The germinal center/activated B-cell subclassification has a prognostic impact for response to salvage therapy in relapsed/refractory diffuse large B-cell lymphoma: a bio-CORAL study.

Abstract

PURPOSE:

To evaluate the prognostic value of the cell of origin (COO) in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBLC), prospectively treated by rituximab, dexamethasone, high-dose cytarabine, and cisplatin (R-DHAP) versus rituximab, ifosfamide, carboplatin, and etoposide and followed by intensive therapy plus autologous stem-cell transplantation on the Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) trial.

PATIENTS AND METHODS:

Among the 396 patients included on the trial, histologic material was available for a total of 249 patients at diagnosis (n = 189 patients) and/or at relapse (n = 147 patients), which included 87 matched pairs. The patient data were analyzed by immunochemistry for CD10, BCL6, MUM1, FOXP1, and BCL2 expression and by fluorescent in situ hybridization for BCL2, BCL6 and c-MYC breakpoints. The correlation with survival data was performed by using the log-rank test and the Cox model.

RESULTS:

Characteristics of immunophenotype and chromosomal abnormalities were statistically highly concordant in the matched biopsies. In univariate analysis, the presence of c-MYC gene rearrangement was the only parameter to be significantly correlated with a worse progression-free survival (PFS; P = .02) and a worse overall survival (P = .04). When treatment interaction was tested, the germinal center B (GCB) -like DLBCL that was based on the algorithm by Hans was significantly associated with a better PFS in the R-DHAP arm. In multivariate analysis, independent prognostic relevance was found for the GCB/non-GCB the Hans phenotype interaction treatment (P = .04), prior rituximab exposure (P = .0052), secondary age-adjusted International Prognostic Index (P = .039), and FoxP1 expression (P = .047). Confirmation was obtained by gene expression profiling in a subset of 39 patients.

CONCLUSION:

COO remains a major and independent factor in relapsed/refractory DLBCL, with a better response to R-DHAP in GCB-like DLBCL. This needs confirmation by a prospective study.

• Authors: Catherine Thieblemont, Josette Briere, Nicolas Mounier, Hans-Ullrich Voelker, Wendy Cuccuini, Edouard Hirchaud, Andreas Rosenwald, Andrew Jack, Christer Sundstrom, Sergio Cogliatti, Philippe Trougouboff, Ludmila Boudova, Loic Ysebaert, Jean Soulier, Catherine Chevalier, Dominique Bron, Norbert Schmitz, Philippe Gaulard, Remi Houlgatte, Christian Gisselbrecht
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 29 Issue 31 Pg. 4079-87 (Nov 01 2011) ISSN: 1527-7755 [Electronic] United States
• PMID: 21947824 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antigens, CD20
• Biomarkers, Tumor
• Neoplasm Proteins
• Cytarabine
• Rituximab
• Etoposide
• Dexamethasone
• Carboplatin
• Cisplatin
• Ifosfamide

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antigens, CD20 (blood)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Biomarkers, Tumor (analysis, genetics)
• Carboplatin (administration & dosage)
• Cisplatin (administration & dosage)
• Cytarabine (administration & dosage)
• Dexamethasone (administration & dosage)
• Disease-Free Survival
• Etoposide (administration & dosage)
• Female
• Gene Expression Profiling
• Gene Expression Regulation, Neoplastic
• Germinal Center (pathology)
• Humans
• Ifosfamide (administration & dosage)
• Immunohistochemistry
• In Situ Hybridization, Fluorescence
• Lymphoma, Large B-Cell, Diffuse (chemistry, drug therapy, immunology, pathology)
• Male
• Microarray Analysis
• Middle Aged
• Multicenter Studies as Topic
• Multivariate Analysis
• Neoplasm Proteins (analysis, genetics)
• Neoplasm, Residual (drug therapy)
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Randomized Controlled Trials as Topic
• Recurrence
• Risk Factors
• Rituximab
• Salvage Therapy (methods)