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However, they may experience histological transformation into aggressive large B\u2010cell lymphoma. We conducted a nationwide population\u2010based study to estimate the risk of transformation in FL, considering different FL grades, and studied the relative survival (RS) of patients diagnosed with FL in Finland from 1995 to 2018. We identified a total of 4014 patients with newly diagnosed grade 1\u20133A FL. The median age at diagnosis was 64\u2009years, and 55% of patients were female. The cumulative incidence of transformation across the entire cohort was 8.4% at 10\u2009years (95% confidence interval [CI], 7.5\u20139.5). The 10\u2010year RS was 78% for the whole cohort and showed improvement over time. Transformation was associated with a significantly increased risk of death (hazard ratio [HR] 5.0; 95% CI, 4.2\u20136.0;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Grade 3A was associated with higher excess mortality compared to patients with low\u2010grade FL. Lymphoma was the most common cause of death. We conclude that, although the 10\u2010year RS was relatively good, grade 3A FL and transformation led to significantly higher mortality compared to low\u2010grade FL or no transformation. Our results also indicate a reduction in excess mortality over time.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70181","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T05:00:48Z","timestamp":1758862848000},"page":"2417-2425","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Transformation and causes of death in follicular lymphoma: A Finnish nationwide population\u2010based study"],"prefix":"10.1111","volume":"207","author":[{"given":"Ilja","family":"Kalashnikov","sequence":"first","affiliation":[{"name":"Research Programs Unit, Faculty of Medicine University of Helsinki  Helsinki Finland"},{"name":"Department of Oncology Helsinki University Hospital Comprehensive Cancer Centre  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taina","family":"Reunamo","sequence":"additional","affiliation":[{"name":"Wellbeing Services County of Southwest Finland, Department of Oncology Turku University Hospital and University of Turku  Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Tanskanen","sequence":"additional","affiliation":[{"name":"Finnish Cancer Registry Cancer Society of Finland  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leevi","family":"Viisanen","sequence":"additional","affiliation":[{"name":"Research Programs Unit, Faculty of Medicine University of Helsinki  Helsinki Finland"},{"name":"Department of Oncology Helsinki University Hospital Comprehensive Cancer Centre  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nea","family":"Malila","sequence":"additional","affiliation":[{"name":"Finnish Cancer Registry Cancer Society of Finland  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirkku","family":"Jyrkki\u00f6","sequence":"additional","affiliation":[{"name":"Wellbeing Services County of Southwest Finland, Department of Oncology Turku University Hospital and University of Turku  Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8265-511X","authenticated-orcid":false,"given":"Sirpa","family":"Lepp\u00e4","sequence":"additional","affiliation":[{"name":"Research Programs Unit, Faculty of Medicine University of Helsinki  Helsinki Finland"},{"name":"Department of Oncology Helsinki University Hospital Comprehensive Cancer Centre  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.00400"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2014.251"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw185"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2017.07.002"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2018.11.010"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2011.08942.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2017.175059"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01620-2"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1985.3.1.25"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022015851"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-017-3151-2"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.7163"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.3260"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-01-643569"},{"key":"e_1_2_11_16_1","volume-title":"Manual of tumor nomenclature and coding","author":"American Cancer Society","year":"1951"},{"key":"e_1_2_11_17_1","unstructured":"World Health Organization.Manual of the international statistical classification of diseases injuries and causes of death based on the recommendations of the seventh revision Conference 1955 and adopted by the ninth World Health Assembly under the WHO Nomenclature Regulations.1957. 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