Educational theme: Prognostic factors in lymphoma

During SOHO 2019, Houston, US, Dr. Alessandra Ferrajoli from the University of Texas, MD Anderson Cancer Center, Houston, US, spoke to the Lymphoma Hub about new prognostic factors, and how they are used for the treatment of patients with chronic lymphocytic leukemia (CLL). She highlights mutational status as the most important prognostic factor, which should be supplemented with a cytogenetic assessment. She also describes other prognostic factors that should be considered, such as the age of the patient and TP53 status. Since only the mutational status of the IgG chain stays constant during disease progression, she highlights the need for reassessment before each line of therapy.

UK real-world gene expression profiling for DLBCL

DLBCL is the most common B-cell malignancy, which presents with a wide range of clinical characteristics and prognostic factors, depending on the subtype of the disease. GEP of DLBCL is crucial for outcome analysis and the planning of treatment for different molecular subgroups. This large real-world GEP of DLBCL included follow-up of all newly diagnosed DLBCL patients from 2004 until death up to March 2018, across 14 Haematological Malignancy Research Network (HMRN) hospitals in the UK. The results indicate that genetic profiling in DLBCL plays an important prognostic role and should be incorporated into routine diagnostic procedures. Furthermore, authors indicate that molecular high-grade (MHG) stratification might encourage the development of targeted trials for outcome improvement in this specific population.

Intratumor heterogeneity as a predictor of disease progression in DLBCL

Cellular heterogeneity plays a crucial role in tumor development, recurrence, and metastasis. It also impacts on the clinical diagnosis, as patients with high tumor heterogeneity have a poor prognosis due to limited therapeutic responses. In this study, the authors used a novel quantitative technique, mutant-allele tumor heterogeneity (MATH) to evaluate the effects of intratumor heterogeneity (ITH) on the risk of progression in patients with early-stage DLBCL. They found that higher ITH was associated with a higher risk of DLBCL progression. Moreover, MATH score based on whole-exome sequencing was an independent risk factor in patients with early-stage DLBCL and could potentially be used for deciding clinical treatment in these patients.

Combination of COO and CNS-IPI improves CNS relapse prognosis in DLBCL

This article summarizes the retrospective analysis of the phase III trial GOYA, where patients with DLBCL were treated with either obinutuzumab (G) or rituximab (R), plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP; G-CHOP versus R-CHOP). This analysis aimed to investigate the impact of cell-of-origin (COO), central nervous system (CNS)-International Prognostic Index (IPI), and BCL2/MYC double-expression on CNS relapse in these patients. High CNS-IPI score, activated B-cell (ABC) subtype, or unclassified COO subtypes were found to be independent risk factors for CNS relapse in patients with DLBCL. Additionally, combining CNS-IPI score and COO improved the identification of patients at risk of CNS relapse. Interestingly, no significant difference in the incidence of CNS relapse was observed between the intermediate and low-risk CNS-IPI subgroups.