{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:03:03Z","timestamp":1792508583492,"version":"4.5.0"},"reference-count":32,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"22","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2016,8,1]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> To study the outcome of histologic transformation (HT) in a large prospective cohort of patients with follicular lymphoma (FL) who previously responded to immunochemotherapy. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> After a median 6-year follow-up of 1,018 randomly assigned patients from the PRIMA trial, disease progression was observed in 463 patients, 194 of whom had histologic documentation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Forty patients had histology consistent with HT, and 154 had untransformed FL (median time to recurrence, 9.6 v 22.8 months, respectively; P = .018). Thirty-seven percent of biopsies performed during the first year of follow-up showed HT corresponding to 58% of all HTs. Altered performance status, anemia, high lactate dehydrogenase level, \u201cB\u201d symptoms, histologic grade 3a, and high Follicular Lymphoma International Prognostic Index scores at diagnosis were identified as HT risk factors. Response (complete v partial) to immunochemotherapy or rituximab maintenance had no impact on the risk of HT. After salvage treatment, patients with HT had less frequent complete response (50.3% v 67.4%; P = .03) and more disease progression (28.2% v 9.6%; P &lt; .001) than patients without HT. Estimated overall survival for the patients with HT was poorer (median, 3.8 v 6.4 years; hazard ratio, 3.9; 95% CI, 2.2 to 6.9). Autologous stem cell transplantation improved the outcomes of patients with HT (median overall survival, not reached v 1.7 years) but not of patients with persistent FL histology. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> HT in patients with FL who previously responded to immunochemotherapy is an early event associated with a poor outcome that may deserve intensive salvage with autologous stem cell transplantation. These data emphasize the necessity for biopsy at the first recurrence of FL. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2015.65.7163","type":"journal-article","created":{"date-parts":[[2016,6,14]],"date-time":"2016-06-14T03:09:08Z","timestamp":1465873748000},"page":"2575-2582","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":176,"title":["Risk Factors and Outcomes for Patients With Follicular Lymphoma Who Had Histologic Transformation After Response to First-Line Immunochemotherapy in the PRIMA Trial"],"prefix":"10.1200","volume":"34","author":[{"given":"Cl\u00e9mentine","family":"Sarkozy","sequence":"first","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Trneny","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Xerri","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Wickham","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Feugier","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirpa","family":"Leppa","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Brice","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; 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Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehan","family":"Dupuis","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; Luc Xerri, Aix-Marseille University and Institut Paoli-Calmettes, Marseille; Pierre Feugier, Centre Hospitalier Universitaire de Nancy and INSERM 954 Universit\u00e9 de Lorraine, Nancy; Pauline Brice, H\u00f4pital Saint Louis APHP and Universit\u00e9 Paris VII; Danielle Canioni, Assistance Publique..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Caballero","sequence":"additional","affiliation":[{"name":"Cl\u00e9mentine Sarkozy and Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'H\u00e9matologie, Pierre B\u00e9nite and Universit\u00e9 Claude Bernard, Facult\u00e9 de M\u00e9decine Lyon-Sud Charles M\u00e9rieux Pierre B\u00e9nite; 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