High-Grade B-Cell Lymphoma,NOS : Does Prognosis End with the Diagnosis? - a Retrospective Analysis

Background

High-Grade B-cell Lymphoma (HGBL) was a new disease entity proposed in 2016 to define a particularly aggressive subset of DLBCL. It consisted of two entities - HGBL with double hit(DH)/ triple hit(TH) and HGBL,NOS. While the aggressive nature of HGBL with DH/TH is well described, the data on the other subset of HGBL - HGBL,NOS is lacking in literature. We conducted this analysis to study the clinical profile of HGBL,NOS versus DLBCL,NOS.

Methodology

Retrospective, registry-based, single centre analysis of all patients diagnosed between 1.1.2017 till 31.12.2019 with the histopathological diagnosis of (1) DLBCL (2) HGBL,NOS and (3) HGBL with DH/TH.

Results

One hundred and forty four cases were identified, including 109 DLBCL,NOS, 29 HGBL, NOS and 6 cases of HGBL with DH/TH. The comparison of these 3 aggressive lymphoma subsets has been shown in table 1. HGBL,NOS had worse outcome in comparison to DLBCL,NOS (median PFS 20months vs NR, p=0.12) with a median follow up of 19 months. But the multivariate Cox analysis confirmed that DLBCL vs HGBL significantly affected PFS(p<0.005). End of treatment complete remission showed significant(p<0.001) PFS benefit with respect to both subsets. GCB subtype and IPI score significantly(p=0.03) influenced PFS in DLBCL,NOS but not in HGBL NOS. The DA-EPOCH-R arm did significantly (p<0.05) worse than R CHOP arm with respect to DLBCL NOS. For HGBL,NOS the analysis failed to show any significant difference in PFS with respect to different chemotherapeutic regimen delivered (RCHOP/DA EPOCH R/R mini CHOP).

Conclusion

High-grade B-cell lymphoma, NOS is part of the spectrum of aggressive large B -cell lymphomas with prognosis intermediate to DLBCL, NOS and HGBL with DH/TH. The ideal therapeutic regimen for this aggressive lymphoma needs to be addressed prospectively in clinical trials.

Table

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Table

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