Journal article
Increasing tissue requirements in lymphoma trials may exclude patients with high-risk disease or worse prognosis
Blood advances, Vol.6(24), pp.6180-6186
12/27/2022
DOI: 10.1182/bloodadvances.2022007569
PMCID: PMC9791316
PMID: 36170803
Abstract
An enhanced understanding of the molecular heterogeneity of diffuse large B-cell lymphoma (DLBCL) has opened the door to clinical trials evaluating novel agents with subtype-specific activity. It is an emerging question whether core needle biopsies (CNB) can adequately meet the increasing tissue requirements of these clinical trials. This can potentially lead to selective enrollment of patients who can undergo excisional biopsy (EB). It is also important to know whether patients who can undergo extensive diagnostic work up differ in their disease characteristics and outcomes from those who cannot. In this observational study, we describe the characteristics, outcomes, and adequacy of diagnostic tissue in patients with newly diagnosed DLBCL and primary mediastinal large B-cell lymphoma who underwent EB vs CNB. Of the 1061 patients, 532 (49.8%) underwent EB and 529 (50.1%) underwent CNB. A significantly higher proportion of patients with CNB had advanced stage disease, an international prognostic index of ≥3, and inadequate tissue for molecular analyses. Patients with CNB had significantly worse 5-year event-free survival (67.6% vs 56.9%; hazard ratio [HR], 0.76; confidence interval [CI]95, 0.6-0.9, P < .001) and 5-year overall survival (76.4% vs 69.2%; HR, 0.8; CI95, 0.6-0.9, P < .001). Thus, patients who underwent CNB have poor-risk features and inferior outcomes on frontline chemoimmunotherapy, are more likely to have inadequate tissue for molecular analyses, and might not meet the tissue requirements of biomarker-driven clinical trials. Thus, the increasing tissue requirements of biomarker-driven clinical trials may result in the exclusion of patients with high-risk DLBCL who need novel agents.
Details
- Title: Subtitle
- Increasing tissue requirements in lymphoma trials may exclude patients with high-risk disease or worse prognosis
- Creators
- Sanjal H Desai - Mayo Clinic in FloridaRaphael Mwangi - Mayo Clinic in FloridaWern Lynn Ng - Mayo Clinic, Rochester, Minnesota, United StatesRebecca L King - Mayo Clinic in FloridaMatthew J Maurer - Department of Quantitative Health SciencesJames R Cerhan - Mayo Clinic in FloridaAndrew L Feldman - Mayo Clinic, Rochester, Minnesota, United StatesUmar Farooq - University of Iowa Hospitals and ClinicsEric Mou - University of IowaThomas M Habermann - Mayo ClinicCarrie A Thompson - Mayo ClinicYucai Wang - Mayo Clinic, Rochester, Minnesota, United StatesThomas E Witzig - Mayo Clinic, Rochester, Minnesota, United StatesGrzegorz S Nowakowski - Mayo Clinic
- Resource Type
- Journal article
- Publication Details
- Blood advances, Vol.6(24), pp.6180-6186
- DOI
- 10.1182/bloodadvances.2022007569
- PMID
- 36170803
- PMCID
- PMC9791316
- NLM abbreviation
- Blood Adv
- ISSN
- 2473-9529
- eISSN
- 2473-9537
- Grant note
- U01 CA195568 / NCI NIH HHS
- Language
- English
- Date published
- 12/27/2022
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Epidemiology; Internal Medicine
- Record Identifier
- 9984362349902771
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