Quiz: Genetics and Epidemiology of Diffuse Large B-Cell Lymphoma

Can you name biomarkers that are associated with PCNS-DLBCL? Are you aware of contraindications for use of rituximab in DLBCL? Test your knowledge by taking this multiquestion quiz.

Question 1

Answer

D.PD1/PDL1

According to a recent study in Hematological Oncology, expression of PD1 (programmed death 1) in tumor-infiltrating lymphocytes is associated with tumor cell expression of its ligand, PDL1 (programmed death ligand 1) and poorer overall survival (P = .01). Tumors of patients with PCNS-DLBCL expressed BCL2, CMYC, and P53 at rates similar to those of patients with systemic DLBCL, but without the prognostic significance such expression has for patients with systemic DLBCL.

Question 2

Answer

A. True

In an analysis of 137 hepatitis C virus–positive patients with DLBCL, patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) had a significantly higher risk of grade 3/4 liver toxicity (28% vs 18%; P = .001) and worse progression-free survival than those receiving CHOP without rituximab.

Question 3

Answer

D.30%

Approximately 30% of patients with DLBCL are not cured. It is the most common type of non-Hodgkin lymphoma among adults.

Question 4

Answer

B.Four

The analysis of 574 DLBCL biopsy samples identified four prominent genetic subtypes of the disease: (1) “MCD” (harboring co-mutations in MYD88^L265P and NOTCH1), (2) “BN2” (harboring BCL6 fusions and NOTCH2 mutations), (3) “N1” (harboring NOTCH1 mutations), and (4) “EZB” (harboring BCL2 translocations and EZH2 mutations). BN2 and EZB subtypes were associated with better survival than MCD or N1 subtypes, and patients with EZB subtype DLBCL had significantly higher ECOG (Eastern Cooperative Oncology Group) performance status than other patients. However, International Prognostic Index (IPI) scores did not vary between the genetic subtypes, the authors reported. The N1 subtype is associated with poor response to R-CHOP and a prominent T-cell gene expression pattern, leading the authors to call for studies of immune checkpoint inhibitors in these patients.

Question 5

Answer

D.All of the above: Epstein-Barr virus, hepatitis B virus, and hepatitis C virus

Epstein-Barr virus (EBV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are each associated with DLBCL. HCV is involved in lymphomagenesis, and antiviral therapy can sometimes cure patients with HCV-positive low-grade B-cell lymphomas, according to authors of a recent case-control study of 44 hepatitis C virus (HCV)-positive patients and 132 HCV-negative control patients. The authors found that HCV-positive DLBCL exhibits distinct pathologic and genetic signatures compared with HCV-negative DLBCL; these include different patterns of expression for genes involved in immune response, and an absence of BCL2 translocations.