Early, Late DLBCL Relapse Linked With Distinct Evolutionary Dynamics

The timing of relapse in patients with diffuse large B-cell lymphoma (DLBCL) is associated with specific evolutionary patterns, according to study results published online ahead of print in the Journal of Clinical Oncology.

“These results emphasize the importance of repeat biopsy and molecular analysis of relapsed DLBCL, and further our understanding of malignant B-cell evolutionary dynamics,” wrote the journal’s editor in chief Jonathan W Friedberg, MD.

To investigate the evolutionary dynamics that underpin the relationship between relapse timing and outcomes after second-line (immuno)chemotherapy, researchers studied serial DLBCL biopsies of 129 patients.

Between diagnosis and relapse, biopsies were mostly consistent for the broader molecular categories of cell-of-origin classification and genetics-based subgroups, according to the study.

Relapses that occurred more than 2 years after diagnosis derived from serial, potentially treatment-naïve transformations from persistent common precursor cell populations, researchers reported. Relapses that occurred earlier, however, were more closely genetically related, suggesting innate resistance to (immuno)chemotherapy.

“These observations have implications for clinical trial design and patient management, where early and late relapse patient populations should be considered separately and support additional molecular characterization of tumors at relapse to guide precision medicine approaches,” wrote corresponding author David W Scott, PhD, Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, Canada, and study coauthors.

Reference: 
Hilton LK, Ngu HS, Collinge B, et al. Relapse Timing Is Associated With Distinct Evolutionary Dynamics in Diffuse Large B-Cell lymphoma. J Clin Oncol. Published online June 15, 2023. doi:10.1200/JCO.23.00570