A large proportion of patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) do not undergo repeat biopsy, primarily because their radiologic findings are stable and another diagnosis is deemed unlikely, according to the results of a study that was presented at the EHA 2022 Hybrid Congress.
“Although guidelines recommend histological confirmation of R/R [relapsed/refractory] disease, repeat biopsies are not always performed,” the authors wrote in a poster presentation. The aim of this study was to determine the proportion of repeat biopsies that are not ordered and to understand the underlying reasons.
The study comprised 2 parts. The first was a single-center, retrospective study that included data from 61 patients with 116 occurrences of relapsed/refractory DLBCL. These results were corroborated with the second part, which was a nationwide, electronic survey of 64 practicing hematologists that included 8 clinical vignettes.
In the retrospective study, 36% of patients underwent a repeat biopsy at their first occurrence of relapsed/refractory disease. Of these patients, 57% had relapsed and 24% were refractory to their first-line treatment. Across all occurrences of relapsed/refractory disease, a repeat biopsy was not performed in 72% of cases.
The most common reason for not conducting a repeat biopsy was that the radiologic findings were stable and another diagnosis seemed unlikely, followed by problematic location to biopsy, ineligibility for curative treatment, and rapid deterioration or clinical urgency.
Patients who did undergo a repeat biopsy were more likely to have relapsed rather than refractory disease (47% vs 19%; P =.002) and were more likely to have a good rather than poor performance status (34% vs 8.7%; P =.02). Patients with DLBCL were also more likely to undergo repeat biopsy compared with patients who had primary central nervous system lymphoma (38.6% vs 0%; P =.001).
Findings from the retrospective study were consistent with the survey data. Hematologists who participated in the survey did not recommend a repeat biopsy in at least 1 vignette, and over 50% of hematologists would not repeat biopsy in 3 vignettes. A repeat biopsy was more likely to be recommended if the vignette was of relapsed rather than refractory disease (67% vs 45%; P <.001).
“[W]e show that, in clinical practice, many patients do not undergo repeat biopsy for relapsed/refractory DLBCL, especially in cases of refractory disease,” the authors wrote. “Since this is a recurrent dilemma faced in clinical practice, we believe this should be addressed in future studies.”
Disclosures are not available for this presentation.
Berger T, Geiger KR, Yeshurun M, et al. Repeat biopsy in relapsed or refractory diffuse large B cell lymphoma: a nationwide survey and retrospective study. Presented at EHA 2022; June 9-12, 2022. Abstract P1166.