Impact of concurrent indolent lymphoma on the clinical outcome of newly diagnosed diffuse large B-cell lymphoma

Wang, Yucai; Link, Brian K.; Witzig, Thomas E.; Maurer, Mathew S.; Allmer, Cristine; King, Rebecca; Feldman, Andrew L.; Habermann, Thomas M.; Ansell, Stephen M.; Slager, Susan L.; Cerhan, James R.; Nowakowski, Grzegorz S.

doi:10.1182/blood.2019000858

Cited by 31 publications

(44 citation statements)

References 24 publications

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“…[1,2] Outcomes of concurrent/transformed DLBCL are mainly described in retrospective studies as clinical trials tend to exclude these patients. [1][2][3][4] Outcomes of transformed DLBCL were dismal in pre-rituximab era with median survival of 0.6-1 year. [5,6] Addition of rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) has improved 5 year survival to 40-60% in retrospective studies.…”

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confidence: 99%

Single-Center Analysis of Characteristics and Outcomes of De Novo, Concurrent, and Transformed Diffuse Large B-Cell Lymphoma

et al. 2021

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Outcomes of diffuse large B cell lymphoma (DLBCL) either concurrent with or transformed from indolent lymphoma after rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP) are described in retrospective studies. Efficacy of other regimens in transformed or concurrent DLBCL is largely unknown. In this single center retrospective study, we present characteristics of concurrent and transformed DLBCL and outcomes after dose adjusted etoposide, vincristine, cyclophosphamide, prednisone and doxorubicin with rituximab (DA-EPOCH-R) comparative to de novo

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confidence: 99%

Single-Center Analysis of Characteristics and Outcomes of De Novo, Concurrent, and Transformed Diffuse Large B-Cell Lymphoma

et al. 2021

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“…However, in clinical practice, lymph node biopsy often yields composite or discordant histology of both FL and DLBCL (FL/DLBCL). One recent study suggested that synchronous FL/DLBCL at diagnosis denotes outcomes intermediate between FL and DLBCL (5-year OS: 85%, 73% and 63% for FL, FL/DLBCL and DLBCL respectively) 14 , while another study suggests that the prognosis of concurrent FL/DLBCL is similar to that of germinal centre B-cell-like (GCB)-subtype DLBCL 15 . Few studies have investigated the behavior, prognostic factors and optimal management of biopsy-proven synchronous FL/DLBCL at the point of histological diagnosis.…”

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confidence: 99%

A Clinico-Genotypic Prognostic Index for De Novo Composite Diffuse Large B-Cell Lymphoma Arising from Follicular Lymphoma in Asian patients treated in the Rituximab Era

Lim

Chan

Khoo

et al. 2020

Sci Rep

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Composite follicular lymphoma with diffuse large B-cell lymphoma (FL/DLBCL) is uncommonly found on lymph node biopsy and represents a rare haematological malignancy. We aim to examine clinicopathological features of patients with FL/DLBCL and investigate predictors of survival outcome. We included in our retrospective study patients with histologically-proven FL/DLBCL at diagnosis (n = 106) and who were subsequently treated with rituximab-based chemoimmunotherapy from 2002-2017 at the National Cancer Centre. The cohort consisted of 34 women and 72 men with a median age of 59 years (range, 24-82). In a multivariate model inclusive of known clinico-pathological parameters at diagnosis, advanced stage (p = 0.0136), presence of MYC and/or BCL6 rearrangement (p = 0.0376) and presence of B symptoms (p = 0.0405) were independently prognostic for worse overall survival (OS). The only remaining independent prognostic variables for worse OS after including first-line treatment data in the model were use of chemotherapy regimens other than R-CHOP (p = 0.0360) and lack of complete response to chemotherapy (p < 0.0001) besides the presence of B symptoms (p = 0.0022). We generated a Clinico-Genotypic Index by point-wise addition of all five adverse parameters (score of 0-1, 2, 3, 4-5) which revealed four prognostic risk groups with a predicted 5-year OS of 100%, 62%, 40% and 0% (p < 0.0001) accounting for 50.0%, 24.5%, 18.9% and 6.6% of the cohort respectively. We propose that R-CHOP should be the recommended first-line regimen for composite FL/DLBCL. Follicular lymphoma (FL) is among the most common subtype of non-Hodgkin lymphoma (NHL), accounting for over one-fifth of NHL worldwide 1 . It is a heterogeneous group of tumours that originate from centrocytes and centroblasts among germinal centre B cells 2 . It is also well-known that FL has a propensity to transform to diffuse large B-cell lymphoma (DLBCL) at a rate of approximately 3% per year for the first 15 years 3,4 . Histological transformation (HT) to DLBCL portends a poor prognosis with a median survival of 14 to 27 months 3,5,6 .Multiple studies have elucidated various clinical and molecular markers predicting for HT and overall survival (OS) post-HT. High-risk Follicular Lymphoma International Prognostic Index (FLIPI), grade 3 histology, stage III or IV disease, low serum albumin and high serum lactate dehydrogenase (LDH) levels are commonly cited as risk factors for HT 5,7-9 . Molecular alterations such as TP53 10 and CDKN2A/B mutations 11 , as well as www.nature.com/scientificreports www.nature.com/scientificreports/ 50.0%, 24.5%, 18.9% and 6.6% of the cohort, with a predicted 5-year OS of 100%, 62%, 40% and 0% and a predicted 5-year PFS of 81%, 60%, 41% and 0% respectively (p < 0.0001) (Table 7) (Fig. 3b).Using the CGI, we were able to more precisely stratify patients into 4 unique prognostic risk groups as compared to the 3 risk groups using the earlier initial prognostic model. Most patients initially categorised as low risk remained in the same group, with 3.3...

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“…Secondly, high rates of censoring and unequal censoring between ASCT and no ASCT arms at the time of analysis weakens the ability to draw conclusions from the data. Thirdly, most patients in this study had concurrent iNHL and DLBCL who may have a better prognosis compared to ‘sequential’ HT of iNHL 24 . Finally, the OS data are immature given low numbers of patients with events and bias introduced by unequal post‐relapse therapy.…”

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confidence: 92%

Autologous stem cell transplant in first remission for transformed indolent non‐Hodgkin lymphoma: additional data to guide practice

Reneau

William

2020

Br J Haematol

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Impact of concurrent indolent lymphoma on the clinical outcome of newly diagnosed diffuse large B-cell lymphoma

Abstract: In this month's CME article, an analysis of over 1300 patients with diffuse large B-cell lymphoma (DLBCL), Wang et al demonstrate that the approximately 13% of patients with concurrent indolent lymphoma at diagnosis had the same prognosis as those patients with isolated DLBCL.

Cited by 31 publications

References 24 publications

Single-Center Analysis of Characteristics and Outcomes of De Novo, Concurrent, and Transformed Diffuse Large B-Cell Lymphoma

Single-Center Analysis of Characteristics and Outcomes of De Novo, Concurrent, and Transformed Diffuse Large B-Cell Lymphoma

A Clinico-Genotypic Prognostic Index for De Novo Composite Diffuse Large B-Cell Lymphoma Arising from Follicular Lymphoma in Asian patients treated in the Rituximab Era

Autologous stem cell transplant in first remission for transformed indolent non‐Hodgkin lymphoma: additional data to guide practice

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