Outcome of non-germinal center/activated b-cell type diffuse large b-cell lymphoma determined by ihc in a single institution over 7 years.

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Conference Proceeding

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Publication Title

Biol Blood Marrow Transplant


Background: The classification of diffuse large B cell lymphoma takes into consideration the cell of origin (COO), germinal center B-cell (GCB) versus non-germinal center/activated B-cell type (non-GCB/ABC), since its determination by gene expression profiling predicts prognosis when treated with standard therapy. In this report, we evaluated the impact of choice of therapy on the outcome of ABC subtype in our institution determined by IHC using Hans algorithm.

Methods: We reviewed the pathology reports of patients with DLBCL diagnosed between 2009- 2016.

Results: We identified 285 patients with DLBCL. Per Hans algorithm, 140 (49.1%) were of GCB, 94 (32.9%) non-GCB/ABC and 51 (18%) indeterminate. For the non-GCB/ABC group, median age at diagnosis was 67 (range, 21 to 101 y) with 67% of the patients older than 60 years. Lactate dehydrogenase (LDH) was high in 64% of the patients. There was more than one site of extranodal disease in 42% of the patients. 47% of the patients had IPI score of 0-2, 53% had score of 3-5. Double expressers who were positive for MYC and BCL-2 identified in 19% of the patients. Frontline therapy was R-CHOP in 78% of the patients. Patients who received other treatments were 19 (20%), 2 of those received R-EPOCH and the rest received either BR (Bendamustine plus Rituximab) or Rituximab or radiation by itself due to poor functional status or comorbidities. 21% of the patients needed multiple lines of treatment. Complete response was achieved in 76% of all patients. A median survival time for all patients was 59.2 month. Median OS for patients who received R-CHOP alone was 75.8 month. For patients who received treatments other than R-CHOP, the median OS for that group is 16.2 month. Patients who did not receive any treatments had median OS of .56 month. Median duration of remission for patients who received R-CHOP was 2 years and was 1.25 years for patients who received other treatments. Double expressers available for clinical follow up were 9 patients, and all received R-CHOP as frontline therapy and their median OS was 5.6. There were only 7 patients (7.4%) who had stem cell transplant (SCT). Of the patients who received SCT, 5 had auto SCT and 2 had allogeneic SCT. None of the transplanted patients died of disease relapse. A median survival time for all patients who had SCT from date of diagnosis and SCT was 34.8 and 22.3 months respectively. The two allo-SCT patients were disease free for one year and two years post SCT however died of infections secondary to GVHD. A median survival time for all patients who had auto-SCT from date of diagnosis and SCT was 37.8 and 29.7 months respectively.

Conclusions: In our institution, non-GCB/ABC DLBCL patients identified by IHC who received R-CHOP as induction had better outcome than other treatments. However, the median duration of first remission in that group was only 2 years. Clinical trials adding newer agents and better stratifying patients who benefit from SCT are warranted.





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