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Histologic Transformation in Follicular Lymphoma: Real-World Outcomes with Rituximab vs. Obinutuzumab-Based

Dor Shpitzer1,2, Chava Perry1,2, Tamir Shragai1,2

  • 1Department of Haematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel.

Cancers
|May 13, 2026
PubMed
Summary

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Obinutuzumab (O)-based regimens may reduce the risk of histologic transformation in follicular lymphoma (FL). Previously treated transformed FL patients face poorer survival outcomes, highlighting the need for further validation of these findings.

Area of Science:

  • Hematology
  • Oncology
  • Clinical Medicine

Background:

  • Follicular lymphoma (FL) patients experiencing histologic transformation (tFL) have inferior survival compared to non-transformed FL.
  • Rituximab (R) reduces FL transformation rates, but data on Obinutuzumab (O), a newer anti-CD20 antibody, are limited.

Purpose of the Study:

  • To analyze risk factors for tFL.
  • To evaluate patient outcomes following FL transformation.
  • To compare the efficacy of Obinutuzumab versus Rituximab in reducing transformation risk.

Main Methods:

  • Retrospective analysis of 1145 consecutive FL patients diagnosed between 2010 and 2023.
  • Multivariate analysis to identify risk factors for transformation and survival.
  • Assessment of outcomes based on treatment regimens (O-based vs. R-based) and maintenance therapy.
Keywords:
follicular lymphomaobinutuzumabreal-world study

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Main Results:

  • 9% of FL patients developed tFL over a median follow-up of 70 months.
  • Obinutuzumab-based regimens and maintenance therapy were associated with a reduced risk of histologic transformation compared to Rituximab-based regimens and no maintenance.
  • Transformed FL patients had significantly shorter overall survival (OS) than non-transformed FL patients.
  • Prior anti-FL chemoimmunotherapy, male sex, and age over 65 were associated with shorter OS in tFL patients.

Conclusions:

  • Obinutuzumab-based regimens may decrease the risk of histologic transformation in follicular lymphoma.
  • Previously treated transformed FL patients demonstrate adverse survival outcomes.
  • Further validation is needed, but findings support Obinutuzumab's potential role in reducing transformation and highlight survival challenges in treated tFL.