Treatments and Outcomes of Newly Diagnosed CD5‐Positive Diffuse Large B‐Cell Lymphoma: A Multi‐Institutional Observational Study

CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) is characterized by a poor prognosis and frequent central nervous system (CNS) relapse. Sandwich therapy comprising dose-adjusted (DA)-EPOCH-R (etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, and rituximab) and high-dose methotrexate (HD-MTX) (DA-EPOCH-R/HD-MTX) showed excellent efficacy and manageable safety in a phase II study of patients diagnosed with stage II-IV CD5+ DLBCL. To validate the results of that study and elucidate the current state of treatment for CD5+ DLBCL, we retrospectively analyzed the outcomes of patients with CD5+ DLBCL diagnosed between 2016 and 2021 who received anthracycline-containing chemotherapy with rituximab. Among the 346 patients evaluated, 62 (18%) received DA-EPOCH-R/HD-MTX. The median follow-up time was 43 months. In 55 patients with stage II-IV disease treated with DA-EPOCH-R/HD-MTX, the 2-year overall survival (OS), progression-free survival, and cumulative incidence of CNS relapse were 87% (95% CI, 73%-94%), 76% (95% CI, 61%-86%), and 7.3% (95% CI, 2.4%-16%), respectively. There were no treatment-related deaths. Febrile neutropenia occurred in 18 (33%) patients. Multivariate analysis of the 346 patients identified elevated serum lactate dehydrogenase levels, multiple extranodal involvement, no intrathecal MTX (IT-MTX), and no DA-EPOCH-R/HD-MTX as independent risk factors for OS. Only one CNS relapse event was observed in 28 patients who received both HD-MTX and IT-MTX. Our study provides real-world data on the treatments and outcomes of a large number of patients. The favorable survival and manageable toxicity of DA-EPOCH-R/HD-MTX have been validated in clinical settings. The use of HD-MTX and IT-MTX might be effective for preventing CNS relapse in patients with CD5+ DLBCL.

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Publication Details

Journal
Hematological Oncology
Published
2025-02-12
DOI
https://doi.org/10.1002/hon.70047
Citations
4
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
5.89

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article

Treatments and Outcomes of Newly Diagnosed CD5‐Positive Diffuse Large B‐Cell Lymphoma: A Multi‐Institutional Observational Study

Koichi Ohshima, Ritsuro Suzuki, Isao Tawara, Kana Miyazaki et al.
4 citations
Hematological Oncology
Lymphoma Diagnosis and Treatment
5.89
article

Treatments and Outcomes of Newly Diagnosed CD5‐Positive Diffuse Large B‐Cell Lymphoma: A Multi‐Institutional Observational Study

Koichi Ohshima, Ritsuro Suzuki, Isao Tawara, Kana Miyazaki, Eiju Negoro, Koji Izutsu, Yuma Nato, Naoto Tomita, Yuto Kaneda, Dai Maruyama, Tomotaka Suzuki, Hiroyuki Takahashi, Kazutaka Sunami, Motoko Yamaguchi, Junji Hiraga, Hiroko Tsunemine, Koji Kato, Noriko Fukuhara, Momoko Nishikori, Akio Saito, Junya Makiyama, Yasufumi Masaki, Hiroshi Gomyo, Taro Masunari, Shuji Momose, Ilseung Choi, Jun Takizawa, Masahiro Yoshida, Nobuyuki Takayama, Naoki Takahashi, Takeharu Kato, Takahiro Okada, Yuri Miyazawa, Naoko Asano, Satsuki Murakami, Kohtaro Toyama, Masataka Okamoto
article en
4 citations

Abstract

CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) is characterized by a poor prognosis and frequent central nervous system (CNS) relapse. Sandwich therapy comprising dose-adjusted (DA)-EPOCH-R (etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, and rituximab) and high-dose methotrexate (HD-MTX) (DA-EPOCH-R/HD-MTX) showed excellent efficacy and manageable safety in a phase II study of patients diagnosed with stage II-IV CD5+ DLBCL. To validate the results of that study and elucidate the current state of treatment for CD5+ DLBCL, we retrospectively analyzed the outcomes of patients with CD5+ DLBCL diagnosed between 2016 and 2021 who received anthracycline-containing chemotherapy with rituximab. Among the 346 patients evaluated, 62 (18%) received DA-EPOCH-R/HD-MTX. The median follow-up time was 43 months. In 55 patients with stage II-IV disease treated with DA-EPOCH-R/HD-MTX, the 2-year overall survival (OS), progression-free survival, and cumulative incidence of CNS relapse were 87% (95% CI, 73%-94%), 76% (95% CI, 61%-86%), and 7.3% (95% CI, 2.4%-16%), respectively. There were no treatment-related deaths. Febrile neutropenia occurred in 18 (33%) patients. Multivariate analysis of the 346 patients identified elevated serum lactate dehydrogenase levels, multiple extranodal involvement, no intrathecal MTX (IT-MTX), and no DA-EPOCH-R/HD-MTX as independent risk factors for OS. Only one CNS relapse event was observed in 28 patients who received both HD-MTX and IT-MTX. Our study provides real-world data on the treatments and outcomes of a large number of patients. The favorable survival and manageable toxicity of DA-EPOCH-R/HD-MTX have been validated in clinical settings. The use of HD-MTX and IT-MTX might be effective for preventing CNS relapse in patients with CD5+ DLBCL.

Hematological OncologyVol. 43(2)
Kurume University (JP), University of Fukui (JP), Kyushu University (JP), Fujita Health University (JP), St. Marianna University School of Medicine (JP), Aichi Medical University (JP), Kanazawa Medical University (JP), Gunma University (JP), Shimane University (JP), Mie University (JP), Kyorin University (JP), Kyoto University (JP), Kanagawa Prefectural Hospital Organization (JP), Nagoya City University (JP), Sasebo City General Hospital (JP), National Hospital Organization Kyushu Cancer Center (JP), Tohoku University Hospital (JP), Nagano Prefectural Suzaka Hospital (JP), Osaka City General Hospital (JP), Gifu University Hospital (JP), Chugoku Central Hospital (JP), Shinko Hospital (JP), Toyota Kosei Hospital (JP), Okayama Medical Center (JP), Tokyo National Hospital (JP), Social Insurance Saitama Chuo Hospital (JP), Hyogo Prefectural Cancer Center (JP), Nagasaki University Hospital (JP), Japanese Foundation For Cancer Research (JP), Fujita Health University Okazaki Medical Center, Kanagawa Cancer Center, Niigata University (JP), Saitama Medical University (JP)
Japan Society for the Promotion of Science
Openalex Percentile: Top 5%
Lymphoma Diagnosis and Treatment
5.89
DOIOpen Access PDFOpenAlex
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