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Higher-grade transformation of follicular lymphoma – a continuous enigma

Leukemia volume 19, pages 1331–1333 (2005)Cite this article

Higher-grade histological transformation is a pivotal event in the natural history of low-grade non-Hodgkin's lymphoma (NHL), typically associated with more aggressive clinical behavior and a rapidly progressive clinical course refractory to treatment and short survival. Better understanding of the pathogenesis of the higher-grade transformation might lead to the identification of new therapeutic approaches that could improve patients' outcome. In this issue of the journal, Davies et al1 evaluated the role of TP53 gene mutations in transformation of follicular lymphoma (FL) to diffuse large B-cell lymphoma (DLBCL).1

FL is a distinct clinicopathological entity, accounting for 20–40% of newly diagnosed adult NHL.2, 3 It is composed of cells arranged in follicles that are morphologically and immunophenotypically similar to lymphocytes of the normal germinal center (GC), from which they are thought to originate. Although FL are indolent malignancies with the median survival of >7–8 years, it is an incurable fatal malignancy, unless it is irradiated in stage I of the disease. Higher-grade transformation to a more aggressive DLBCL occurs in 10–60% of patients.4 The actual risk of FL transformation increases over time with reported probability ranging from 20 to 31% at 5 years to approximately 60% at 8–10 years.5, 6, 7 The high frequency of higher-grade transformation of FL, regardless of treatment, suggests that the emergence of more virulent subclone of cells, typically associated with the loss of follicular histological architecture, is inherent to the genetic nature of FL cells.

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Acknowledgements

This work was supported by the Grant RO1 CA109335 from the United States Public Health Service, National Institutes of Health.

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  1. Division of Hematology-Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    I S Lossos

  2. Department of Molecular and Cellular Pharmacology, University of Miami, Miami, FL, USA

    I S Lossos

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Correspondence to I S Lossos.

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Lossos, I. Higher-grade transformation of follicular lymphoma – a continuous enigma. Leukemia 19, 1331–1333 (2005). https://doi.org/10.1038/sj.leu.2403801

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