Prognostic factors in diffuse large B-cell lymphoma at diagnosis (excluding the International Prognostic Index) Ahead of print
- Key words: diffuse large B cell lymphoma, prognosis, cell of origin, MYC/BCL2/BCL6, total metabolic tumour volume, circulating tumour DNA
- DOI : 10.1684/hma.2022.1716
Diffuse large B cell lymphoma (DLBCL) is the most common adult non-Hodgkin's lymphoma, accounting for between 30% and 40% of all lymphomas. The prognosis varies widely, depending on various factors related to the patient (in particular, age and performance status) or to the characteristics of the lymphoma. Initially based on the Ann Arbor staging developed in 1971, the prognostic stratification was later enriched with the International Prognostic Index (IPI) developed in 1993 and revised in 2007 after the introduction of rituximab (R-IPI). Since then, a large number of prognostic factors have been identified, based on morphological (presence or absence of immunoblastic aspect), immunohistochemical (cell of origin, overexpression of MYC and/or BCL2 proteins, expression of TP53 protein, expression of CD30, CD5, PD-1 and/or PD-L1, proliferation index), and molecular (rearrangement of MYC/BCL2/BCL6 genes and mutational profile) characteristics of DLBCLs, and, more recently, information drawn from functional imaging (total metabolic tumour volume) or circulating tumour DNA. All these elements can be taken into consideration when deciding on patient treatment during multidisciplinary consultation meetings, although as of 2021, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) still remains the reference treatment for DLBCL.