Cell of Origin Key in Relapsed B-Cell Lymphoma Prognosis
Better response in germinal center B-like diffuse large B-cell lymphoma with R-DHAP therapy
TUESDAY, Sept. 27 (HealthDay News) -- Patients with relapsed/refractory germinal center B (GCB)-like diffuse large B-cell lymphoma (DLBCL) have improved outcomes when treated with rituximab, dexamethasone, high-dose cytarabine, and cisplatin (R-DHAP), according to a study published online Sept. 26 in the Journal of Clinical Oncology.
Catherine Thieblemont, M.D., Ph.D., from Hôpital Saint Louis in Paris, and colleagues investigated the prognostic value of cell of origin (COO) in patients with relapsed/refractory DLBLC treated with R-DHAP versus those treated with rituximab, ifosfamide, carboplatin, and etoposide and followed by intensive therapy plus autologous stem-cell transplantation. Histologic material was collected from 249 patients (189 patients at diagnosis and/or 147 patients at relapse, including 87 matched pairs). CD10, BCL6, MUM1, FOXP1, and BCL2 expression was measured by immunohistochemical analysis, and fluorescent in-situ hybridization analysis was performed for BCL2, BCL6 and c-MYC breakpoints. Results were correlated with survival data.
The investigators found that the matched biopsies had statistically significant highly concordant characteristics of immunophenotype and chromosomal abnormalities. Univariate analysis revealed that only c-MYC rearrangement was significantly associated with worse progression-free and overall survival. When testing treatment interaction, there was a significant association for improved progression-free survival in the R-DHAP group for GCB-like DLBCL, based on the algorithm by Hans. The GCB/non-GCB interaction treatment, prior rituximab exposure, secondary age-adjusted International Prognostic Index, and FoxP1 expression all showed independent prognostic relevance in multivariate analysis. Gene expression profiling in a subset of 39 patients confirmed the results.
"COO remains a major and independent factor in relapsed/refractory DLBCL, with a better response to R-DHAP in GCB-like DLBCL," the authors write.
Several authors disclosed financial relationships with the pharmaceutical industry.