Non-GCB DLBCL May Benefit Most From Immunochemotherapy

Micrograph of DLBCL, lymph node FNA specimen, field stain; source: Nephron, Wikimedia Commons

The added survival benefit in patients with diffuse large B-cell lymphoma (DLBCL) when treated with the immunochemotherapy regimen R-ACVBP compared with R-CHOP may be related to the non-germinal center B-cell (GCB)-like subtype, according to the results of a study published in the Journal of Clinical Oncology. 

Thierry Jo Molina, MD, PhD, Hôpital Universitaire Necker Enfants-Malades, Université Paris Descartes, and colleagues came to this conclusion by conducting a biomarker analysis of patients in the LNH 03-2B trial. Results of the LNH 03-2B trial showed that treatment with R-ACVBP (rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) in addition to subsequent consolidation improved survival in patients with low-intermediate risk DLBCL compared to treatment with R-CHOP.

“At a time when ongoing phase III trials are aiming to improve R-CHOP by adding lenalidomide or a Bruton’s tyrosine kinase inhibitor to the treatment regimen for non-GCB patients, the observation of increased survival in this specific population when using a conventional regimen such as R-ACVBP could offer an attractive comparison,” Molina and colleagues wrote.

The researchers used immunohistochemistry to examine several tumor biomarkers- CD10, BCL6, MUM1, MYC, NCL2, and co-expression of MYC/BCL2-in 329 patients from the LNH 03-2B trial. They also classified 229 tumor samples using the Hans algorithm as GCB (n = 128) or non-GCB (n = 101).

The only significant interaction found between a biomarker and survival was between the Hans algorithm and the treatment arm for progression-free and overall survival. Those patients with non-GCB DLBCL treated with R-CHOP were found to have worse progression-free survival (HR = 3.21; 95% CI, 1.29-8.00) and overall survival (HR = 6.09; 95% CI, 1.37-27.03) compared with patients treated with the R-ACVBP regimen. Progression-free and overall survival were significantly longer in patients with non-GCB DLBCL who were treated with R-ACVBP compared with R-CHOP.

No differences in survival between regimens were found for patients with GCB DLBCL.

“The better survival observed in this study among patients with non-GCB tumors when treated with R-ACVBP compared with R-CHOP suggests that oncogenic events specific to non-GCB tumor cells, the hallmark being nuclear factor-κB activation, can be better targeted with R-ACVBP and a consolidation regimen than with R-CHOP,” the researchers wrote.