Respective prognostic values of germinal center phenotype and early (18)fluorodeoxyglucose-positron emission tomography scanning in previously untreated patients with diffuse large B-cell lymphoma.
OBJECTIVE
Diffuse large B-cell lymphomas (DLBCL) have a variable outcome, and powerful methods of prognostication are needed in order to choose the best treatment for each patient. Immunophenotypic classification of the tumor as germinal center (GC) or non-germinal center-like (nGC) and early response evaluation with 18fluorodeoxyglucose positron emission tomography (18FDG-PET) scanning have been correlated with survival in DLBCL but the two methods have never been evaluated simultaneously in the same patient population. Our aim was to investigate their respective prognostic values in the same series of patients.


METHODS
We investigated the expression of CD10, Bcl-6, and MUM1 in 81 patients with DLBCL evaluated early with 18FDG-PET. The tumors were classified as GC or nGC using the algorithm of Hans et al. The results of both methods were correlated with the patients' characteristics and survival.


RESULTS
CD10 was positive in 27/76 (36%), Bcl-6 in 43/74 (58%), and MUM1 in 33/73 (45%) interpretable cases. Thirty-eight (51%) were in the GC group, and 36 (49%) in the nGC group. With a median follow-up of 33 months, estimated 3-year event-free survival (EFS) of the whole population was 67%. There was no influence of GC/nGC phenotype on survival. Three-year EFS was 46% in the early PET-positive group versus 80% in the PET-negative group (p=0.0003).


CONCLUSIONS
The prognostic value of GC/nGC phenotype is not confirmed in this heterogeneous series, whereas early PET findings are confirmed to be a powerful predictor of outcome. The impact of treatment decisions based on early PET results should be evaluated.
Dupuis
Jehan
J
Departments of Clinical Hematology, Hôpital H. Mondor, Paris XII University, Créteil, France.
Gaulard
Philippe
P
Hemery
Francois
F
Itti
Emmanuel
E
Gisselbrecht
Christian
C
Rahmouni
Alain
A
Copie-Bergman
Christiane
C
Brière
Josette
J
El Gnaoui
Taoufik
T
Gaillard
Isabelle
I
Meignan
Michel
M
Haioun
Corinne
C
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D018858:Germinal Center / Q000473:pathology*; D006801:Humans; D016130:Immunophenotyping; D016393:Lymphoma, B-Cell / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D016403:Lymphoma, Large B-Cell, Diffuse / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D015996:Survival Rate
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D019788:Fluorodeoxyglucose F18