Survival outcomes of diffuse large B-cell lymphoma by association with concurrent or antecedent follicular lymphoma and double hit status

Amir Behdad; Craig S Boddy; Angela J Fought; Timothy Taxter; Marissa K Falkiewicz; Emily Ayers; Qing C Chen; Yi-Hua Chen; Reem Karmali; Barbara Pro; Jane N Winter; Daniel J Landsburg; Leo I Gordon; Jason B Kaplan

doi:10.1080/10428194.2019.1622099

Survival outcomes of diffuse large B-cell lymphoma by association with concurrent or antecedent follicular lymphoma and double hit status

Leuk Lymphoma. 2019 Dec;60(13):3266-3271. doi: 10.1080/10428194.2019.1622099. Epub 2019 Jun 21.

Authors

Affiliations

¹ Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
² Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
³ Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁴ Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 31225766
DOI: 10.1080/10428194.2019.1622099

Abstract

Diffuse large B-cell lymphoma (DLBCL) transformed from follicular lymphoma (FL) (tDLBCL) has been traditionally associated with an aggressive course, but more recent studies have shown longer survivals. The clinical significance of concurrent FL at the time of diagnosis of DLBCL (cDLBCL/FL) is less clear. We compared outcomes of tDLBCL, cDLBCL/FL, and de novo DLBCL (dDLBCL) and then evaluated the impact of double hit (DH) rearrangements (MYC with BCL2 and/or BCL6) in these subgroups' outcomes. The progression free survival (PFS) and overall survival (OS) were not significantly different among the three groups (dDLBCL, tDLBCL, and cDLBCL/FL). The effect of DH on survival was then analyzed in two subgroups: (1) dDLBCL and (2) tDLBCL + cDLBCL/FL. PFS and OS were significantly shorter in lymphomas with DH in each of these two subgroups. We conclude that DH status drives outcomes in all DLBCLs, regardless of their transformation status.

Keywords: MYC; Transformed follicular lymphoma; diffuse large B-cell lymphoma; double hit lymphoma; high grade B-cell lymphoma.

Publication types

Comparative Study

MeSH terms

Aged
Antineoplastic Agents, Immunological / therapeutic use
Antineoplastic Combined Chemotherapy Protocols
Cell Transformation, Neoplastic / genetics*
Female
Gene Rearrangement
Humans
Lymphoma, Follicular / complications
Lymphoma, Follicular / drug therapy
Lymphoma, Follicular / genetics
Lymphoma, Follicular / mortality*
Lymphoma, Large B-Cell, Diffuse / drug therapy
Lymphoma, Large B-Cell, Diffuse / etiology
Lymphoma, Large B-Cell, Diffuse / genetics
Lymphoma, Large B-Cell, Diffuse / mortality*
Male
Middle Aged
Neoplasms, Multiple Primary / drug therapy
Neoplasms, Multiple Primary / genetics
Neoplasms, Multiple Primary / mortality*
Neoplasms, Multiple Primary / pathology
Neoplasms, Second Primary / drug therapy
Neoplasms, Second Primary / genetics
Neoplasms, Second Primary / mortality*
Neoplasms, Second Primary / pathology
Progression-Free Survival
Proto-Oncogene Proteins c-bcl-2 / genetics
Proto-Oncogene Proteins c-bcl-6 / genetics
Proto-Oncogene Proteins c-myc / genetics
Retrospective Studies
Rituximab / therapeutic use
Time Factors

Substances

Antineoplastic Agents, Immunological
BCL2 protein, human
BCL6 protein, human
MYC protein, human
Proto-Oncogene Proteins c-bcl-2
Proto-Oncogene Proteins c-bcl-6
Proto-Oncogene Proteins c-myc
Rituximab