Does cell-of-origin or MYC, BCL2 or BCL6 translocation status provide prognostic information beyond the International Prognostic Index score in patients with diffuse large B-cell lymphoma treated with rituximab and chemotherapy? A systematic review

Abstract

We examined the additional prognostic value for survival of cell-of-origin, and MYC, BCL2 and BCL6 translocation status to that provided by the International Prognostic Index in newly-diagnosed diffuse large B-cell lymphoma (DLBCL) patients treated firstline with rituximab-containing immunochemotherapy. We searched Medline, Premedline, Embase, the Cochrane Library, Web of Science, and ISI Proceedings (2000–2015) and assessed study risk-of-bias using a prognostic study checklist. Forty-four studies of moderate–high risk of bias with 100–712 participants were included. Immunohistochemistry-determined cell-of-origin, and BCL2 and BCL6 translocation status added no additional prognostic value. Half of the studies on gene expression profiling-determined cell-of-origin and MYC translocation status found that germinal center B-cell–like (GCB) and no translocation were associated with better overall survival (OS) whereas the remaining studies found no effect of these covariates. Further studies are required to ensure that biological information assessed using newer technologies can be reliably used for studies that incorporate newer agents targeting distinct molecular abnormalities identified in high-risk DLBCL patients.

Keywords:

• Prognosis
• cell-of-origin
• translocation
• rearrangement
• multivariate analyses
• DLBCL

Acknowledgements

This article presents a systematic review undertaken as part of the 2016 NICE guideline on non-Hodgkin’s lymphoma, which was developed by what was formerly the National Collaborating Centre for Cancer (NCC-C) and now the National Guideline Alliance (NGA). The NCC-C and the NGA received funding from the National Institute for Health and Care Excellence (NICE). The authors thank NICE, the NCC-C, the NGA and the Guideline Development Group for the non-Hodgkin’s lymphoma NICE Guideline (5). The views expressed in this publication are those of the authors and not necessarily those of NICE.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://dx.doi.org/10.1080/10428194.2017.1287364.