Journal article
High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study
Blood advances, Vol.7(21), pp.6381-6394
11/14/2023
DOI: 10.1182/bloodadvances.2023009731
PMCID: PMC10598493
PMID: 37171397
Abstract
In this multi-institutional retrospective study, we examined characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS). This rare lymphoma category is defined by high-grade morphologic features, most commonly Burkitt-like, and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements (so-called double-hit). Our results show that HGBL-NOS tumors are heterogeneous: 83% had a germinal center B-cell immunophenotype, 37% a dual expressor immunophenotype (MYC and BCL2 expression), 28% (single-hit) MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage 4 disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included DA-EPOCH-R (43%), R-CHOP (33%), or other intensive chemotherapy programs (11%). We found no significant differences in the rates of complete response (CR, P=0.32), progression-free (PFS, P=0.82), or overall survival (OS, P=0.60) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% (95%CI, 46.9-62.7), and OS was 68.1% (95%CI, 59.7-75.0). In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3x upper limit of normal, and a dual expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS (13% at 2 years). Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R versus 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.
Details
- Title: Subtitle
- High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study
- Creators
- Adam Stephen Zayac - WMCHealth Advanced Oncology Hematology, Hawthorne, New York, United StatesDaniel J Landsburg - University of PennsylvaniaMitchell E Hughes - University of PennsylvaniaAllison M Bock - Mayo ClinicGrzegorz S Nowakowski - Mayo ClinicEmily C Ayers - University of VirginiaMark Ryan Girton - University of VirginiaMarie Hu - University of Minnesota SystemAmy K Beckman - University of Minnesota SystemShaoying Li - The University of Texas MD Anderson Cancer CenterL Jeffrey Medeiros - The University of Texas MD Anderson Cancer CenterJulie E Chang - University of Wisconsin–MadisonAdam Stepanovic - University of Wisconsin–MadisonHabibe Kurt - Brown UniversityJose Sandoval-Sus - Moffitt Cancer CenterMohammad Ali Ansari-Lari - Memorial Healthcare SystemShalin K Kothari - Yale UniversityAnna Kress - Yale UniversityMina L Xu - Yale UniversityPallawi Torka - Roswell Park Cancer InstituteSuchitra Sundaram - Roswell Park Cancer InstituteStephen D Smith - Fred Hutch Cancer CenterKikkeri N Naresh - University of WashingtonYasmin H Karimi - University of MichiganNarendranath Epperla - The Ohio State UniversityDavid A Bond - The Ohio State UniversityUmar Farooq - University of Iowa Hospitals and ClinicsMahak Saad - University of IowaAndrew M Evens - Rutgers, The State University of New JerseyKaran Pandya - Rutgers Cancer InstituteSeema G Naik - Penn State Milton S. Hershey Medical CenterManali Kamdar - University of Colorado DenverBradley M Haverkos - University of Colorado DenverReem Karmali - Northwestern UniversityTimothy S Oh - Northwestern UniversityJulie M Vose - University of Nebraska Medical CenterHeather R Nutsch - University of Nebraska Medical CenterPaul G Rubinstein - UIC Medical Center, Chicago, Illinois, United StatesAmina Chaudhry - University of Illinois ChicagoAdam J Olszewski - Brown University
- Resource Type
- Journal article
- Publication Details
- Blood advances, Vol.7(21), pp.6381-6394
- DOI
- 10.1182/bloodadvances.2023009731
- PMID
- 37171397
- PMCID
- PMC10598493
- NLM abbreviation
- Blood Adv
- ISSN
- 2473-9529
- eISSN
- 2473-9537
- Language
- English
- Electronic publication date
- 05/12/2023
- Date published
- 11/14/2023
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984407606902771
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