab, as has been previously described. The timing of this treatment had an impact on the survival of these patients.<\/jats:p>","DOI":"10.1002\/hon.2601","type":"journal-article","created":{"date-parts":[[2019,3,6]],"date-time":"2019-03-06T18:46:00Z","timestamp":1551897960000},"page":"143-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Transformed follicular lymphoma in the rituximab era: A report from the <scp>S<\/scp>panish <scp>L<\/scp>ymphoma <scp>O<\/scp>ncology <scp>G<\/scp>roup"],"prefix":"10.1002","volume":"37","author":[{"given":"Miriam","family":"M\u00e9ndez","sequence":"first","affiliation":[{"name":"Medical Oncology Department Hospital Universitario Puerta de Hierro\u2010Majadahonda  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8791-7660","authenticated-orcid":false,"given":"Maria","family":"Torrente","sequence":"additional","affiliation":[{"name":"Medical Oncology 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