Prognostic impact of history of follicular lymphoma, induction regimen and stem cell transplant in patients with MYC/BCL2 double hit lymphoma
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Shaoying Li1, Annapurna Saksena1, Parth Desai1, Jie Xu1, Zhuang Zuo1, Pei Lin1, Guilin Tang1, C. Cameron Yin1, Adam Seegmiller2, Jeffrey L. Jorgensen1, Roberto N. Miranda1, Nishitha M Reddy3, Carlos Bueso-Ramos1, L. Jeffrey Medeiros1
1Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
2Division of Hematopathology, Vanderbilt University Medical Center, Nashville, TN, USA
3Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
Shaoying Li, email: firstname.lastname@example.org
Keywords: double hit lymphoma, MYC/8q24, BCL2/t(14;18)(q32;q21), high grade B cell lymphoma
Received: February 08, 2016 Accepted: April 26, 2016 Published: May 19, 2016
MYC/BCL2 double hit lymphoma (DHL) has been the subject of many studies; however, no study has systemically compared the clinicopathologic features and prognostic factors between patients with de novo disease versus those with a history of follicular lymphoma (FL). In addition, the prognostic importance of several other issues remains controversial in these patients. In this retrospective study, we assess 157 patients with MYC/BCL2 DHL including 108 patients with de novo disease and 49 patients with a history of FL or rarely other types of low-grade B-cell lymphoma. Patients received induction chemotherapy regimens including 61 R-CHOP, 31 R-EPOCH, 29 R-Hyper-CVAD, and 23 other regimens. Thirty-nine patients received a stem cell transplant (SCT) including 31 autologous and 8 allogeneic. Sixty-two patients achieved complete remission (CR) after induction chemotherapy. Median overall survival (OS) was 19 months. Clinicopathologic features were similar between patients with de novo tumors versus those with a history of FL (P > 0.05). Using multivariate analysis, achieving CR, undergoing SCT, stage and the International Prognostic Index were independent prognostic factors for OS. Stem cell transplantion was associated with improved OS in patients who failed to achieve CR, but not in patients who achieved CR after induction chemotherapy. In conclusion, patients with MYC/BCL2 DHL who present with de novo disease and patients with a history of FL have a similarly poor prognosis. Achievement of CR, regardless of the induction chemotherapy regimen used, is the most important independent prognostic factor. Patients who do not achieve CR after induction chemotherapy may benefit from SCT.
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