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Researchers characterize new subtype of high-grade DLBCL

3 articles from the Journal of Clinical Oncology

Key clinical point: Researchers have characterized a subtype of diffuse large B-cell lymphoma (DLBCL) dubbed “molecular high-grade” (MHG) DLBCL.

Major finding: Patients with this subtype were more likely to have germinal center B-cell-like (GCB) DLBCL, MYC rearrangements, double-hit lymphoma, and inferior survival.

Study details: A discovery cohort of 928 DLBCL patients, a validation cohort of 624 DLBCL patients, and a comparison cohort of 70 patients with Burkitt lymphoma.

Disclosures: This research was supported by Bloodwise. The researchers disclosed relationships with a range of pharmaceutical companies.

Citation:

Sha C et al. J Clin Oncol. 2019 Jan 20;37(3):202-12. doi: 10.1200/JCO.18.01314; Chan WC. J Clin Oncol. 2019 Jan 20;37(3):175-7. doi: 10.1200/JCO.18.01910; Ennishi D et al. J Clin Oncol. 2019 Jan 20;37(3):190-201. doi: 10.1200/JCO.18.01583

Commentary:

Dr. David Henry, Editor in Chief of MDedge Hematology/Oncology, comments:

Dr. Sha and colleagues published their findings of a new subtype of diffuse large B-cell lymphoma (DLBCL), they call molecular high-grade (MHG). They applied a 70-gene sequence panel to a group of 928 DLBCL patients and found that 83 (9%) came out in this MHG group, who had a worse prognosis than usual DLBCL.

This MHG group was highly enriched with MYC single or double-hit mutations. They found these patients had a poorer response to standard aggressive DLBCL chemotherapy and tended to have a higher International Prognostic Index (IPI) score. In the same JCO issue, Dr. Ennishi and colleagues published similar results supporting Dr. Sha's findings of this new MHG group (2019 Jan 20;37[3]:190-201).

While the IPI score has helped clinicians immensely in its ability to stage and guide aggressive systemic chemotherapy choice, in this increasingly molecular and biomarker targeting era, this MHG analysis (with prognostic and possibly predictive information for treating DLBCL patients) will further help characterize who may need more or less aggressive therapy and help clinicians with their patient discussions regarding possible outcomes.