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Matched control analysis suggests that R-CHOP followed by (R)-ICE may improve outcome in non-GCB DLBCL compared with

Kurt S Bantilan¹, Alexandra N Smith², Matthew J Maurer²

¹Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY.

|January 25, 2024

Summary

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An alternative chemoimmunotherapy regimen of R-CHOP induction and R-ICE consolidation may improve outcomes for diffuse large B-cell lymphoma patients with the non-germinal center B-cell like (non-GCB) phenotype. This approach may overcome the poor prognosis typically associated with the non-GCB subtype.

Area of Science:

Hematology
Oncology
Immunology

Background:

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is standard care for advanced diffuse large B-cell lymphoma (DLBCL).
Patients with the nongerminal center B-cell like (non-GCB) cell of origin (COO) have worse outcomes with R-CHOP.
The Hans algorithm is used to classify DLBCL COO.

Purpose of the Study:

To evaluate the prognostic significance of COO in DLBCL patients treated with an alternative chemoimmunotherapy regimen.
To determine if sequential R-CHOP induction and R-ICE consolidation can overcome the negative prognostic impact of the non-GCB phenotype.

Main Methods:

A cohort of 151 DLBCL patients at Memorial Sloan Kettering Cancer Center (MSK) received sequential R-CHOP induction and R-ICE consolidation.

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Outcomes were analyzed based on COO (GCB vs. non-GCB) using the Hans algorithm.

Propensity score-matched cohorts from MSK and the Mayo Clinic Molecular Epidemiology Resource (MER) were used for validation.

Main Results:

In the MSK cohort, non-GCB patients showed superior event-free survival (EFS) compared to GCB patients (HR, 0.53; 95% CI, 0.29-0.98).
Overall survival (OS) showed a similar trend but was not statistically significant.
Propensity score-matched analyses in both MSK and MER cohorts did not yield statistically significant differences in EFS or OS, though trends varied.

Conclusions:

Sequential R-CHOP induction and R-ICE consolidation may overcome the adverse prognostic effect of the non-GCB phenotype in DLBCL.
This alternative regimen could be preferentially considered for patients with the non-GCB subtype.
Further validation is needed to confirm these findings in larger, diverse cohorts.