title: Evaluating cell-of-origin subtype methods for predicting diffuse large B-cell lymphoma survival: a meta-analysis of gene expression profiling and immunohistochemistry algorithms.
abstract: BACKGROUND
  Patients with DLBCL exhibit widely divergent outcomes despite harboring histologically identical tumors. Currently, GEP and IHC algorithms assign patients to 1 of 2 main subtypes: germinal center B cell-like (GCB), or activated B cell-like (ABC), the latter of which historically carries a less favorable prognosis. However, it remains controversial as to whether these prognostic groupings remain valid in the era of rituximab therapy.
  
  
  METHODS
  A systematic literature review identified 24 articles from which meta-analyses were conducted, comparing survival outcomes for patients assigned to either GCB or ABC/non-GCB subtype using GEP and/or Hans, Choi, or Muris IHC algorithms.
  
  
  RESULTS
  Patients designated as GCB DLBCL using GEP fared significantly better in terms of overall survival than those with ABC DLBCL (hazard ratio, 1.85; P < .0001). In contrast, the Hans and Choi algorithms failed to identify significant differences in overall survival (P = .07 and P = .76, respectively) between GCB and non-GCB groups.
  
  
  CONCLUSIONS
  Our study illustrates a lack of evidence supporting the use of the Hans and Choi algorithms for stratifying patients into distinct prognostic groups. Rather, GEP remains the preferred method for predicting the course of a patient's disease and informing decisions regarding treatment options.
authors: Emory University School of Medicine, Atlanta, GA.
authors: Jay A
authors: JA
authors: Read
authors: Emory University School of Medicine, Atlanta, GA.
authors: Jean L
authors: JL
authors: Koff
authors: The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors: Loretta J
authors: LJ
authors: Nastoupil
authors: Emory University School of Medicine, Atlanta, GA.
authors: Jessica N
authors: JN
authors: Williams
authors: Emory University School of Medicine, Atlanta, GA.
authors: Jonathon B
authors: JB
authors: Cohen
authors: Emory University School of Medicine, Atlanta, GA. Electronic address: crflowe@emory.edu.
authors: Christopher R
authors: CR
authors: Flowers
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D020869:Gene Expression Profiling; D006801:Humans; D007150:Immunohistochemistry; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics* / Q000378:metabolism* / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
keywords: Chemoimmunotherapy; Non-Hodgkin lymphoma; Prognosis; Rituximab; Systematic review