Cell of Origin Predicts Outcome to Treatment with Etoposide-containing Chemotherapy in Young Patients with High-risk Diffuse Large B-cell Lymphoma

Abstract Addition of etoposide to the R-CHOP chemotherapy-regimen with cyclofosfamide, doxorubicin, vincristine, prednisone and rituximab (R-CHOEP), has resulted in improved survival in young patients with high-risk diffuse large B-cell lymphoma (DLBCL). It is not known if biological factors can predict this effect. In this study 245 patients representing all young patients with high-risk DLBCL treated with R-CHOP or R-CHOEP in 2004-2012 in Denmark, were extracted from the Danish lymphoma database. Patients were stratified according to cell-of-origin (COO) into germinal-center B-cell-like (GCB) or nonGCB by Hans algorithm. Only in patients with GCB phenotype was treatment with R-CHOEP associated with improved progression free survival (PFS) and overall survival (OS) compared with R-CHOP. Patients with GCB phenotype treated with R-CHOEP also had superior OS compared with patients with nonGCB phenotype treated with R-CHOEP. This was not seen in R-CHOP treated patients. This could suggest that R-CHOEP should be restricted to patients with GCB phenotype.