Feili Chen, Wenyu Li, Xiaojuan Wei, Ling Huang, Xingmiao Jiang, Hanguo Guo, Zhanli Liang

 Lymphoma division, Guangdong General Hospital

Objective:Addition of theanti-CD20 monoclonal antibody Rituximab to chemotherapies has improved the outcome of DLBCL with over 50% of patients achieving long-term survival. However, there are still 10-15% patients failing the first line chemotherapy. Some patients even have no response to first line chemotherapy which could beidentified as primary refractory ones. For this group of patients, the prognosis is really poor. Thus, it is challenging for oncologists to identify and improve the survival rates of them. Method: Clinical data of 38patients with primary refractory DLBCL admitted to our centre from March 2006and October 2014 were retrospectively reviewed to figure out the characteristic of this subset of disease, compare the efficacy of different salvage treatment and explore the factors influencing efficacy and survival. Result: The median age was 52(23-79), with 13 (34.2%) patients older than 60. More than half patients (65.8%) had an non-GCB type with 50% had a Ki67 more than90%. C-Myc was detected by IHC and FISH in 18 (47.4%) and 17 (46.0%) patients respectively, of them, 10(55.6%) had C-Myc more than 40%, 6 (35.3%) had C-Myc break gene. 34.2% of patients had an IPI higher than 2 at diagnosis and 44.7%had it at relapse. All patients received anthracycline-based chemotherapy, with22 (57.9%) having rituximab. Patients received a median of 3(1-7) lines regimens, 3(8.1%) patients had given up after progression. Gemcitabine-based regimens were the most commonly used salvage regimen (43.2%). However, 32(94.1%) of patients got no response. Some patients benefit from new target drugs. The median follow-up time is 10.32 (0.82~97.54) months with a median OS being 7.85 months and a median PFS being 1.71 months. SIPI>2, B-symptom and malegender were the strong negative predictors for PFS and OS in univariate analysis. Conclusion: Patients with primary refractory DLBCL had poor prognosis. Common salvage chemotherapy might not work. Higher expression of C-myc might contribute to the poor survival.

Key Words: DLBCL  Refractory  C myc