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Higher response to lenalidomide in relapsed/refractory diffuse large B‐cell lymphoma in nongerminal center B‐cell–like than in germinal center B‐cell–like phenotype
Author(s) -
HernandezIlizaliturri Francisco J.,
Deeb George,
Zinzani Pier L.,
Pileri Stefano A.,
Malik Farhana,
Macon William R.,
Goy Andre,
Witzig Thomas E.,
Czuczman Myron S.
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26135
Subject(s) - lenalidomide , germinal center , rituximab , diffuse large b cell lymphoma , medicine , single center , oncology , refractory (planetary science) , lymphoma , salvage therapy , b cell , international prognostic index , gastroenterology , chemotherapy , immunology , multiple myeloma , biology , antibody , astrobiology
BACKGROUND: There is a need to develop novel therapies for relapsed/refractory diffuse large B‐cell lymphoma (DLBCL) and to identify biomarkers predictive for therapeutic response. Lenalidomide was previously shown to induce an overall response rate (ORR) of 28% in patients with relapsed/refractory DLBCL. It is currently unknown if response rates differ between patients with different DLBCL subtypes. METHODS: The authors retrospectively evaluated clinical outcomes of patients with germinal center B‐cell–like versus nongerminal center B‐cell–like DLBCL treated with salvage lenalidomide at 4 academic institutions. RESULTS: Forty patients with relapsed/refractory DLBCL were included (24 men; 16 women; median age, 66 years; median of 4 prior treatments, including rituximab chemotherapy). Patients were classified as germinal center B‐cell–like (n = 23) or nongerminal center B‐cell–like (n = 17) DLBCL according to the Hans algorithm. The subgroups were similar in terms of stage, international prognostic index score, prior number of treatments, and rituximab resistance. A significant difference in clinical response to lenalidomide was observed in nongerminal center B‐cell–like versus germinal center B‐cell–like patients. ORR was 52.9% versus 8.7% ( P = .006); complete response rate was 23.5% versus 4.3%. Median progression‐free survival was 6.2 versus 1.7 months ( P = .004), although no difference in OS was observed between nongerminal center B‐cell–like and germinal center B‐cell–like DLBCL patients. CONCLUSIONS: The data suggest that the 2 major subgroups of patients with DLBCL (germinal center B cell and nongerminal center B cell) have different antitumor responsiveness to lenalidomide in the relapsed/refractory setting. A large international trial (NCT01197560) has been opened to enrollment in an attempt to prospectively validate these retrospective observations. Cancer 2011;. © 2011 American Cancer Society.