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REPEAT BIOPSY IN RELAPSED OR REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA: A NATIONWIDE SURVEY AND RETROSPECTIVE STUDY
Author(s): ,
Tamar Berger
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
,
Karyn Revital Geiger
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
,
Moshe Yeshurun
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
,
Anat Gafter‑Gvili
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
,
Tzippy Shochat
Affiliations:
Bio-Statistical Unit,Rabin Medical Center, Beilinson Campus,Petah-Tikva,Israël;Bio-Statistical Unit,Rabin Medical Center, Beilinson Campus,Petah-Tikva,Israel;Bio-Statistical Unit,Rabin Medical Center, Beilinson Campus,Petah-Tikva,Israele;Bio-Statistical Unit,Rabin Medical Center, Beilinson Campus,Petah-Tikva,Israel;Bio-Statistical Unit,Rabin Medical Center, Beilinson Campus,Petah-Tikva,Israel;Bio-
,
Ronit Gurion
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
,
Pia Raanani
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
Oren Pasvolsky
Affiliations:
Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israël;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israel;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Petah Tikva,Israele;Hematology division,Davidoff cancer center, Beilinson hospital, Rabin medical center,Pe
(Abstract release date: 05/12/22) EHA Library. Berger T. 06/10/22; 358026; P1166
Tamar Berger
Tamar Berger
Contributions
Abstract
Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P1166

Type: Poster presentation

Session title: Aggressive Non-Hodgkin lymphoma - Clinical

Background
Almost half of patients with diffuse large B-cell lymphoma (DLBCL) will have relapsed/refractory (R/R) disease after frontline immunochemotherapy. Although guidelines recommend histological confirmation of R/R disease, repeat biopsies are not always performed.

Aims
To better appreciate the extent and reasoning for not performing repeat biopsies in R/R DLBCL.

Methods
We conducted a two-part study: (1) using a nationwide electronic questionnaire consisting of 8 clinical vignettes, we evaluated the views of practicing hematologists in Israel regarding the need for repeat biopsies in suspected R/R DLBCL; (2) a single center retrospective study was utilized to describe real-life clinical practice patterns of performing procedures aimed at achieving tissue diagnosis for relapsed/refractory aggressive NHL (aNHL) patients: we included all consecutive adult (≥18 years of age) patients diagnosed with aNHL treated at a tertiary center in Israel, between 1/1/2013 and 1/1/2020, we identified patients who were diagnosed with R/R disease and analyzed data pertaining to utilization of histological confirmation via repeat biopsy. Each timepoint of management decision regarding biopsy performance was considered as a separate “episode of R/R lymphoma”. We extracted data regarding reasons for not performing the biopsies from the computerized system, according to the treating physician.

Results
In the survey part, all 64 participating physicians opted not to perform a repeat biopsy in at least one clinical case scenario. Physicians’ age, gender, tenure or clinical experience with DLBCL patients did not correlate with the decision to perform a biopsy, whereas more physicians chose to perform biopsies in relapsed compared to refractory disease cases.

In the retrospective part, 116 episodes of R/R aNHL among 61 patients were identified. In 72% of these episodes a repeat biopsy was not performed, mostly due to low likelihood of an alternative diagnosis or problematic location for biopsy. Patients with relapsed disease were more likely to undergo biopsy, as compared to those with refractory disease (47% vs 19%, p=0.002). Focusing on the group of patients with DLBCL (excluding primary CNS lymphoma , primary mediastinal B cell lymphoma and Burkitt lymphoma), there were 43 patients with refractory (n=26) or relapsed (n=17) DLBCL. In 61.4% out of the 83 episodes of R/R disease in these 43 patients, a biopsy was not performed: 74.5% of refractory DLBCL episodes versus 35.7% of relapsed DLBCL episodes (p=0.001). Stratifying biopsy utilization for each patient according to the timing of event, i.e first, second or third event of R/R disease, revealed that less biopsies were performed at more advanced relapse episodes. The most common reason for not performing a repeat biopsy was having stable radiological findings and other diagnoses deemed unlikely, as depicted in Figure 1.

Conclusion
Our study suggests that contrary to guideline recommendations, in clinical practice many patients do not undergo repeat biopsy in R/R DLBCL, especially in refractory cases. Since this is a common dilemma faced in clinical practice, future studies and recommendations should address the necessity of repeat biopsy, according to patient and disease related characteristics.

Keyword(s): Diagnosis, Diffuse large B cell lymphoma, Refractory, Relapsed lymphoma

Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P1166

Type: Poster presentation

Session title: Aggressive Non-Hodgkin lymphoma - Clinical

Background
Almost half of patients with diffuse large B-cell lymphoma (DLBCL) will have relapsed/refractory (R/R) disease after frontline immunochemotherapy. Although guidelines recommend histological confirmation of R/R disease, repeat biopsies are not always performed.

Aims
To better appreciate the extent and reasoning for not performing repeat biopsies in R/R DLBCL.

Methods
We conducted a two-part study: (1) using a nationwide electronic questionnaire consisting of 8 clinical vignettes, we evaluated the views of practicing hematologists in Israel regarding the need for repeat biopsies in suspected R/R DLBCL; (2) a single center retrospective study was utilized to describe real-life clinical practice patterns of performing procedures aimed at achieving tissue diagnosis for relapsed/refractory aggressive NHL (aNHL) patients: we included all consecutive adult (≥18 years of age) patients diagnosed with aNHL treated at a tertiary center in Israel, between 1/1/2013 and 1/1/2020, we identified patients who were diagnosed with R/R disease and analyzed data pertaining to utilization of histological confirmation via repeat biopsy. Each timepoint of management decision regarding biopsy performance was considered as a separate “episode of R/R lymphoma”. We extracted data regarding reasons for not performing the biopsies from the computerized system, according to the treating physician.

Results
In the survey part, all 64 participating physicians opted not to perform a repeat biopsy in at least one clinical case scenario. Physicians’ age, gender, tenure or clinical experience with DLBCL patients did not correlate with the decision to perform a biopsy, whereas more physicians chose to perform biopsies in relapsed compared to refractory disease cases.

In the retrospective part, 116 episodes of R/R aNHL among 61 patients were identified. In 72% of these episodes a repeat biopsy was not performed, mostly due to low likelihood of an alternative diagnosis or problematic location for biopsy. Patients with relapsed disease were more likely to undergo biopsy, as compared to those with refractory disease (47% vs 19%, p=0.002). Focusing on the group of patients with DLBCL (excluding primary CNS lymphoma , primary mediastinal B cell lymphoma and Burkitt lymphoma), there were 43 patients with refractory (n=26) or relapsed (n=17) DLBCL. In 61.4% out of the 83 episodes of R/R disease in these 43 patients, a biopsy was not performed: 74.5% of refractory DLBCL episodes versus 35.7% of relapsed DLBCL episodes (p=0.001). Stratifying biopsy utilization for each patient according to the timing of event, i.e first, second or third event of R/R disease, revealed that less biopsies were performed at more advanced relapse episodes. The most common reason for not performing a repeat biopsy was having stable radiological findings and other diagnoses deemed unlikely, as depicted in Figure 1.

Conclusion
Our study suggests that contrary to guideline recommendations, in clinical practice many patients do not undergo repeat biopsy in R/R DLBCL, especially in refractory cases. Since this is a common dilemma faced in clinical practice, future studies and recommendations should address the necessity of repeat biopsy, according to patient and disease related characteristics.

Keyword(s): Diagnosis, Diffuse large B cell lymphoma, Refractory, Relapsed lymphoma

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