Contributions
Abstract: PB1724
Type: Publication Only
Background
Cytogenetic abnormalities of MYC are associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL). Rearrangement of MYC reportedly occurs in approximately 10% of DLBCL cases. In addition, in various clinical trials of rituximab with standard dosing, female receiving rituximab have had better outcomes than male. However, gender-segregated outcomes of patients with MYC rearrangement have not been reported. In addition, the gender segregation of known prognostic factors, such as high international prognostic index (IPI) score, elevated lactate dehydrogenase (LDH) level, poor Eastern Cooperative Oncology Group performance status (PS), advanced stage, and ≥2 extranodal sites, not as yet been fully elucidated.
Aims
The aim of this study was to determine the gender segregation of clinicopathological and genetic prognostic factors, including MYC (fluorescence in-situ hybridization: FISH) in patients with DLBCL by analyzing data from consecutive DLBCL patients.
Methods
In order to identify prognostic factors, we analyzed gender segregation from the medical records of patients with DLBCL, including newly diagnosed and transformed, at Juntendo University Hospital from December 2009 to December 2016. We retrospectively analyzed the data of 161 consecutive DLBCL patients (male: 91 patients, female: 70 patients). Patients in this study were treated with R-CHOP or R-CHOP-based regimens with minor modifications. The relationships between overall survival (OS), progression free survival (PFS) and age, LDH level, PS, stage, ≥2 extranodal sites, IPI, cell of origin (COO), BCL2 (immunohistochemistry: IHC), BCL6 (IHC), MYC (IHC), double expressor (MYC and BCL2 expression on IHC), and MYC (FISH) were investigated. Univariate and multivariate analyses of estimated risk factors for OS and PFS were performed using the log-rank test and Cox proportional hazard regression analysis.
Results
The median age was 70 years (range: 27–92 years). The median follow-up was 17 months (range: 1–81 months). To adjust the impact of age, LDH level, PS, stage, ≥2 extranodal sites, IPI, COO, BCL2 (IHC), BCL6 (IHC), MYC (IHC), double expressor (IHC), MYC (FISH), and other significant factors, univariate analysis was performed for the OS. Elevated LDH level, stage ≥3, PS ≥2, ≥2 extranodal sites, IPI≥3, BCL6 negative (IHC), and MYC rearrangement (FISH) were significant factors in the female patients; however, PS ≥2 and IPI≥3 were significant factors in the male patients. Univariate analysis was also performed for PFS. Elevated LDH level, PS ≥2, IPI≥3, BCL6 negative (IHC), and MYC rearrangement (FISH) were significant factors in the female patients; however, PS ≥2 was the only significant factor in the male patients. Multivariate analyses were then performed using these factors in the Cox proportional hazard model. MYC rearrangement (FISH) [hazard ratio (HR): 9.13, 95% confidence interval (CI): 2.33–35.77, P = 0.0015], and IPI ≥3 were identified as independent significant prognostic factor for OS in the female patients with DLBCL. Furthermore, MYC rearrangement (FISH) (HR: 2.47, 95% CI: 1.87–327.8, P = 0.01494], and elevated LDH level were identified as independent significant prognostic factor for PFS in the female patients with DLBCL. On the other hand, PS ≥2 was identified as the only significant prognostic factor for OS (HR: 44.27, 95% CI: 6.71–292.2, P < 0.001), but not for PFS in the male patients with DLBCL. Five out of seven female patients with DLBCL and MYC rearrangement died from lymphoma progression. The median OS in the female patients with DLBCL and MYC rearrangement was 8.0 months (range: 1–35 months) compared to 21.5 months in those without MYC rearrangement (range: 1–79 months, P = 0.003). On the other hand, in the male patients (n=13) with DLBCL, MYC rearrangement was not significantly associated with poor OS.
