Expression of programmed cell death ligand 1 is associated with poor overall survival in patients with diffuse large B-cell lymphoma

Abstract

Programmed cell death ligand 1 (PD-L1) is expressed on both select diffuse large B-cell lymphoma (DLBCL) tumor cells and on tumor-infiltrating nonmalignant cells. The programmed cell death 1 (PD-1)/PD-L1 pathway inhibits host antitumor responses; however, little is known about how this pathway functions in the tumor microenvironment. The aim of this study was to determine the clinicopathological impact of PD-L1⁺ DLBCL. We performed PD-L1/PAX5 double immunostaining in 1253 DLBCL biopsy samples and established a new definition of PD-L1⁺ DLBCL. We also defined the criteria for microenvironmental PD-L1⁺ (mPD-L1⁺) DLBCL (ie, PD-L1^– DLBCL in which PD-L1⁺ nonmalignant cells are abundant in the tumor microenvironment). Of the 273 patients whose clinical information was available, quantitative analysis of PD-1⁺ tumor-infiltrating lymphocytes (TILs) was performed. The prevalence rates of PD-L1⁺ and mPD-L1⁺ DLBCL were 11% and 15.3%, respectively. Both PD-L1⁺ and mPD-L1⁺ DLBCL were significantly associated with non–germinal center B-cell (GCB) type and Epstein-Barr virus positivity. The number of PD-1⁺ TILs was significantly higher in GCB-type tumors and lower in mPD-L1^– and PD-L1⁺ DLBCL. Patients with PD-L1⁺ DLBCL had inferior overall survival (OS) compared with that in patients with PD-L1^– DLBCL (P = .0009). In contrast, there was no significant difference in OS between mPD-L1⁺ and mPD-L1^– DLBCL (P = .31). The expression of PD-L1 maintained prognostic value for OS in multivariate analysis (P = .0323). This is the first report describing the clinicopathological features and outcomes of PD-L1⁺ DLBCL. Immunotherapy targeting the PD-1/PD-L1 pathway should be considered in this distinct DLBCL subgroup.