COO and MYC/BCL2 status do not predict outcome among patients with stage I/II DLBCL: a retrospective multicenter study

Abstract

In advanced-stage diffuse large B-cell lymphoma (DLBCL), the presence of an activated B-cell phenotype or a non–germinal center (GCB) phenotype, coexpression of MYC and BCL2 by immunohistochemistry, and the cooccurrence of MYC and BCL2 or BCL6 rearrangements are associated with inferior outcomes. It is unclear whether these variables remain prognostic in stage I/II patients. In this retrospective study, we evaluated the prognostic impact of cell of origin (COO), as well as dual-expressor (DE) status and molecular double-hit (DH) status, in stage I/II DLBCL by positron emission tomography with computed tomography (PET-CT). A total of 211 patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)–like regimens, with or without radiotherapy, was included. The median follow-up in the entire cohort was 4 years (range, 0.4-9.4), with estimated 4-year progression-free survival (PFS) and overall survival (OS) rates of 85% (95% confidence interval [CI], 79-89) and 88% (95% CI, 83-92), respectively. By univariable analysis, DE (PFS: hazard ratio [HR], 1.27; 95% CI, 0.58-2.81, P = .55 and OS: HR, 1.40; 95% CI, 0.60-3.30; P = .44), DH (PFS: HR, 1.21; 95% CI, 0.27-5.31; P = .80 and OS: HR, 0.61; 95% CI, 0.08-4.73; P = .64), and non-GCB status (PFS: HR, 1.59; 95% CI, 0.83-3.03; P = .16 and OS: HR, 1.80; 95% CI, 0.89-3.67; P = .10) were associated with poorer outcomes. In patients with PET-CT–defined stage I/II DLBCL treated with R-CHOP–like therapy, with or without radiation, COO and DE and DH status were not significantly associated with inferior PFS or OS.

Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics

“…Definitive conclusions are difficult to be drawn given the low number of DHL patients. 22 The current study is the first multicenter analysis to focus specifically on LS-DLBCL/HGBL with MYC-R and/or BCL2-R and/or BCL6-R within 1 radiation field. Although the 2-year PFS and OS in our cohort (78% and 86%, respectively) were lower than historical cohorts of LS-DLBCL, 23,24 they are significantly better than previous reports that included patients with advanced-stage MYC-R DLBCL/HGBL and DHL.…”

Australian and New Zealand consensus statement on the management of lymphoma, chronic lymphocytic leukaemia and myeloma during the COVID‐19 pandemic

“…We suggest weighing up the resources needed and the immunosuppression risks associated with intensified regimens, such as dose‐adjusted R‐EPOCH, particularly in those with low IPI and older patients who may experience increased toxicity. It may be reasonable to treat such patients with R‐CHOP (II,III) …”

The Incidence and Treatment Response of Double Expression of MYC and BCL2 in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis

“…IHC interpretation was performed by hematopathologists or other pathologists nearly three-quarters of the time (30/41, 73.2%). In brief, the study design was prospective in one study [59], retrospective in 22 [3,32,33,36,[38][39][40]42,[44][45][46][47][49][50][51]54,60,61,63,66,67,69], secondary analysis of primary clinical trials in six [37,41,48,53,57,58], and not-explained in 12 [19][20][21]34,35,43,52,55,56,62,65,68]. The number of patients per study ranged from 20 to 688, with median ages of 46-70 years.…”