Frontline treatment of aggressive B-cell lymphoma

Authors

  • Shannon Murphy, MD Dalhousie University, Halifax, NS

DOI:

https://doi.org/10.58931/cht.2023.2341

Abstract

Aggressive B-cell non-Hodgkin lymphoma, which most often manifests as diffuse large B-cell lymphoma (DLBCL), is the most common non-Hodgkin lymphoma, accounting for up to 30% of diagnosed cases. It is responsible for considerable morbidity and mortality worldwide, with a global burden of approximately 150,000 new patients annually. Large B-cell lymphoma encompasses a group of lymphomas with significant clinical and biological heterogeneity. While there are approximately 18 variations of large B-cell lymphoma in the upcoming 5th edition of the World Health Organization classification of lymphoid neoplasms (WHO-HAEM5), for the purposes of this review the aggressive B-cell lymphomas will refer to the most common entity, diffuse large B-cell lymphoma, not otherwise specified (DLBCL), as well as diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements (DLBCL/HGBL-MYC/BCL2), and high-grade B-cell lymphoma, not otherwise specified (HGBL,NOS).

Author Biography

Shannon Murphy, MD, Dalhousie University, Halifax, NS

Dr. Shannon Murphy is a Hematologist and Assistant Professor at Dalhousie University and practices at the QEII Health Sciences Centre in Halifax, NS. Prior to joining the Division of Hematology and Hematologic Oncology in Halifax, Dr. Murphy completed her internal medicine and hematology training at Dalhousie University, followed by a 1-year clinical lymphoma fellowship with BC Cancer in Vancouver. Her practice focuses on lymphoma and chronic lymphocytic leukemia.

References

Sehn LH, Salles G. Diffuse large b-cell lymphoma. N Engl J Med. 2021;384(9):842-858.

Alaggio R, Amador C, Anagnostopoulos I, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia. 2022;36(7):1720–1748.

Barraclough A, Hawkes E, Sehn LH, et al. Diffuse large B-cell lymphoma. Haematol Oncol. 2023;

Rosenwald A, Wright G, Chan WC, et al. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(25):1937-1947.

Scott DW, Mottok A, Ennishi D, et al. Prognostic significance of diffuse large b-cell lymphoma cell of origin determined by digital gene expression in formalin-fixed paraffin-embedded tissue biopsies. J Clin Oncol. 2015;33(26):2848-2856.

Alduaij W, Collinge B, Ben-Neriah S, et al. Molecular determinants of clinical outcomes in a real-world diffuse large B-cell lymphoma population. Blood. 2023;141(20):2493-2507.

Vitolo U, Trněný M, Belada D, , et al. Obinutuzumab or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in previously untreated diffuse large b-cell lymphoma. J Clin Oncol. 2017;35(31):3529-3537.

Delarue R, Tilly H, Mounier N, et al. Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncology. 2013;14(6):525-533.

Bartlett NL, Wilson WH, Jung SH, et al. Dose-adjusted EPOCH-R compared with R-CHOP as frontline therapy for diffuse large b-cell lymphoma: clinical outcomes of the Phase III Intergroup Trial Alliance/CALGB 50303. J Clin Oncol. 2019;37(21):1790-1799.

Davies A, Cummin TE, Barrans S, et al. Gene-expression profiling of bortezomib added to standard chemoimmunotherapy for diffuse large B-cell lymphoma (REMoDL-B): an open-label, randomised, phase 3 trial. Lancet Oncology. 2019;20(5):649-662.

Davies AJ, Stanton L, Caddy J, et al. Five-year survival results from the remodl-B trial (ISRCTN 51837425) show improved outcomes in diffuse large B-cell lymphoma molecular subgroups from the addition of bortezomib to R-CHOP chemoimmunotherapy. Blood. 2022;140(Suppl 1):1770-1772. Abstract 735.

Younes A, Sehn LH, Johnson P, et al. Randomized phase III trial of ibrutinib and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in non-germinal center b-cell diffuse large b-cell lymphoma. J Clin Oncol. 2019;37(15):1285-1295.

Nowakowski GS, Hong F, Scott DW, et al. Addition of lenalidomide to R-CHOP improves outcomes in newly diagnosed diffuse large b-cell lymphoma in a randomized phase II US Intergroup Study ECOG-ACRIN E1412. J Clin Oncol. 2021;39(12):1329–38.

