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COO and MYC/BCL2 status do not predict outcome among patients with stage I/II DLBCL: a retrospective multicenter study

Allison Barraclough, Musa Alzahrani, Marianne Schmidt Ettrup, Mark Bishton, Chris van Vliet, Pedro Farinha, Clare Gould, Simone Birch, Laurie H. Sehn, Vishakha Sovani, Mitchell Steven Ward, Bradley Augustson, Jorne Biccler, Joseph M. Connors, David W. Scott, Maher K. Gandhi, Kerry J. Savage, Tarec El-Galaly, Diego Villa and Chan Yoon Cheah

Key Points

  • In early-stage DLBCL, COO and DE/DH status may not confer an inferior prognosis.

  • Stage I/II DLBCL has an excellent outcome when treated with R-CHOP–like therapy ± radiation, with 4-year PFS and OS rates of 85% and 88%.

Abstract

In advanced-stage diffuse large B-cell lymphoma (DLBCL), the presence of an activated B-cell phenotype or a non–germinal center (GCB) phenotype, coexpression of MYC and BCL2 by immunohistochemistry, and the cooccurrence of MYC and BCL2 or BCL6 rearrangements are associated with inferior outcomes. It is unclear whether these variables remain prognostic in stage I/II patients. In this retrospective study, we evaluated the prognostic impact of cell of origin (COO), as well as dual-expressor (DE) status and molecular double-hit (DH) status, in stage I/II DLBCL by positron emission tomography with computed tomography (PET-CT). A total of 211 patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)–like regimens, with or without radiotherapy, was included. The median follow-up in the entire cohort was 4 years (range, 0.4-9.4), with estimated 4-year progression-free survival (PFS) and overall survival (OS) rates of 85% (95% confidence interval [CI], 79-89) and 88% (95% CI, 83-92), respectively. By univariable analysis, DE (PFS: hazard ratio [HR], 1.27; 95% CI, 0.58-2.81, P = .55 and OS: HR, 1.40; 95% CI, 0.60-3.30; P = .44), DH (PFS: HR, 1.21; 95% CI, 0.27-5.31; P = .80 and OS: HR, 0.61; 95% CI, 0.08-4.73; P = .64), and non-GCB status (PFS: HR, 1.59; 95% CI, 0.83-3.03; P = .16 and OS: HR, 1.80; 95% CI, 0.89-3.67; P = .10) were associated with poorer outcomes. In patients with PET-CT–defined stage I/II DLBCL treated with R-CHOP–like therapy, with or without radiation, COO and DE and DH status were not significantly associated with inferior PFS or OS.

  • Submitted January 15, 2019.
  • Accepted May 9, 2019.
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