Repeat biopsy in relapsed or refractory diffuse large B cell lymphoma: a nationwide survey and retrospective study

Abstract

Almost half of patients with diffuse large B-cell lymphoma (DLBCL) have relapsed/refractory (R/R) disease after frontline immunochemotherapy. Although guidelines recommend histological confirmation of R/R disease, repeat biopsies are not always performed. We conducted a two-part study: a nationwide case-vignette survey among treating hematologists, and a single center retrospective analysis. In the survey part, all 64 participating physicians opted not to perform a repeat biopsy in at least one scenario, more often in refractory cases. In the retrospective part, 116 episodes of R/R aNHL among 61 patients were identified. Repeat biopsy was not performed in 72%, more often in refractory episodes, mostly due to low likelihood of alternative diagnoses or problematic location for biopsy. Our study suggests that many patients do not undergo repeat biopsy in R/R DLBCL, especially in refractory cases. Future studies and recommendations should address the necessity of repeat biopsy, according to patient and disease related characteristics.

Keywords:

• Diffuse large B cell lymphoma (DLBCL)
• biopsy
• relapsed
• refractory
• diagnosis

Ethics approval

Approval was obtained from the ethics committee of Rabin Medical Center (RMC) Institutional Review Board (IRB), protocol approval number 0238-21-RMC. Informed consent was waived due to the retrospective design of the study. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Author contributions

OP and TB conceived the presented idea for the study. TB, MY, RG, PR and OP designed the research study. OP, KRG identified through our databases aggressive NHL patients as potential candidates for the study. TB, KRG and OP collected the data. TB, OP and TS analyzed the data. TB and OP drafted the manuscript. TB, MY, AGG, RG, PR, OP contributed to the interpretation of results and along with KRR and TS critically revised the paper. All authors approved the submitted and final version of the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author, TB, upon reasonable request.