The different roles of molecular classification according to upfront autologous stem cell transplantation in advanced-stage diffuse large B cell lymphoma patients with elevated serum lactate dehydrogenase.
The non-germinal center B cell (non-GCB) subtype of diffuse large B cell lymphoma (DLBCL) is more related to poor prognosis than the GCB subtype. To investigate the role of molecular classification according to upfront autologous hematopoietic stem cell transplantation (ASCT), we retrospectively evaluated 219 newly diagnosed high-risk DLBCL patients. Eighty-one patients were in the ASCT group, and 138 patients were in the non-ASCT group. The ASCT group yielded significantly better overall survival (OS) and progression-free survival (PFS) than the non-ASCT group (p = 0.038 and p = 0.007), and patients with the non-GCB subtype were more related to inferior PFS than those with the GCB subtype (p = 0.020). After performing age-matching by using propensity scores, upfront ASCT continued to show better OS and PFS than non-ASCT (p = 0.046 and p = 0.026). In the non-ASCT group, the non-GCB subtype showed worse OS and PFS than the GCB subtype (p = 0.039 and p = 0.007). Patients who achieved complete response showed differences in OS and PFS according to molecular subtype (p = 0.007 and p = 0.002). In the ASCT group, there were no significant differences in OS and PFS according to molecular classification (p = 0.277 and p = 0.892). In conclusion, non-GCB subtype DLBCL patients showed poor OS and PFS in the non-ASCT group while they did not show clinical significance in the ASCT group. This suggests the possibility that upfront ASCT may improve the poor prognosis of non-GCB subtype in high-risk DLBCL.
Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Yu Ri
YR
Kim
Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Soo-Jeong
SJ
Kim
Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
June-Won
JW
Cheong
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, South Korea.
Deok-Hwan
DH
Yang
Hematologic-Oncology Clinic, Center for Specific Organs Cancer, National Cancer Center, Goyang, South Korea.
Hyewon
H
Lee
Hematologic-Oncology Clinic, Center for Specific Organs Cancer, National Cancer Center, Goyang, South Korea.
Hyeon-Seok
HS
Eom
Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
Yong Oh
YO
Sung
Department of Internal Medicine, Division of Hematology-Oncology, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, South Korea.
Hyo Jung
HJ
Kim
Department of Internal Medicine, Division of Hematology-Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea.
Hye Jin
HJ
Kang
Department of Internal Medicine, Division of Hematology-Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
Won-Sik
WS
Lee
Department of Internal Medicine, Division of Hematology-Oncology, Korea University College of Medicine, Seoul, South Korea.
Yong
Y
Park
Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea.
Woo-Ick
WI
Yang
Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Yoo Hong
YH
Min
Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. hemakim@yuhs.ac.
Jin Seok
JS
Kim
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood / Q000378:metabolism*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000145:classification / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D055815:Young Adult
D007770:L-Lactate Dehydrogenase
Autologous hematopoietic stem cell transplantation; Diffuse large B cell lymphoma; Germinal center B cell; Non-germinal center B cell; Rituximab