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Abstract: Detection of bone marrow involvement (BMI) in diffuse large B-cell lymphoma (DLBCL) typically relies on invasive bone marrow biopsy (BMB) that faces procedure limitations, while 18F-FDG PET/CT imaging offers a noninvasive alternative. The present study assesses the performance of 18F-FDG PET/CT in DLBCL BMI detection, its agreement with BMB, and the impact of BMI on survival outcomes. Patients and methods This retrospective study analyzes baseline 18F-FDG PET/CT and BMB findings in145 stage II–IV DLBCL patients, evaluating both performance of the two diagnostic procedures and the impact of BMI on survival. Results DLBCL BMI was detected in 38 patients (26.2%) using PET/CT and in 18 patients (12.4%) using BMB. Concordant results were seen in 79.3% of patients, with 20.7% showing discordant results. Combining PET/CT and BMB data, we identified 29.7% of patients with BMI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT for detecting DLBCL BMI were 88.4%, 100%, 100%, 95.3%, and 96.5%, respectively, while BMB showed lower sensitivity (41.9%) and NPV (46.8%). The median overall survival (OS) was not reached in any gender subgroup, with 5-year OS rates of 82% (total), 84% (female), and 80% (male) (p = 0.461), while different International Prognostic Index (IPI) groups exhibited varied 5-year OS rates: 94% for low risk (LR), 91% for low-intermediate risk (LIR), 84% for high-intermediate risk (HIR), and 65% for high risk (HR) (p = 0.0027). Bone marrow involvement did not impact OS significantly (p = 0.979). Conclusions 18F-FDG PET/CT demonstrated superior diagnostic accuracy compared to BMB. While other studies reported poorer overall and BMI 5-year OS in DLBCL, our findings demonstrated favourable survival data.
Keywords: diffuse large B-cell lymphoma, bone marrow, biopsy
Published in DiRROS: 26.06.2026; Views: 137; Downloads: 59
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Abstract: CAR T cell therapy is a promising immunotherapy for hematologic malignancies, yet early prediction of outcomes and adverse events remains difficult, especially in small real-world cohorts. We retrospectively analyzed 14 adult patients with diffuse large B-cell lymphoma (DLBCL) treated with CAR T cells in Slovenia, assessing IL-6 increase rates and established predictive metrics including EASIX-C, CAR-HEMATOTOX, and IBPS on Day -5 (pre-lymphodepletion) and Day 0 (infusion). Contrary to our expectation, an inverse correlation was observed between the increase rate of IL-6 and the occurrence of severe cytopenias, indicating higher IL-6 increase rate leads to less severe cytopenias. The EASIX-C score showed higher predictive values when calculated on Day 0, contrary to the CAR-HEMATOTOX score, whose higher predictive values were observed on Day -5. The IBPS predictive values showed mixed results when comparing Day -5 to Day 0. We observed 50% response rate and 29% remission rate. The results highlight the utility of predictive scores, with unexpected findings on IL-6 suggesting further study is necessary.
Keywords: CAR T cell therapy, adverse events, diffuse large B-cell lymphoma, hematologic malignancies
Published in DiRROS: 07.04.2026; Views: 242; Downloads: 266
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Abstract: Diffuse large B-cell lymphoma (DLBCL) has variable prognosis, with only 50 to 60% of patients cured by standard first line treatment. Identifying patients unlikely to benefit from standard first line therapy is therefore crucial. Schmitz’s study identified four molecular subtypes of DLBCL with differing prognoses: MCD, BN2, N1, and EZB, with BN2 and EZB showing more favorable outcomes. This study aimed to evaluate the effectiveness of the Archer FusionPlex Lymphoma Assay in identifying the newly defined genetic subtypes of DLBCL, while also exploring the association between immunohistochemical (IHC) and next-generation sequencing (NGS) methods for classifying the cell of origin (COO) and assessing their predictive value for patient survival. Materials and methods. We classified 131 DLBCL patients using Hans algorithm into GCB (germinal center B-celllike) and ABC (activated B-cell-like) subtypes, and with NGS applying Archer FusionPlex lymphoma assay into ABC, GCB, unclassified, and into Schmitz’s novel genetic subtypes. A mutational analysis of just 7 genes (MYD88L265P, CD79B, EZH2, NOTCH1, NOTCH2, BCL2, and BCL6) was used for genetic classification. Various statistical models were applied to assess survival differences between subtypes. Finally, STRATOS analysis was conducted to validate our preliminary statistical findings. Results. 35.9% of patients were successfully classified into new genetic subtypes, with acceptable consistency between IHC and NGS method for COO determination. However, the new genetic subtype classification by NGS did not correlate with overall survival, nor did the COO classifications by IHC or NGS. The inclusion of these classifications also did not improve the predictive value of models compared to the basic model based on the International Prognostic Index (IPI) only. Conclusions. The Archer FusionPlex Lymphoma assay showed a somewhat lower detection rate of novel genetic subtypes compared to reports based on exome sequencing, yet identified novel genetic subtypes in over one-third of patients. However, an in-depth STRATOS statistical analysis did not confirm its predictive value for DLBCL prognosis, likely due to factors like patient selection and sample size limitations.
Keywords: diffuse large B-cell lymphoma, new genetic types, prognostic factors
Published in DiRROS: 26.11.2025; Views: 701; Downloads: 192
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Abstract: Approximately 40% of patients with diffuse large B-cell lymphoma (DLBCL) are not cured with first-line chemoimmunotherapy, resulting in poor prognosis. Schmitz et al. classified DLBCL into four prognostic genetic groups using whole-exome sequencing. We applied a simplified approach using a targeted next-generation sequencing assay (Archer FusionPlex Lymphoma Assay) to analyze samples from 105 patients—53 with a progression-free survival (PFS) < 2 years (the “Relapse group”) and 52 with a PFS > 5 years (the “Remission group”) following first-line systemic treatment. Patients were classified according to Schmitz et al. into the following categories: “MCD” (MYD88L265P and CD79B alteration), “N1” (NOTCH1 alteration), “BN2” (NOTCH2 alteration and BCL6 translocation), and “EZB” (EZH2 alteration and BCL2 translocation). The predictive value of this simplified genetic classification and of relevant clinical features were evaluated. The “Relapse group” included more patients classified as MCD and N1, while fewer were classified as EZB and BN2. Also, cell-of-origin (COO) characteristics and the size of N1 aligned with the classification of Schmitz et al. However, the limited sample size precludes definitive conclusions about the predictive value of our simplified approach. Additionally, male sex, B symptoms, and bone marrow involvement were associated with relapse. Therefore, these clinical features may be useful in predicting outcomes until an effective molecular classification is widely adopted.
Keywords: DLBCL, genetic classification, predictive, lymphoma
Published in DiRROS: 21.11.2025; Views: 575; Downloads: 239
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Published in DiRROS: 08.08.2025; Views: 617; Downloads: 211
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