Clinicobiological features and prognostic impact of diffuse large B-cell lymphoma component in the outcome of patients with previously untreated follicular lymphoma
Por:
Magnano L., Balagué O., Dlouhy I., Rovira J., Karube K., Pinyol M., Rivas-delgado A., Costa D., Martínez-Trillos A., González-Farre B., Martínez-Pozo A., Giné E., Colomer D., Delgado J., Villamor N., Campo E., López-Guillermo A.
Publicada:
1 ene 2017
Resumen:
Background: The co-existence at diagnosis of follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) components (FL/DLBCL) has been considered a transformed lymphoma and accordingly treated although clinicobiological information on these patients is scarce. The aim of this study was to analyze the initial features and outcome of FL/DLBCL patients in the rituximab era. Patients and methods: All patients consecutively diagnosed at a single institution with FL/DLBCL (n=40), as well as those with pure FL (n=328) or de novo DLBCL (n=510) as controls. Results: The proportion of the DLBCL component was highly variable (median 50%). In 29 FL/DLBCL cases analyzed, the cell of origin was GCB in 86%, ABC in 10% and unclassifiable in 4%. NOTCH1-2 was mutated in 10% of these cases. The proportion of DLBCL component did not impact on overall survival (OS). Regarding initial characteristics, patients with FL/DLBCL were closer to FL in terms of primary nodal origin, good performance status and advanced stage, whereas the other features were intermediate between FL and DLBCL. FL/DLBCL patients were treated as DLBCL with no further intensification. Complete response and primary refractory rates were 65% and 20%, respectively, with these figures being similar to DLBCL and worse than FL. Progression-free survival and OS were intermediate between FL and DLBCL (5-year OS: 85%, 73% and 63% for FL, FL/DLBCL and DLBCL, respectively). FL/DLBCL histology did not reach independent prognostic value for OS in the multivariate analyses. Conclusions: The outcome of FL/DLBCL patients is not worse than that of de novo DLBCL. These cases should be treated with immunochemotherapy as DLBCL, but intensification with ASCT may not be necessary. The biological insights of FL/DLBCL warrants further genetic and molecular studies. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Filiaciones:
Magnano L.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Balagué O.:
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Dlouhy I.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Rovira J.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Karube K.:
Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Japan
Faculty of Medicine, University of the Ryukyus, Japan
Pinyol M.:
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Genomics Unit, IDIBAPS, Barcelona, Spain
Rivas-delgado A.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Costa D.:
Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Martínez-Trillos A.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
González-Farre B.:
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Martínez-Pozo A.:
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Giné E.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Colomer D.:
Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Delgado J.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Villamor N.:
Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Campo E.:
Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
López-Guillermo A.:
Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
CIBERONC, Hospital Clínic, DIBAPS, University of Barcelona, Barcelona, Spain
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