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Prognostic analysis of CD5 expression in double-hit diffuse large B-cell lymphoma and effectiveness comparison in patients treated with dose-adjusted EPOCH plus rituximab/R-CHOP regimens.
Blood Lymphat Cancer 2019; 9:33-43BL

Abstract

Objectives

To compare the efficacy of rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) with traditional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimens in CD5+ double-hit lymphoma (DHL) and to evaluate prognostic factors.

Methods

We retrospectively studied 139 patients with newly diagnosed DHL/THL diffuse large B-cell lymphoma (including 20 cases CD5+ and 119 cases CD5-), 87 cases were MYC/BCL2 DHL, 30 cases were MYC/BCL6 DHL, 22 cases were THL. MYC, BCL2 and BCL6 rearrangements were examined by fluorescence in-situ hybridization. CD5 is detected by immunohistochemistry (IHC).

Results

The objective response rate (ORR) difference between CD5+ and CD5- was significant (80.0% vs 63.8%, P=0.003). The median follow-up time was 18 months (range: 4-39 months). Progression-free survival (PFS) of CD5+ group was significantly worse than that of CD5- (28.1% vs 59.0%, P=0.028), while no significant difference was observed in overall survival (OS) (32.1% vs 59.9%, P=0.057). Compared with the two regimens, the 2-year survival rate of DA-EPOCH-R group was significantly superior than that of R-CHOP (63.6% vs 45.4%, P=0.034 for PFS; 67.4% vs 47.8%, P=0.038 for OS). Besides, CD5+ patients receiving DA-EPOCH-R had survival benefits compared with R-CHOP in PFS (85.7% vs 23.0%, P=0.029), but there was no statistical difference in OS (87.7% vs 34.4.0%, P=0.064). However, in DA-EPOCH-R protocol, there was no significant difference between CD5+ DHL (MYC/BCl2 and MYC/BCL6) and triple-hit lymphoma (P=0.776 for PFS; P=0.728 for OS). Multivariate analysis showed that CD5+ treatment regimen and disease stage were independent prognostic factors.

Conclusion

Our retrospective study shows that CD5+ has a poorer prognosis than CD5- patients. Based on its improved lifetime and good tolerance on CD5+ patients, which is expected to become the first-line treatment for high-risk DLBCL types based on more clinical research.

Authors+Show Affiliations

Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China. Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31692510

Citation

Zhang, Fangwen, et al. "Prognostic Analysis of CD5 Expression in Double-hit Diffuse Large B-cell Lymphoma and Effectiveness Comparison in Patients Treated With Dose-adjusted EPOCH Plus rituximab/R-CHOP Regimens." Blood and Lymphatic Cancer : Targets and Therapy, vol. 9, 2019, pp. 33-43.
Zhang F, Li L, Zhang L, et al. Prognostic analysis of CD5 expression in double-hit diffuse large B-cell lymphoma and effectiveness comparison in patients treated with dose-adjusted EPOCH plus rituximab/R-CHOP regimens. Blood Lymphat Cancer. 2019;9:33-43.
Zhang, F., Li, L., Zhang, L., Li, X., Fu, X., Wang, X., ... Zhang, M. (2019). Prognostic analysis of CD5 expression in double-hit diffuse large B-cell lymphoma and effectiveness comparison in patients treated with dose-adjusted EPOCH plus rituximab/R-CHOP regimens. Blood and Lymphatic Cancer : Targets and Therapy, 9, pp. 33-43. doi:10.2147/BLCTT.S216292.
Zhang F, et al. Prognostic Analysis of CD5 Expression in Double-hit Diffuse Large B-cell Lymphoma and Effectiveness Comparison in Patients Treated With Dose-adjusted EPOCH Plus rituximab/R-CHOP Regimens. Blood Lymphat Cancer. 2019;9:33-43. PubMed PMID: 31692510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic analysis of CD5 expression in double-hit diffuse large B-cell lymphoma and effectiveness comparison in patients treated with dose-adjusted EPOCH plus rituximab/R-CHOP regimens. AU - Zhang,Fangwen, AU - Li,Ling, AU - Zhang,Lei, AU - Li,Xin, AU - Fu,Xiaorui, AU - Wang,Xinhua, AU - Wu,Jingjing, AU - Sun,Zhenchang, AU - Kong,Fei, AU - Ren,Liangliang, AU - Zhang,Mingzhi, Y1 - 2019/08/19/ PY - 2019/05/19/received PY - 2019/07/11/accepted PY - 2019/11/7/entrez PY - 2019/11/7/pubmed PY - 2019/11/7/medline KW - CD5 KW - DA-EPOCH-R KW - R-CHOP KW - diffuse large B-cell lymphoma KW - double-hit KW - prognosis KW - treatment SP - 33 EP - 43 JF - Blood and lymphatic cancer : targets and therapy JO - Blood Lymphat Cancer VL - 9 N2 - Objectives: To compare the efficacy of rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) with traditional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimens in CD5+ double-hit lymphoma (DHL) and to evaluate prognostic factors. Methods: We retrospectively studied 139 patients with newly diagnosed DHL/THL diffuse large B-cell lymphoma (including 20 cases CD5+ and 119 cases CD5-), 87 cases were MYC/BCL2 DHL, 30 cases were MYC/BCL6 DHL, 22 cases were THL. MYC, BCL2 and BCL6 rearrangements were examined by fluorescence in-situ hybridization. CD5 is detected by immunohistochemistry (IHC). Results: The objective response rate (ORR) difference between CD5+ and CD5- was significant (80.0% vs 63.8%, P=0.003). The median follow-up time was 18 months (range: 4-39 months). Progression-free survival (PFS) of CD5+ group was significantly worse than that of CD5- (28.1% vs 59.0%, P=0.028), while no significant difference was observed in overall survival (OS) (32.1% vs 59.9%, P=0.057). Compared with the two regimens, the 2-year survival rate of DA-EPOCH-R group was significantly superior than that of R-CHOP (63.6% vs 45.4%, P=0.034 for PFS; 67.4% vs 47.8%, P=0.038 for OS). Besides, CD5+ patients receiving DA-EPOCH-R had survival benefits compared with R-CHOP in PFS (85.7% vs 23.0%, P=0.029), but there was no statistical difference in OS (87.7% vs 34.4.0%, P=0.064). However, in DA-EPOCH-R protocol, there was no significant difference between CD5+ DHL (MYC/BCl2 and MYC/BCL6) and triple-hit lymphoma (P=0.776 for PFS; P=0.728 for OS). Multivariate analysis showed that CD5+ treatment regimen and disease stage were independent prognostic factors. Conclusion: Our retrospective study shows that CD5+ has a poorer prognosis than CD5- patients. Based on its improved lifetime and good tolerance on CD5+ patients, which is expected to become the first-line treatment for high-risk DLBCL types based on more clinical research. SN - 1179-9889 UR - https://www.unboundmedicine.com/medline/citation/31692510/Prognostic_analysis_of_CD5_expression_in_double-hit_diffuse_large_B-cell_lymphoma_and_effectiveness_comparison_in_patients_treated_with_dose-adjusted_EPOCH_plus_rituximab/R-CHOP_regimens L2 - https://dx.doi.org/10.2147/BLCTT.S216292 DB - PRIME DP - Unbound Medicine ER -