[Clinical characteristics and prognostic analysis of diffuse large B-cell lymphoma with TP53 mutation]

Abstract

Exploring the clinical and pathological characteristics and prognostic factors of diffuse large B-cell lymphoma (DLBCL) patients with TP53 mutation. Data of 86 DLBCL patients with TP53 mutation treated with R-CHOP and 19 DLBCL patients with TP53 mutation treated with R-CHOP like regimen as first-line treatment at the Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) and the Cancer Hospital of the CAMS in Shenzhen, China, from January 2006 to June 2023 were retrospectively analyzed. Multivariate Cox analysis was applied to assess the effects of the factors on survival. Among the 105 DLBCL patients with TP53 mutation, 56 were male (53.3%); the median age was 59 years. There were 54 cases with stage Ⅰ-Ⅱ and 51 cases with stage Ⅲ-Ⅳ diseases. The proportion of B-cell lymphoma 2 (BCL2) gene amplification was 9.5% (10/105). The complete response rate in the whole group of patients treated with the R-CHOP regimen was 28.6% (30/105). The median progression-free survival (PFS) was 10.1 (95%CI: 7.3-13.0) months, and the median overall survival (OS) was not reached. Stage Ⅲ-Ⅳ was a risk factor for OS (HR=2.80, 95%CI: 1.04-7.54), and elevated lactic dehydrogenase (LDH) was a risk factor for PFS (HR=2.86, 95%CI: 1.56-5.26) and OS (HR=2.90, 95%CI: 1.08-7.69). The median PFS was lower in patients with BCL2 amplification than in patients without amplification [4.0 (95%CI: 2.7-5.3) vs 11.3 (95%CI: 8.5-14.1) months, P=0.011]. Thirty-one of the 54 (57.4%) patients with stage Ⅰ-Ⅱ disease received combination therapy based on the R-CHOP protocol. In conclusion, stage Ⅲ-Ⅳ and elevated LDH were associated with poor prognosis in TP53 mutation DLBCL patients, and patients with BCL2 amplification had a poor prognosis. For TP53 mutation DLBCL patients with stage Ⅰ-Ⅱ disease, combination of therapeutic modalities based on the R-CHOP may improve the prognosis.