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Prognostic factors for diffuse large B-cell lymphoma in the R(X)CHOP era.

R Vaidya1, T E Witzig1

  • 1Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, USA.

Annals of Oncology : Official Journal of the European Society for Medical Oncology
|March 15, 2014
PubMed
Summary
This summary is machine-generated.

Rituximab plus CHOP chemotherapy (RCHOP) is standard for diffuse large B-cell lymphoma (DLBCL), but relapses occur. New markers are needed to predict outcomes and guide treatment with novel agents in R(X)CHOP therapy.

Keywords:
double hitlarge celllymphomanon-Hodgkinprognosis

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Area of Science:

  • Hematology
  • Oncology
  • Clinical Pathology

Background:

  • Rituximab (R) combined with CHOP chemotherapy (RCHOP) improved survival for diffuse large B-cell lymphoma (DLBCL), becoming the standard of care.
  • Despite RCHOP, approximately 40% of DLBCL patients experience disease relapse, necessitating improved therapeutic strategies.
  • The development of R(X)CHOP regimens requires robust prognostic and predictive markers to identify aggressive disease and optimize clinical trial enrollment.

Purpose of the Study:

  • To review prognostic factors in DLBCL relevant in 2014.
  • To emphasize markers that are accurate, readily available, and clinically applicable.
  • To inform the selection of patients for clinical trials involving novel agents in DLBCL treatment.

Main Methods:

  • Review of existing literature on prognostic factors in DLBCL.
  • Emphasis on markers with established clinical utility and availability.
  • Discussion of emerging biomarkers and their potential clinical application.

Main Results:

  • The International Prognostic Index remains valid but has limitations in predicting long-term survival.
  • Gene expression profiling and immunohistochemistry (IHC) algorithms offer insights into DLBCL biology and are in routine practice.
  • Identifying 'double-hit' (DH) lymphoma via FISH is crucial due to its poor prognosis with RCHOP. Other promising markers include absolute lymphocyte count (ALC), free light chains, vitamin D, cytokines, and PET imaging.

Conclusions:

  • Future DLBCL treatment holds promise with novel agents (bortezomib, lenalidomide, ibrutinib) being tested in R(X)CHOP trials.
  • Predictive factors are essential for appropriate patient selection and randomization in clinical trials.
  • Personalized medicine in DLBCL will involve selecting therapies based on tumor biology.