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Hematology / Oncology
Henry Ford Hospital
Outcome of Germinal Center B-Cell Type Vs Non Germinal Center/Activated B-Cell Type Diffuse Large B-Cell Lymphoma as Determined by Immunohistochemistry at Henry Ford Hospital Over 7 Years. Background: The classification of diffuse large B cell lymphoma (DLBCL) takes into consideration the cell of origin (COO), germinal center B-cell (GCB) vs 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 GBC and ABC subtype in our institution determined by immunohistochemistry (IHC) using Hans algorithm. Methods: We reviewed the pathology reports of patients with DLBCL diagnosed from 2009-2016. For GCB and non-GCB/ABC patients additional data was collected including demographics, stage, initial and subsequent chemo, response to chemo, stem cell transplant (SCT), last follow up etc. Results: We identified 267 patients with DLBCL. Per Hans algorithm, 117 (43.8%) were of GCB, 94 (35.2%) were non-GCB/ABC and 51 (19%) were indeterminate. GCB group - Median age at diagnosis was 65 years (25-91). 76 patients (65%) were older than 60 years. Double expressers positive for MYC and BCL-2 were identified in 32 of the patients. 10 patient had double hit lymphoma. Frontline therapy was R-CHOP in 79 (67.5%) of the patients. Patients who received other treatments were 45 (38%) which included R-EPOCH, BR (Bendamustine plus Rituximab), Rituximab, hyperCVAD, RICE, RCVP, RCOEP, or radiation. Radiation was received by 34 while Intrathecal was given in 8 patients. 31 patients needed multiple lines of treatment. Average duration of first remission was 2.6 years. Overall Complete response (CR) was achieved in 60 patients. Partial response (PR) in 32 and progressive disease (PD) in 48 patients. There were 14 patients (12%) who underwent SCT. At time of transplant 6 were in CR, 6 in PR, 1 in PD. Out of these 8 patients are alive at last follow up. After SCT - 8 achieved CR, 3 PR, and 1 in PD.Non-GCB/ABC group - Median age at diagnosis was 67 years (21 to 101) with 67% of the patients older than 60 years. 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%). 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 0.56 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 SCT. Of the patients who received SCT, 5 had auto SCT and 2 had allogeneic SCT. A median survival time for all patients who had SCT from date of diagnosis and SCT was 34.8 and 22.3 months respectively. 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. Conclusion: In our institution GCB and 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 these patients was only 2 to 2.6 years. Clinical trials adding newer agents and better stratifying patients who benefit from SCT are warranted.
Patil, Neha, "Outcome of Germinal Center B-Cell Type Compared to Non Germinal Center/Activated B-Cell Type Diffuse Large B-Cell Lymphoma as Determined by Immunohistochemistry Using The Hans Algorithm" (2019). Clinical Research. 6.