The different roles of molecular classification according to upfront autologous stem cell transplantation in advanced-stage diffuse large B cell lymphoma patients with elevated serum lactate dehydrogenase.

Abstract

The non-germinal center B cell (non-GCB) subtype of diffuse large B cell lymphoma (DLBCL) is more related to poor prognosis than the GCB subtype. To investigate the role of molecular classification according to upfront autologous hematopoietic stem cell transplantation (ASCT), we retrospectively evaluated 219 newly diagnosed high-risk DLBCL patients. Eighty-one patients were in the ASCT group, and 138 patients were in the non-ASCT group. The ASCT group yielded significantly better overall survival (OS) and progression-free survival (PFS) than the non-ASCT group (p=0.038 and p=0.007), and patients with the non-GCB subtype were more related to inferior PFS than those with the GCB subtype (p=0.020). After performing age-matching by using propensity scores, upfront ASCT continued to show better OS and PFS than non-ASCT (p=0.046 and p=0.026). In the non-ASCT group, the non-GCB subtype showed worse OS and PFS than the GCB subtype (p=0.039 and p=0.007). Patients who achieved complete response showed differences in OS and PFS according to molecular subtype (p=0.007 and p=0.002). In the ASCT group, there were no significant differences in OS and PFS according to molecular classification (p=0.277 and p=0.892). In conclusion, non-GCB subtype DLBCL patients showed poor OS and PFS in the non-ASCT group while they did not show clinical significance in the ASCT group. This suggests the possibility that upfront ASCT may improve the poor prognosis of non-GCB subtype in high-risk DLBCL.