Prognostic impact of immunohistochemically defined germinal center phenotype in diffuse large B-cell lymphoma patients treated with immunochemotherapy.

Germinal center (GC) and non-GC phenotypes are predictors of outcome in diffuse large B-cell lymphoma (DLBCL) and can be used to stratify chemotherapy-treated patients into low- and high-risk groups. To determine how combination of rituximab with chemotherapy influences GC-associated clinical outcome, GC and non-GC phenotypes were identified immunohistochemically from samples of 90 de novo DLBCL patients treated with rituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like regimen (immunochemotherapy). One hundred and four patients previously treated with chemotherapy served as a control group. Consistent with previous studies, chemotherapy-treated patients with immunohistochemically defined GC phenotype displayed a significantly better overall (OS) and failure-free survival (FFS) than the non-GC group (OS, 70% vs 47%, P = .012; FFS, 59% vs 30%, P = .001). In contrast, immunohistochemically defined GC phenotype did not predict outcome in immunochemotherapy-treated patients (OS, 77% vs 76%, P = ns; FFS, 68% vs 63%, P = ns). In comparison, International Prognostic Index (IPI) could separate the high-risk patients from low- and intermediate-risk groups (OS, 84% vs 63%, P = .030; FFS, 79% vs 52%, P = .028). We conclude that rituximab in combination with chemotherapy seems to eliminate the prognostic value of immunohistochemically defined GC- and non-GC phenotypes in DLBCL.

Outcome for young high-risk aggressive B-cell lymphoma patients treated with CHOEP-14 and rituximab (R-CHOEP-14).

PURPOSE: To study the effectiveness and tolerability of a dose-intensified treatment including rituximab for patients, not older than 65 yr, with high-risk aggressive B-cell lymphoma. PATIENTS: Thirty-eight patients with high-risk aggressive B-cell lymphoma, the majority classified as grade 2 or 3 using age-adjusted International Prognostic Index, were treated with six courses of CHOEP + rituximab on a 2-wk schedule with G-CSF d 4-11. CNS prophylaxis was administered using intravenous Ara-C as a single dose at the end of treatment. RESULTS: All patients were considered responders after three courses. Thirty-one patients (82%) achieved a complete remission or a complete remission unverified. With a median follow up of 27 mo, overall and event-free survival are 79% and 60%, respectively. Treatment was given on an outpatient basis. There were no treatment- related unexpected toxic events or mortalities. Large-cell lymphoma involvement of the bone marrow was a poor prognostic sign even with this intensified treatment and 4/6 patients relapsed. CNS relapse occurred in three patients, two of whom had large cell bone marrow involvement. CONCLUSION: Although only a short follow up, the R-CHOEP-14 regimen is promising and could be an improvement compared to conventional treatment, with acceptable toxicity. The value of intravenous Ara-C at the end of treatment can be questioned, as it did not prevent CNS relapse or affect treatment outcome.