A high central nervous system (CNS) International Prognostic Index (IPI) score and activated B cell-like (ABC) or unclassified cell-of-origin (COO) subtype appear to be independent risk factors for CNS relapse in patients with diffuse large B cell lymphoma (DLBCL), according to a study published in Blood.
Researchers assessed whether CNS-IPI score, COO, and B cell lymphoma 2 (BCL2)/MYC dual-expression status could help stratify patients with DLBCL for CNS relapse risk. The team analyzed CNS relapse rates from the phase 3 GOYA study (ClinicalTrials.gov Identifier: NCT01287741), in which 1418 patients with DLBCL received obinutuzumab or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. COO was classified using gene expression profiling.
Within 2 years of treatment, 2.8% of patients experienced CNS relapse. High CNS-IPI score was found to be independently associated with CNS relapse (hazard ratio [HR], 4.0), as were ABC (HR, 5.2) and unclassified COO subtypes (HR, 4.2). BCL2/MYC dual-expression status was not associated with CNS relapse risk.
The researchers identified 3 subgroups by combining CNS-IPI score and ABC or unclassified COO to create the CNS-IPI-C risk stratification model. The 2-year CNS relapse rates were 0.5% for the low-risk subgroup (no risk factors), 4.4% in the intermediate-risk subgroup (1 risk factor), and 15.2% in the high-risk subgroup (2 risk factors).
The researchers concluded that combining high CNS-IPI and ABC/unclassified COO improved CNS relapse prediction and identified a patient subgroup at high risk of CNS relapse.
- Klanova M, Sehn LH, Bence-Bruckler I, et al. Integration of COO into the clinical CNS International Prognostic Index could improve CNS relapse prediction in DLBCL [published online January 7, 2019]. Blood. doi: 10.1182/blood-2018-07-862862