The largest study to date evaluating the impact of circulating lymphoma cells (CL) on outcomes in patients with newly diagnosed de novo diffuse large B-cell lymphoma (DLBCL) found that presence of CL at diagnosis was associated with inferior response rates and survival compared to those without CL.

The results, which were published in the Journal of Hematology & Oncology, suggest that clinicians should consider checking peripheral blood (PB) flow at diagnosis in all newly diagnosed patients with DLBCL.

In the retrospective study, adults with de novo DLBCL (diagnosed in or after 2010) who had received anthracycline-based chemotherapy in the first-line setting were grouped into the categories CL-positive (n=85, 15%) and CL- (n=503, 85%) based on PB immunophenotyping, where CL was defined as detectable clonally restricted B-cells that matched the actual or expected B-cell immunophenotype of DLBCL.

Patients in CL-positive group were younger (67 vs 70 years, P= 0.03) with a higher proportion of nonbulky disease (85% vs 56%, P< 0.0001), normal albumin (79% vs 54%, P< 0.0001), and MYC/BCL2 or BCL6 rearrangements (18% vs 7%, P= 0.003) compared to the CL-negative group.

The median progression-free survival (PFS) and overall survival (OS) in the entire cohort was 7.35 years and 9.8 years, respectively. Median PFS (1.7 versus 7.93 years, P< 0.0001) and OS (7.82 versus 10.04 years, P= 0.0019) were significantly inferior in the CL-positive group compared to CL- group.

After adjusting for factors associated with inferior PFS and OS in univariable analysis, presence of CL remained significantly associated with inferior PFS (HR=2.04, P< 0.0001) and OS (HR=1.61, P = 0.01), respectively. There was no significant difference in diagnosis-to-treatment interval between the two groups.

“Given the prognostic relevance associated with the presence of CL, clinicians should consider checking PB flow at diagnosis in all newly diagnosed patients with DLBCL,” the authors concluded.

Reference

Chowdhury SM, Bhatta S, Voorhees TJ, et al. Impact of circulating lymphoma cells at diagnosis on outcomes in patients with newly diagnosed de novo diffuse large B-cell lymphoma. J Hematol Oncol. 2025;18(1):4. 2025. doi:10.1186/s13045-024-01658-y