Conclusion
These results suggest that MYC rearrangement by FISH is significantly associated with very poor OS and PFS in the female patients with DLBCL but not the male patients with DLBCL. On the other hand, PS ≥ 2 is significantly associated with poor OS in the male patients with DLBCL.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Female, Diffuse large B cell lymphoma, Prognostic factor, MYC
Abstract: PB1724
Type: Publication Only
Background
Cytogenetic abnormalities of MYC are associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL). Rearrangement of MYC reportedly occurs in approximately 10% of DLBCL cases. In addition, in various clinical trials of rituximab with standard dosing, female receiving rituximab have had better outcomes than male. However, gender-segregated outcomes of patients with MYC rearrangement have not been reported. In addition, the gender segregation of known prognostic factors, such as high international prognostic index (IPI) score, elevated lactate dehydrogenase (LDH) level, poor Eastern Cooperative Oncology Group performance status (PS), advanced stage, and ≥2 extranodal sites, not as yet been fully elucidated.
Aims
The aim of this study was to determine the gender segregation of clinicopathological and genetic prognostic factors, including MYC (fluorescence in-situ hybridization: FISH) in patients with DLBCL by analyzing data from consecutive DLBCL patients.
Methods
In order to identify prognostic factors, we analyzed gender segregation from the medical records of patients with DLBCL, including newly diagnosed and transformed, at Juntendo University Hospital from December 2009 to December 2016. We retrospectively analyzed the data of 161 consecutive DLBCL patients (male: 91 patients, female: 70 patients). Patients in this study were treated with R-CHOP or R-CHOP-based regimens with minor modifications. The relationships between overall survival (OS), progression free survival (PFS) and age, LDH level, PS, stage, ≥2 extranodal sites, IPI, cell of origin (COO), BCL2 (immunohistochemistry: IHC), BCL6 (IHC), MYC (IHC), double expressor (MYC and BCL2 expression on IHC), and MYC (FISH) were investigated. Univariate and multivariate analyses of estimated risk factors for OS and PFS were performed using the log-rank test and Cox proportional hazard regression analysis.
Results
The median age was 70 years (range: 27–92 years). The median follow-up was 17 months (range: 1–81 months). To adjust the impact of age, LDH level, PS, stage, ≥2 extranodal sites, IPI, COO, BCL2 (IHC), BCL6 (IHC), MYC (IHC), double expressor (IHC), MYC (FISH), and other significant factors, univariate analysis was performed for the OS. Elevated LDH level, stage ≥3, PS ≥2, ≥2 extranodal sites, IPI≥3, BCL6 negative (IHC), and MYC rearrangement (FISH) were significant factors in the female patients; however, PS ≥2 and IPI≥3 were significant factors in the male patients. Univariate analysis was also performed for PFS. Elevated LDH level, PS ≥2, IPI≥3, BCL6 negative (IHC), and MYC rearrangement (FISH) were significant factors in the female patients; however, PS ≥2 was the only significant factor in the male patients. Multivariate analyses were then performed using these factors in the Cox proportional hazard model. MYC rearrangement (FISH) [hazard ratio (HR): 9.13, 95% confidence interval (CI): 2.33–35.77, P = 0.0015], and IPI ≥3 were identified as independent significant prognostic factor for OS in the female patients with DLBCL. Furthermore, MYC rearrangement (FISH) (HR: 2.47, 95% CI: 1.87–327.8, P = 0.01494], and elevated LDH level were identified as independent significant prognostic factor for PFS in the female patients with DLBCL. On the other hand, PS ≥2 was identified as the only significant prognostic factor for OS (HR: 44.27, 95% CI: 6.71–292.2, P < 0.001), but not for PFS in the male patients with DLBCL. Five out of seven female patients with DLBCL and MYC rearrangement died from lymphoma progression. The median OS in the female patients with DLBCL and MYC rearrangement was 8.0 months (range: 1–35 months) compared to 21.5 months in those without MYC rearrangement (range: 1–79 months, P = 0.003). On the other hand, in the male patients (n=13) with DLBCL, MYC rearrangement was not significantly associated with poor OS.
Conclusion
These results suggest that MYC rearrangement by FISH is significantly associated with very poor OS and PFS in the female patients with DLBCL but not the male patients with DLBCL. On the other hand, PS ≥ 2 is significantly associated with poor OS in the male patients with DLBCL.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Female, Diffuse large B cell lymphoma, Prognostic factor, MYC