High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study
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- Adam S. Zayac
- 1Division of Hematology/Oncology, The Warren Alpert Medical School Medical School of Brown University, Providence, RI
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- Daniel J. Landsburg
- 2Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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- Mitchell E. Hughes
- 2Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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- Allison M. Bock
- 3Division of Hematology, Mayo Clinic, Rochester, MN
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- Grzegorz S. Nowakowski
- 3Division of Hematology, Mayo Clinic, Rochester, MN
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- Emily C. Ayers
- 4Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
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- Mark Girton
- 5Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
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- Marie Hu
- 6Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
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- Amy K. Beckman
- 7Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
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- Shaoying Li
- 8Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- L. Jeffrey Medeiros
- 8Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Julie E. Chang
- 9Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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- Adam Stepanovic
- 9Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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- Habibe Kurt
- 10Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
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- Jose Sandoval-Sus
- 11Department of Malignant Hematology and Cellular Therapy, Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
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- M. Ali Ansari-Lari
- 12Department of Pathology, Memorial Healthcare System, Hollywood, FL
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- Shalin K. Kothari
- 13Division of Hematology, Yale University School of Medicine, New Haven, CT
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- Anna Kress
- 13Division of Hematology, Yale University School of Medicine, New Haven, CT
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- Mina L. Xu
- 14Department of Pathology and Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
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- Pallawi Torka
- 15Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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- Suchitra Sundaram
- 15Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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- Stephen D. Smith
- 16Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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- Kikkeri N. Naresh
- 18Department of Pathology, University of Washington, Seattle, WA
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- Yasmin H. Karimi
- 19Division of Hematology-Oncology, University of Michigan Health, Ann Arbor, MI
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- Narendranath Epperla
- 20The Ohio State University Comprehensive Cancer Center, Columbus, OH
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- David A. Bond
- 20The Ohio State University Comprehensive Cancer Center, Columbus, OH
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- Umar Farooq
- 21Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
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- Mahak Saad
- 21Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
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- Andrew M. Evens
- 22Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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- Karan Pandya
- 22Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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- Seema G. Naik
- 23Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA
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- Manali Kamdar
- 24Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado, Denver, CO
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- Bradley Haverkos
- 24Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado, Denver, CO
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- Reem Karmali
- 25Division of Hematology and Oncology, Northwestern University, Chicago, IL
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- Timothy S. Oh
- 25Division of Hematology and Oncology, Northwestern University, Chicago, IL
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- Julie M. Vose
- 26Department of Medicine, University of Nebraska Medical Center, Omaha, NE
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- Heather Nutsch
- 26Department of Medicine, University of Nebraska Medical Center, Omaha, NE
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- Paul G. Rubinstein
- 27Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
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- Amina Chaudhry
- 27Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
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- Adam J. Olszewski
- 1Division of Hematology/Oncology, The Warren Alpert Medical School Medical School of Brown University, Providence, RI
抄録
<jats:title>Abstract</jats:title> <jats:p>In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)—a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ("double hit"). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3 × upper limit of normal, and a dual-expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.</jats:p>
収録 刊行 物
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- Blood Advances
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Blood Advances 7 (21), 6381-6394, 2023-10-25
American Society of Hematology