High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) may overcome adverse prognosis in patients with diffuse large B-cell lymphoma (DLBCL) with an activated B-cell (ABC) molecular profile.

Abstract

e18522 Background: The genomic expression profiling of DLBCL into ABC and germinal center B cell (GCB) has divided patients into two groups with dramatically different prognoses. We explored the effect of ASCT on patients with relapsed DLBCL and unknown molecular subtype. Methods: We performed a 10 year retrospective review of patients with relapsed/refractory DLBCL that underwent ASCT. We analyzed diagnostic biopsies with TMAs using the Hans algorithm. We excluded patients with other lymphomas,insufficient tissue or incomplete data. The Chi squared test and the Kaplan-Meier method was used for statistical analyses. Results: We identified 37 patients with relapsed/refractory DLBCL. Data from 20 patients was analyzed after excluding 17 patients. 13 (65%) were ABC type and 7 (35%) were the GCB type. There was no statistically significant difference between patient characteristics in both groups. Median age was 52 yrs (44% > 60 yrs in the ABC and 42% in GCB group). 1 patient in each group had a high IPI score. 69% of patients in the ABC group and 57% of the GCB group had a CR to first line chemotherapy. 46% of the ABC and 42% of the GCB group had Relapse-1 sensitive disease at ASCT. Only 2 patients (ABC group) had primary refractory disease. 53% of patients in the ABC and 71% of patients in the GCB groups were greater than 24 months from diagnosis to ASCT. The median follow-up of was 48 months (23–69 months). The median EFS in the GCB group was 48 months, while the median EFS in the ABC group has not been reached (p = 0.84). The median OS in the GCB and ABC groups is 61 months and 48 months respectively (p = 0.98). Conclusions: In our retrospective analysis of patients with relapsed/refractory DLBCL, 65% of patients that proceeded to an ASCT were of the ABC profile compared to 35% with the GCB profile. However the GCB profile did not predict for a difference in the EFS and OS after ASCT and the median EFS for patients with the ABC profile has not been reached. This suggests that high dose chemotherapy may overcome poor prognostic factors of the ABC profile in patients selected for ASCT and a larger multicenter study is planned to confirm these observations.