PURPOSE: To evaluate the prognostic value of the cell of origin (COO) in 
patients with relapsed/refractory diffuse large B-cell lymphoma (DLBLC), 
prospectively treated by rituximab, dexamethasone, high-dose cytarabine, and 
cisplatin (R-DHAP) versus rituximab, ifosfamide, carboplatin, and etoposide and 
followed by intensive therapy plus autologous stem-cell transplantation on the 
Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) trial.
PATIENTS AND METHODS: Among the 396 patients included on the trial, histologic 
material was available for a total of 249 patients at diagnosis (n = 189 
patients) and/or at relapse (n = 147 patients), which included 87 matched pairs. 
The patient data were analyzed by immunochemistry for CD10, BCL6, MUM1, FOXP1, 
and BCL2 expression and by fluorescent in situ hybridization for BCL2, BCL6 and 
c-MYC breakpoints. The correlation with survival data was performed by using the 
log-rank test and the Cox model.
RESULTS: Characteristics of immunophenotype and chromosomal abnormalities were 
statistically highly concordant in the matched biopsies. In univariate analysis, 
the presence of c-MYC gene rearrangement was the only parameter to be 
significantly correlated with a worse progression-free survival (PFS; P = .02) 
and a worse overall survival (P = .04). When treatment interaction was tested, 
the germinal center B (GCB) -like DLBCL that was based on the algorithm by Hans 
was significantly associated with a better PFS in the R-DHAP arm. In 
multivariate analysis, independent prognostic relevance was found for the 
GCB/non-GCB the Hans phenotype interaction treatment (P = .04), prior rituximab 
exposure (P = .0052), secondary age-adjusted International Prognostic Index (P = 
.039), and FoxP1 expression (P = .047). Confirmation was obtained by gene 
expression profiling in a subset of 39 patients.
CONCLUSION: COO remains a major and independent factor in relapsed/refractory 
DLBCL, with a better response to R-DHAP in GCB-like DLBCL. This needs 
confirmation by a prospective study.