Summary
In recent years, it has become increasingly apparent that diffuse large B-cell lymphoma (DLBCL) is not a single pathologic entity. Widely available diagnostic techniques such as immunohistochemical staining and fluorescence in situ hybridization (FISH) have helped to subcategorize DLBCLs by their pathologic features and identify those associated with a lower probability of cure after standard first-line rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
Original Article
Molecular Risk Stratification in Aggressive B-Cell Lymphomas
Journal of Clinical Oncology
Zachary A.K. Frosch, MD and Daniel J. Landsburg, MD
In recent years, it has become increasingly apparent that diffuse large B-cell lymphoma (DLBCL) is not a single pathologic entity. Widely available diagnostic techniques such as immunohistochemical staining and fluorescence in situ hybridization (FISH) have helped to subcategorize DLBCLs by their pathologic features and identify those associated with a lower probability of cure after standard first-line rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). This recognition has prompted increased use of diagnostic testing to identify patients with high-risk aggressive lymphoma, the results of which have, at times, led clinicians to offer such patients alternative first-line treatment regimens in hopes of increasing their likelihood of achieving cure. Here, we further explore this concept of molecular risk stratification among patients with DLBCL or high-grade B-cell lymphoma (HGBL), consider potential limitations to performing such stratification in current practice, and suggest how risk stratification may be more optimally implemented now and in the future.