Diffuse large B-cell lymphoma classification system that associates normal B-cell subset phenotypes with prognosis.

Journal Article (Journal Article)

PURPOSE: Current diagnostic tests for diffuse large B-cell lymphoma use the updated WHO criteria based on biologic, morphologic, and clinical heterogeneity. We propose a refined classification system based on subset-specific B-cell-associated gene signatures (BAGS) in the normal B-cell hierarchy, hypothesizing that it can provide new biologic insight and diagnostic and prognostic value. PATIENTS AND METHODS: We combined fluorescence-activated cell sorting, gene expression profiling, and statistical modeling to generate BAGS for naive, centrocyte, centroblast, memory, and plasmablast B cells from normal human tonsils. The impact of BAGS-assigned subtyping was analyzed using five clinical cohorts (treated with cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP], n = 270; treated with rituximab plus CHOP [R-CHOP], n = 869) gathered across geographic regions, time eras, and sampling methods. The analysis estimated subtype frequencies and drug-specific resistance and included a prognostic meta-analysis of patients treated with first-line R-CHOP therapy. RESULTS: Similar BAGS subtype frequencies were assigned across 1,139 samples from five different cohorts. Among R-CHOP-treated patients, BAGS assignment was significantly associated with overall survival and progression-free survival within the germinal center B-cell-like subclass; the centrocyte subtype had a superior prognosis compared with the centroblast subtype. In agreement with the observed therapeutic outcome, centrocyte subtypes were estimated as being less resistant than the centroblast subtype to doxorubicin and vincristine. The centroblast subtype had a complex genotype, whereas the centrocyte subtype had high TP53 mutation and insertion/deletion frequencies and expressed LMO2, CD58, and stromal-1-signature and major histocompatibility complex class II-signature genes, which are known to have a positive impact on prognosis. CONCLUSION: Further development of a diagnostic platform using BAGS-assigned subtypes may allow pathogenetic studies to improve disease management.

Full Text

Duke Authors

Cited Authors

  • Dybkær, K; Bøgsted, M; Falgreen, S; Bødker, JS; Kjeldsen, MK; Schmitz, A; Bilgrau, AE; Xu-Monette, ZY; Li, L; Bergkvist, KS; Laursen, MB; Rodrigo-Domingo, M; Marques, SC; Rasmussen, SB; Nyegaard, M; Gaihede, M; Møller, MB; Samworth, RJ; Shah, RD; Johansen, P; El-Galaly, TC; Young, KH; Johnsen, HE

Published Date

  • April 20, 2015

Published In

Volume / Issue

  • 33 / 12

Start / End Page

  • 1379 - 1388

PubMed ID

  • 25800755

Pubmed Central ID

  • 25800755

Electronic International Standard Serial Number (EISSN)

  • 1527-7755

Digital Object Identifier (DOI)

  • 10.1200/JCO.2014.57.7080


  • eng

Conference Location

  • United States