Prognostic impact of high-grade transformation in low-grade B-cell lymphomas: a systematic review and meta-analysis.
Hera Jung, Jeongwan Kang, Kang-Min Han et al.
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In 30 seconds
This systematic review and meta-analysis pooled overall-survival data from 38 datasets in 35 studies comparing high-grade transformation (HGT) of low-grade B-cell lymphoma with non-transformed low-grade lymphoma or de novo diffuse large B-cell lymphoma (DLBCL). Across tumor types and treatment eras, HGT was associated with an approximately twofold increase in mortality risk versus low-grade lymphoma. In the rituximab era, the pooled overall-survival hazard ratio for HGT versus de novo DLBCL was 1.12 and statistically significant. The findings indicate that transformation remains an adverse prognostic feature.
Key findings
- Across tumor types and treatment eras, pooled overall-survival hazard ratios for HGT versus low-grade lymphoma were statistically significant and close to 2.
- In the rituximab era, HGT versus de novo DLBCL had a statistically significant pooled overall-survival HR of 1.12.
Why it matters
The pooled evidence indicates that high-grade transformation is associated with substantially worse survival than the underlying low-grade lymphoma, including in the rituximab era. This helps frame transformation as an important prognostic event and supports the authors’ call for more effective therapeutic strategies, while the comparison with de novo DLBCL provides additional context for prognosis.
What to keep in mind
The analysis pooled observational survival comparisons across studies; the abstract does not report study-level sample sizes or quantify heterogeneity.