DLBCL

New ESMO recommendations for prognostic tools

The European Society for Medical Oncology (ESMO) convened a consensus conference whose aim was to produce recommendations on the clinical prognostic factors for different types of mature B-cell lymphomas and CLL. The conference consisted of 25 leading experts who were split into three working groups, one of which was tasked with discussing prognostic factors. After relaying their evidence back to the whole group, a vote was taken on what the recommendation should be. This group looked at four topic areas: interim PET, minimal residual disease, TP53 mutations and Cell of Origin (COO). All recommendations were made with unanimous approval.

Interim FDG-PET as a prognostic tool for DLBCL

The panel defined interim PET as “any FDG-PET carried out during a planned systematic treatment”, typically after chemotherapy for 2–4 cycles. The panel recommended interim PET:

  • To be used as an exploratory surrogate chemosensitivity test and for diagnostics in trials in DLBCL patients
  • Not to be used in routine clinical patients with DLBCL
  • Not be used as a tool for decisions of non-HL, non-DLBCL, FDG-avid lymphomas

The panel also stated that access to FDG-PET needs to be improved.

COO determination as a prognostic tool by IHC or GEP

Clinically, DLBCL can be defined into two types dependent on their COO, GCB and ABC, each with different molecular and clinical characteristics. Different COOs have been identified using either Immunohistochemistry (IHC) or Gene Expression Profiling (GEP) and the panel reviewed both methods. The panel:

  • Does not encourage using IHC in prospective clinical trials for prognostic use or to guide intervention
  • Encourages using GEP for both prognosis and to guide intervention in prospective clinical trials
  • Does not recommend COO determination in clinical practice using either IHC or GEP in DLBCL patients

In conclusion, more studies are required in order to alter the above recommendations.

Title: ESMO consensus conference on malignant lymphoma: general perspectives and recommendations for prognostic tools in mature B-cell lymphomas and chronic lymphocytic leukaemia

Abstract:

The European Society for Medical Oncology (ESMO) consensus conference on mature B-cell lymphomas and chronic lymphocytic leukaemia (CLL) was held on 20 June 2015 in Lugano, Switzerland, and included a multidisciplinary panel of 25 leading experts. The aim of the conference was to develop recommendations on critical subjects difficult to consider in detail in the ESMO Clinical Practice Guidelines. The following areas were identified: (i) the elderly patient, (ii) prognostic factors suitable for clinical use and (iii) the ‘ultra-high-risk’ group. Before the conference, the expert panel was divided into three working groups; each group focused on one of these areas in order to address four clinically relevant questions relating to that topic. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, each working group developed recommendations to address each of the four questions assigned to their group. These recommendations were then presented to the entire panel and a consensus was reached. This manuscript presents recommendations dedicated to the second area of interest, i.e. prognostic factors suitable for clinical use. The four topics [i.e. interim positron emission tomography (PET), TP53 mutations, cell of origin (COO) and minimal residual disease (MRD)] were primarily chosen because of the bulk of available data together with the lack of clear guidance regarding their use in clinical practice and within clinical trials. Results, including a summary of evidence supporting each recommendation, are detailed in this manuscript. The panel acknowledged that detection of TP53 inactivation by deletion or mutation in CLL should be implemented in clinical practice (level of evidence I, strength of recommendation A). Due to their potentially high prognostic value, at least in some lymphoma entities, implementation of interim PET, COO and MRD was highly recommended in the context of clinical trials. All expert panel members approved this final article.

Reference:
  1. Ladetto M. et al. ESMO consensus conference on malignant lymphoma: general perspectives and recommendations for prognostic tools in mature B-cell lymphomas and chronic lymphocytic leukaemia. Annals of Oncology. First published online, 2016 October 4. doi:10.1093/annonc/mdw419