title: De novo CD5+ diffuse large B-cell lymphoma: Adverse outcomes with and without stem cell transplantation in a large, multicenter, rituximab treated cohort.
abstract: De novo CD5+ diffuse large B-cell lymphomas (DLBCL) are a distinct subgroup of DLBCL with poor prognosis. However the role of rituximab-containing therapy and salvage stem cell transplantation in this patients' population remain to be defined. We retrospectively reviewed clinical features and outcomes of 102 patients with de novo CD5+ DLBCL treated with rituximab-containing therapy at nine different institutions. By Hans' criteria, 64 patients had activated B-cell (ABC) subtype, 24 germinal center B-cell (GCB) subtype, and 14 were not evaluated. No patients had a myc translocation. Eighty-three patients were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP), 7 with rituximab, etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone (R-EPOCH), and 6 with R-CHOP with methotrexate, 3 g/m(2) . The overall response rate to front-line therapy was 85%. The 3-year progression free survival (PFS) and overall survival (OS) for all patients were 40 and 65%, respectively. The 3-year PFS for ABC- and GCB-subtypes was 34 and 45%, respectively. The 3-year OS for ABC- and GCB-subtypes was 62 and 67%, respectively. The median time to second treatment failure was 3 months and 1 month for ABC- and GCB-subtypes, respectively. Twenty of 28 (71%) transplanted patients with autologous, allogeneic, or both, relapsed. This study confirms the poor prognosis of de novo CD5+ DLBCL in a large multi-center cohort despite initial rituximab-containing chemotherapy and suggests that stem cell transplantation fails to salvage the majority of these patients. Approaches to prevent recurrence and/or novel therapies for relapsed disease are needed for this subgroup of DLBCL patients.
authors.affiliation: Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Lapo
authors.initials: L
authors.lastname: Alinari
authors.affiliation: Division of Hematopathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gru
authors.affiliation: Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Quinion
authors.affiliation: Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Arletta
authors.initials: A
authors.lastname: Lozanski
authors.affiliation: Division of Hematopathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Gerard
authors.initials: G
authors.lastname: Lozanski
authors.affiliation: Division of Hematology, Department of Internal Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Poston
authors.affiliation: Division of Hematopathology, Department of Pathology, University of Chicago, Chicago, IL, USA.
authors.forename: Girish
authors.initials: G
authors.lastname: Venkataraman
authors.affiliation: Division of Hematology, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Eunhye
authors.initials: E
authors.lastname: Oak
authors.affiliation: Division of Hematopathology, Department of Pathology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Friederike
authors.initials: F
authors.lastname: Kreisel
authors.affiliation: Division of Hematology, Department of Internal Medicine, University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Steven I
authors.initials: SI
authors.lastname: Park
authors.affiliation: Division of Hematology, Department of Internal Medicine, University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Matthews
authors.affiliation: Division of Hematology, Department of Internal Medicine, Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston Harvard Medical School, Boston, MA, USA.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Abramson
authors.affiliation: Division of Hematology, Department of Internal Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Hana
authors.initials: H
authors.lastname: Iris Lim
authors.affiliation: Division of Hematology, Department of Internal Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.affiliation: Division of Hematology, Department of Internal Medicine, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
authors.forename: Jonathon B
authors.initials: JB
authors.lastname: Cohen
authors.affiliation: Division of Hematology, Department of Internal Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Evens
authors.affiliation: Division of Hematology, Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Al-Mansour
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Singavi
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Kristie A
authors.initials: KA
authors.lastname: Blum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018956:CD5 Antigens / Q000378:metabolism*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D000069283:Rituximab / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018956:CD5 Antigens; D000069283:Rituximab