T-Cell-Rich Large B-Cell Lymphoma: Biology and Prognosis

Background: T-cell/histiocyte-rich large B-cell lymphoma (T/HRBCL, THRLBCL) is an uncommon morphological variant of diffuse large B-cell lymphoma (DLBCL) characterized by a distinctive tumor microenvironment and variable clinical behavior.
Objective: to analyze the clinicopathologic feature of T/HRBCL at a single tertiary center and compare presentation, treatment, and survival with a contemporaneous cohort of conventional DLBCL.
Methods: this retrospective cohort study was conducted at the Oncology Center, Mansoura University between January 2015 and December 2022. Thirty-six patients with T/HRBCL were included and compared with 203 randomly selected, unmatched DLBCL controls. Demographic, laboratory, and pathologic data, treatments, and outcomes were extracted. Responses were assessed by Lugano criteria, and OS and PFS were estimated using Kaplan–Meier methods with log-rank testing.
Results: Patients with T/HRBCL were younger, predominantly male, and more frequently presented with B-symptoms, elevated LDH, and advanced disease compared with conventional DLBCL. Most received R-CHOP, achieving a complete remission rate of 59.4%, slightly lower than DLBCL (67.3%) but not statistically significant. Salvage regimens, particularly GDP (gemcitabine, dexamethasone and cisplatin), produced encouraging results with a CR rate of 62.5%. Despite initial responses, survival was inferior in T/HRBCL, with median PFS (progression-free survival) and OS (overall survival) significantly shorter than in DLBCL (14 vs. 40 months for PFS, p = 0.001; 67 months vs. not reached for OS, p < 0.001). Male sex was an independent adverse prognostic factor for OS.
Conclusion: T/HRBCL presented with distinct clinicopathologic features and earlier progression compared with conventional DLBCL despite frequent use of R-CHOP. The data support careful early risk-stratification and exploration of biology-driven therapeutic strategies.