Patients with diffuse large B-cell lymphoma (DLBCL) and concurrent indolent lymphomas may experience similar outcomes compared with patients with DLBCL alone, according to results published in Blood.
Approximately 10% to 15% of patients with DLBCL have a concurrent indolent non-Hodgkin lymphoma (NHL) at the time of diagnosis. Researchers sought to characterize the prevalence, pathological features, and clinical outcomes of DLBCL with concurrent indolent lymphoma in a prospective study.
A total of 1324 patients with DLBCL who were treated with immunochemotherapy at a single center between March 2002 and June 2015 were included. Concurrent indolent lymphomas were present in 171 (12.9%) patients, including follicular lymphoma (FL) in 109 (8.2%) patients, marginal zone lymphoma in 15 (1.1%) patients, chronic lymphocytic leukemia/small lymphocytic lymphoma in 14 (1.1%) patients, lymphoplasmacytic lymphoma in 2 (0.2%) patients, and B-cell NHL not otherwise specified in 31 (2.3%) patients.
Patients with concurrent DLBCL and FL had fewer elevations in lactate dehydrogenase and lower International Prognostic Index (IPI) scores (P <.01 for both) compared with patients with DLBCL alone. DLBCL was germinal center B-cell-like (GCB) for 92.9% of patients with concurrent FL and 61.8% for patients with DLBCL alone (P <.01).
Median overall survival (OS) was not reached for patients with concurrent FL and 14.5 years for patients with DLBCL alone (P =.05); median event-free survival (EFS) was 11.5 years for patients with concurrent FL and 10.1 years for patients with DLBCL alone (P =.47). Patients with concurrent FL had similar median OS (not reached for both; P =.24) and median EFS (11.5 vs 10.6 years; P =.81) compared with patients who had GCB DLBCL alone.
In patients with concurrent DLBCL and other indolent lymphomas, disease stage was more advanced (P <.01) and IPI scores were higher (P =.09) compared with patients with DLBCL alone. A total of 47.7% of patients with other indolent lymphomas had non-GCB DLBCL (P =.06).
Median OS was similar between patients with other concurrent indolent lymphomas and patients with DLBCL alone (10.0 vs 14.5 years; P =.33), while median EFS was decreased for patients with other concurrent indolent lymphomas (4.8 vs 10.1 years; P =.09).
Site of indolent component did not appear to influence either EFS or OS.
The authors concluded that “patients [with DLBCL and] concurrent FL at the time of diagnosis [should] be included in clinical trials of newly diagnosed DLBCL.”
1. Wang Y, Link B, Witzig T, et al. Impact of concurrent indolent lymphoma on the clinical outcome of newly diagnosed diffuse large B-cell lymphoma [published online July 26, 2019]. Blood. doi:10.1182/blood.2019000858