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Comparative Study
. 2015 Dec;171(5):776-83.
doi: 10.1111/bjh.13766. Epub 2015 Oct 12.

Excellent outcomes and lack of prognostic impact of cell of origin for localized diffuse large B-cell lymphoma in the rituximab era

Anita Kumar  1 , Matthew A Lunning  2 , Zhigang Zhang  3 , Jocelyn C Migliacci  1 , Craig H Moskowitz  1 , Andrew D Zelenetz  1
Affiliations
Comparative Study

Excellent outcomes and lack of prognostic impact of cell of origin for localized diffuse large B-cell lymphoma in the rituximab era

Anita Kumar et al. Br J Haematol. 2015 Dec.

Abstract

Therapeutic options for limited-stage diffuse large B cell lymphoma (DLBCL) include short- or full-course R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) ± radiotherapy. The optimal treatment remains unclear. The prognostic value of cell-of-origin (COO) in early stage DLBCL is unknown. Patients with limited-stage DLBCL (stage I or stage II, non-bulky) treated with R-CHOP ± involved field radiotherapy (IFRT) from 1999 to 2012 were included. COO by the Hans algorithm was analysed in a subset of patients. Of 261 patients, 30% were stage I (N = 82), 37% stage IE (N = 96), <1% stage IXEE (N = 1), 18% stage II (N = 46) and 14% stage IIE (N = 37). The stage-modified International Prognostic Index stratified patients into prognostically relevant groups. There was no significant difference in progression-free survival (PFS) or overall survival (OS) for patients in the germinal centre B-cell-like (GCB; n = 65) and non-GCB cohorts (n = 22). Seventeen patients received R-CHOP × 3-4 cycles (Arm A), 147 received R-CHOP × 3-4 cycles + IFRT (Arm B), 48 received R-CHOP × 6 cycles (Arm C), and 50 received R-CHOP × 6 cycles + IFRT (Arm D). The outcomes were excellent, with 5-year PFS of 82% and 5-year OS of 93%, and were similar across the 4 treatment groups. In the rituximab era, outcomes for limited-stage DLBCL, regardless of treatment approach, were excellent. Baseline COO was not a significant prognostic factor in patients treated with short-course R-CHOP + IFRT.

Keywords: cell-of-origin; chemotherapy; diffuse large B-cell lymphoma; outcomes; radiotherapy.

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Figures

Figure 1
Figure 1
Progression-free survival and overall survival stratified by stage-modified International Prognostic Index (SM-IPI) Risk Factors (RF) pts, patients.
Figure 2
Figure 2. Progression-Free Survival by Cell of Origin
GCB, germinal centre B cell-like; pts, patients
Figure 3
Figure 3. Memorial Sloan-Kettering Cancer Center rational treatment algorithm for localized DLBCL based on retrospective analysis
DLBCL, diffuse large B cell lymphoma; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone; IFRT, involved field radiotherapy; RT, radiotherapy; PET, positron emission tomography; LDH, lactate dehydrogenase; SM-IPI, stage-modified International Prognostic Index; COO, cell of origin; BCCA, British Columbia Cancer Agency.
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