Nowakowski GS, Chiappella A, Gascoyne RD, et al, et al. ROBUST: a phase III study of lenalidomide plus R-CHOP versus placebo plus R-CHOP in previously untreated patients with ABC-type diffuse large b-cell lymphoma. J Clin Oncol. 2021;39(12):1317-1328.

Tilly H, Morschhauser F, Sehn LH, et al. Polatuzumab vedotin in previously untreated diffuse large b-cell lymphoma. N Engl J Med. 2022;386(4):351-363.

Olszewski AJ, Kurt H, Evens AM. Defining and treating high-grade B-cell lymphoma, NOS. Blood. 2022;140(9):943–54.

Savage KJ, Johnson NA, Ben-Neriah S, et al. MYC gene rearrangements are associated with a poor prognosis in diffuse large B-cell lymphoma patients treated with R-CHOP chemotherapy. Blood. 2009;114(17):3533-3537.

Laude MC, Lebras L, Sesques P, et al. First-line treatment of double-hit and triple-hit lymphomas: Survival and tolerance data from a retrospective multicenter French study. Am J Hematol. 2021;96(3):302–11.

Chen Y, Cai Q, Chang Yet al. High-intensity chemotherapy improved the prognosis of patients with high-grade B-cell lymphoma. Front Immunol. 2022 Dec 23;13:1047115.

Moharana L, Dasappa L, Babu S, et al. Comparison between CHOP and DAEPOCH with or without rituximab in adult high grade b cell lymphoma, not otherwise specified; a retrospective study from a tertiary cancer hospital in South India. Indian J Front Hematol Blood Transfus. 2022 Jan;38(1):15-23.

Strüßmann T, Glatzki F, Engelhardt M, et al. Favourable outcomes of double-hit/double-expressor lymphoma and high-grade B-cell lymphoma, not otherwise specified after early dose-intensive treatment and up-front autologous stem cell transplantation: a single-centre retrospective experience. Br J Hematol. 2022 Aug;198(4):776-779.

Zeremski V, McPhail ED, Habermann TM, et al. Treatment intensification might not improve survival in high-grade B-cell lymphoma with a concurrent MYC and BCL2 and/or BCL6 rearrangement: A retrospective, multicenter, pooled analysis. Hematol Oncol. 2023 March 21. doi: 10.1002/hon.3130. Online ahead of print.

Zeremski V, Kropf S, Koehler M, et al. Induction treatment in high-grade B-cell lymphoma with a concurrent MYC and BCL2 and/or BCL6 rearrangement: a systematic review and meta-analysis. Front Oncol. 2023 Jul 20;13:1188478.

Mead GM, Barrans SL, Qian W, et al. UK National Cancer Research Institute Lymphoma Clinical Studies Group; Australasian Leukaemia and Lymphoma Group. A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 trial). Blood. 2008 Sep 15;112(6):2248-2260.

McMillan AK, Phillips EH, Kirkwood AA, et al. Favourable outcomes for high-risk diffuse large B-cell lymphoma (IPI 3-5) treated with front-line R-CODOX-M/R-IVAC chemotherapy: results of a phase 2 UK NCRI trial. Ann Oncol. 2020 Sep;31(9):1251-1259.

Dunleavy K, Fanale MA, Abramson JS, et al. Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study. Lancet Haematol. 2018;5(12):e609–e617.

Chen AI, Leonard JT, Okada CY, et al. Outcomes of DA-EPOCH-R induction plus autologous transplant consolidation for double hit lymphoma. Leuk Lymphoma. 2018 Aug;59(8):1884-1889.

Dodero A, Guidetti A, Marino F, et al. Dose-adjusted EPOCH and rituximab for the treatment of double expressor and double-hit diffuse large B-cell lymphoma: impact of TP53 mutations on clinical outcome. Haematologica. 2022;107(5):1153-1162.

Goyal G, Magnusson T, Wang X, et al. Modern, real-world patterns of care and clinical outcomes among patients with newly diagnosed diffuse large B-cell lymphoma with or without double/triple-hit status in the United States. Haematologica. 2023;108(4):1190-1195.

Published

2023-11-06

How to Cite

1.
Murphy S. Frontline treatment of aggressive B-cell lymphoma. Can Hematol Today [Internet]. 2023 Nov. 6 [cited 2024 Jun. 19];2(3):28-31. Available from: https://canadianhematologytoday.com/article/view/2-3-murphy

Issue

Section

Articles