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Mutation tied to central nervous system collapse in DLBCL

Publish date:: August 28, 2020

Key clinical point: A high MYD88 L265P mutation expression may be prognostic for the occurrence of CNS collapse in DLCBL patients.

Major finding: High MYD88 L265P mutation-expressing patients exhibited inferior CNS relapse free survival at 5 years (53.2% vs. 96%-100%, respectively, P < 0.001).

Study details: Digital PCR analysis of samples from 134 patients with DLBCL at diagnosis.

Disclosures: The study was not funded. Dr. Nishimura received consultancy fees from Chugai Pharmaceutical Co.

Commentary

“Central nervous system (CNS) relapse of diffuse large B-cell lymphoma carries a poor prognosis. While the CNS International Prognostic Index is typically used to estimate a patient’s risk of CNS relapse, additional prognostic information would be helpful in determining which patients may benefit from prophylaxis. Drs. Nishimura et al report interesting data on the MYD88 L265P mutation which is known to be present in some cases of DLBCL and other lymphomas, and in particular has been associated with CNS lymphomas. DLBCL patients who carried this mutation were significantly more likely to relapse in the CNS in 5 years compared to patients without this mutation. If validated in a larger number of patients with DLBCL, analysis of this mutation could enable clinicians to more accurately determine which patients to treat with CNS prophylaxis with intrathecal or high dose methotrexate.”