High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study

被引：15

作者：

Zayac, Adam S. ^{[1
]}

Landsburg, Daniel J. ^{[2
]}

Hughes, Mitchell E. ^{[2
]}

Bock, Allison M. ^{[3
]}

Nowakowski, Grzegorz S. ^{[3
]}

Ayers, Emily C. ^{[4
]}

Girton, Mark ^{[5
]}

Hu, Marie ^{[6
]}

Beckman, Amy K. ^{[7
]}

Li, Shaoying ^{[8
]}

Medeiros, L. Jeffrey

Chang, Julie E. ^{[9
]}

Stepanovic, Adam ^{[9
]}

Kurt, Habibe ^{[10
]}

Sandoval-Sus, Jose ^{[11
]}

Ansari-Lari, M. Ali ^{[12
]}

Kothari, Shalin K. ^{[13
]}

Kress, Anna ^{[13
]}

Xu, Mina L. ^{[14
,15
]}

Torka, Pallawi ^{[16
]}

Sundaram, Suchitra ^{[16
]}

Smith, Stephen D. ^{[17
,18
]}

Naresh, Kikkeri N. ^{[19
]}

Karimi, Yasmin H. ^{[20
]}

Epperla, Narendranath ^{[21
]}

Bond, David A. ^{[21
]}

Farooq, Umar ^{[22
]}

Saad, Mahak ^{[22
]}

Evens, Andrew M. ^{[23
]}

Pandya, Karan ^{[23
]}

Naik, Seema G. ^{[24
]}

Kamdar, Manali ^{[25
]}

Haverkos, Bradley ^{[25
]}

Karmali, Reem ^{[26
]}

Oh, Timothy S. ^{[26
]}

Vose, Julie M. ^{[27
]}

Nutsch, Heather ^{[27
]}

Rubinstein, Paul G. ^{[28
]}

Chaudhry, Amina ^{[28
]}

Olszewski, Adam J. ^{[1
,29
]}

机构：

[1] Brown Univ, Warren Alpert Med Sch, Div Hematol Oncol, Med Sch,Div Geriatr & Palliat Med, Providence, RI USA

[2] Univ Penn, Abramson Canc Ctr, Philadelphia, PA USA

[3] Mayo Clin, Div Hematopathol, Rochester, MN USA

[4] Univ Virginia, Div Hematol Oncol, Charlottesville, VA USA

[5] Univ Virginia, Sch Med, Dept Pathol, Charlottesville, VA USA

[6] Univ Minnesota, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MD USA

[7] Univ Minnesota, Dept Lab Med & Pathol, Minneapolis, MN USA

[8] Univ Texas MD Anderson Canc Ctr, Div Pathol & Lab Med, Dept Hematopathol, Houston, TX USA

[9] Univ Wisconsin, Sch Med & Publ Hlth, Dept Med, Madison, WI USA

[10] Brown Univ, Warren Alpert Med Sch, Dept Pathol & Lab Med, Providence, RI 02912 USA

[11] Moffitt Canc Ctr Mem Healthcare Syst, Dept Malignant Hematol & Cellular Therapy, Pembroke Pines, FL USA

[12] Mem Healthcare Syst, Dept Pathol, Hollywood, FL USA

[13] Yale Univ, Sch Med, Div Hematol & Oncol, New Haven, CT 06510 USA

[14] Yale Univ, Sch Med, Dept Pathol, New Haven, CT USA

[15] Yale Univ, Sch Med, Dept Lab Med, New Haven, CT USA

[16] Roswell Pk Comprehens Canc Ctr, Dept Med, Buffalo, NY USA

[17] Fred Hutchinson Canc Res Ctr, Clin Res Div, Seattle, WA 98109 USA

[18] Univ Washington, Div Med Oncol, Seattle, WA USA

[19] Univ Washington, Dept Pathol, Seattle, WA USA

[20] Univ Michigan Hlth Syst, Div Hematol & Oncol, Ann Arbor, MI USA

[21] Ohio State Univ, Comprehens Canc Ctr, Columbus, OH USA

[22] Univ Iowa, Div Hematol Oncol & Blood & Marrow Transplantat, Iowa City, IA USA

[23] Rutgers Canc Inst New Jersey, Dept Med, New Brunswick, NJ USA

[24] Penn State Canc Inst, Penn State Hershey Med Ctr, Hershey, PA USA

[25] Univ Colorado Canc Ctr, Div Hematol Hematol Malignancies & Stem Cell Trans, Denver, CO USA

[26] Northwestern Univ, Div Hematol Oncol, Chicago, IL USA

[27] Univ Nebraska Med Ctr, Dept Med, Omaha, NE USA

[28] Univ Illinois, Dept Med, Sect Hematol Oncol, Chicago, IL USA

[29] Brown Univ, Rhode Isl Hosp, Dept Med, Warren Alpert Med Sch, 593 Eddy St, Providence, RI 02903 USA

来源：

BLOOD ADVANCES | 2023年 / 7卷 / 21期

关键词：

HEALTH-ORGANIZATION CLASSIFICATION; DOUBLE-HIT LYMPHOMA; BURKITT-LYMPHOMA; FEATURES INTERMEDIATE; MYC REARRANGEMENT; OUTCOMES; MULTICENTER; RITUXIMAB; RISK; RECURRENCE;

D O I：

10.1182/bloodadvances.2023009731

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ("double hit"). Our results show that HG BL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3 x upper limit of normal, and adual-expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH -R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.

引用

页码：6381 / 6394

页数：14

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