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Prof. Dr. med. Alexandar Tzankov

Faculty of Medicine

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Clinical Impact of Genetic Pathway Defects on Rituxan (Rituximab)-CHOP therapy in Patients with Diffuse Large B-cell Lymphoma

Research Project  | 1 Project Members

Diffuse large B cell lymphoma (DLBCL) is the most common lymphoid malignancy, comprising approximately 30% of all adult lymphomas, with a rapidly rising incidence [Fisher & Fisher 2006; Mitterlechner et al. 2006; Stein et al. 2008]. DLBCL demonstrate an aggressive clinical course that requires aggressive therapy, but only about 40% of patients can be cured by cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or equivalent regimens [Coiffier 2005 & 2007]. The demonstration of the activity of the monoclonal anti-CD20 antibody rituximab (R) in phase II and III studies [Coiffier et al. 2002] has established R-CHOP as the new standard of DLBCL treatment, potentially curing 60% of patients [Sehn et al. 2005; Pfreundschuh et al. 2006; Coiffier 2007]. Prior to R-CHOP, prediction of survival and stratification of patients for risk-adjusted therapy was based on the international prognostic index (IPI) [Shipp et al. 1993], which consists of five easily assessable, predominantly patient-related, clinical and laboratory parameters: age, serum lactate dehydrogenase, stage, performance status and >1 extranodal sites involved. R-CHOP has not only led to a marked improvement in DLBLC survival, but has also called into question the significance of IPI [Sehn et al. 2007], leading to the introduction of the revised IPI (R-IPI). Importantly, preliminary data suggest that IPI and R-IPI can no longer identify DLBCL risk-groups with <50% chance of survival, although about 40% of patients will still die of/with disease. Thus, there is an urgent need for identification of additional, particularly tumor-related, prognostic and predictive factors in DLBCL. Structural and numerical aberrations of the oncogenes MYC, BCL2 and BCL6 as well as of the tumor suppressor p53 are reliably assessable on paraffin-embedded lymphoma tissue samples [e.g. Obermann et al. 2009a & b; Tibiletti et al. 2009; Tzankov et al. 2009]. Their prognostic role in DLBCL has been postulated in CHOP treated collectives (see Appendix 5.4.1.), but little is known on their prognostic and predictive role in R-CHOP treated cases. The aim of the present study will be to clarify the prognostic and predictive importance of the gene status of MYC, BCL2, BCL6 and p53 on over 800 DLBCL cases treated with R-CHOP with respect to other clinical and phenotypic features, especially DLBCL histogenesis from germinal center- (GC) or non-/post-GC B cells [Alizadeh et al. 2000; Hans et al. 2004].