Poorer DLBCL Survival Outcomes Linked to Dual Expression of MYC, BCL2
Dual expression of MYC and BCL2 was associated with worse survival among patients with GCB-like DLBCL, though this status was not associated with any outcomes among patients with ABC-like DLBCL.
Dual expression of MYC and BCL2 was associated with worse survival among patients with GCB-like DLBCL who underwent R-CHOP, though dual expression status was not associated with any outcomes among patients with ABC-like DLBCL.
In patients with GCB-like DLBCL and dual expression, outcomes were worse than in patients with ABC-like DLBCL without dual expression (5-year PFS, 39% [95% CI, 19-59%] vs 68% [95% CI, 52-85%]; P = .03).
Previous retrospective studies indicated worse prognosis in patients with ABC-like DLBCL.2, 3 The results in this study, however, suggest determining prognosis is even more complicated and that patients with ABC-like DLBCL might not experience worse prognoses.
“The clear message of identifying [dual expression] as a risk factor exclusively in GCB-like DLBCL did not exactly surprise us, but we were impressed,” said Dr Ott.
When the researchers analyzed data from patients without dual expression, outcomes of patients in the ABC-like DLBCL subgroup were worse than in the GCB-like DLBCL subgroup (5-year PFS, 68% [95% CI, 52-85%] vs 85% [95% CI, 74-96%]; P = .04).
Small sample sizes and potential differences in selection criteria for enrollment in the 2 distinct trials limit interpretation of results from this study.
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Assessment of predictive or prognostic biomarkers as part of prospective clinical trials will continue to be important in determining treatment and management of DLBCL.
“Our results and those of other, more recent data, clearly exemplify that prognostication in DLBCL is indeed both of pivotal importance as well as a highly complex task,” said Dr Ott.
- Staiger AM, Ziepert M, Horn H, et al. Clinical impact of the cell-of-origin classification and the MYC/BCL2 dual expresser status in diffuse large b-cell lymphoma treated within prospective clinical trials of the German High-Grade Non-Hodgkin's Lymphoma Study Group. J Clin Oncol. 2017 May 19. doi: 10.1200/JCO.2016.70.3660 [Epub ahead of print]
- Barrans SL, Crouch S, Care MA, et al. Whole genome expression profiling based on paraffin embedded tissue can be used to classify diffuse large B-cell lymphoma and predict clinical outcome. Br J Haematol. 2012;159(4):441-53. doi: 10.1111/bjh.12045
- Gutiérrez-García G, Cardesa-Salzmann T, Climent F, et al. Gene-expression profiling and not immunophenotypic algorithms predicts prognosis in patients with diffuse large B-cell lymphoma treated with immunochemotherapy. Blood. 2011;117(18):4836-43. doi: 10.1182/blood-2010-12-322362