Follicular lymphoma can transform into diffuse large B cell lymphoma, which is usually associated with rapid disease progression, refractoriness to treatment and a poor outcome. We report the 25-year unselected experience of a UK provincial lymphoma treatment centre. This comprises of one of the largest series ever studied. Sixty-three patients were identified (56 initially presented as follicular lymphoma, 5 with ‘transformed’ lymphoma and 2 with follicular and transformed lymphoma from different biopsy sites). The median age at presentation was 54 years (range 32-76). The median time to transformation was 43 months (range 0-172). For all patients, the median overall survival was 76 months (range 8-254) and from transformation 10 months (range 1-166); 46 of 63 patients have died. For those whose transformation was initially treated with CHOP chemotherapy 10 were in complete remission (CR) and 14 were deceased (median survival 24, range 2-114 months). Five patients had high-dose chemotherapy and 3 were alive (at 25, 36 and 137 months). We conclude that CHOP chemotherapy (probably with rituximab) is a reasonable first treatment in fit patients and high dose chemotherapy with autologous stem cell support deserves further study.

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