Haowei Sun1, Kerry J Savage2, Aly Karsan3, Graham W Slack4, Randy D Gascoyne4, Cynthia L Toze5, Laurie H Sehn2, Yasser Abou Mourad5, Michael J Barnett5, Raewyn C Broady5, Joseph M Connors2, Donna L Forrest5, Alina S Gerrie6, Donna E Hogge5, Sujaatha Narayanan5, Thomas J Nevill5, Stephen H Nantel5, Maryse M Power5, Heather J Sutherland5, Diego Villa2, John D Shepherd5, Kevin W Song7. 1. Division of Hematology, University of British Columbia, Vancouver, Canada. 2. Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada. 3. Genome Sciences Centre and Department of Pathology, British Columbia Cancer Agency, Vancouver, Canada. 4. Centre for Lymphoid Cancer and Department of Pathology, British Columbia Cancer Agency, Vancouver, Canada. 5. Division of Hematology, University of British Columbia, Vancouver, Canada; Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada. 6. Division of Hematology, University of British Columbia, Vancouver, Canada; Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada; Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada. 7. Division of Hematology, University of British Columbia, Vancouver, Canada; Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada. Electronic address: ksong@bccancer.bc.ca.
Abstract
BACKGROUND: Double-hit lymphoma is characterized by the presence of concurrent MYC (myelocytomatosis oncogene) and BCL2 (B-cell lymphoma 2) gene rearrangements. Prognosis is poor with standard chemoimmunotherapy. Since 2003, the British Columbia Cancer Agency has used CODOX-M/IVAC+R (cyclophosphamide, vincristine, doxorubicin, methotrexate, cytarabine, ifosfamide, and etoposide, combined with rituximab) followed by consolidative hematopoietic cell transplantation as definitive treatment for double-hit lymphoma. PATIENTS AND METHODS: A retrospective review of the survival outcomes of patients with double-hit lymphoma treated at our institution was conducted. Thirty-two patients diagnosed with non-Hodgkin lymphoma with concurrent MYC and BCL2 translocations from 2003 to 2013 were identified. Cases with MYC or BCL2 amplification and those with overexpression in immunohistochemistry analysis were excluded. RESULTS: Median age at diagnosis was 53.0 years (range, 35.5-70.9 years), 23 (72%) were male, and 30 (94%) had stage III to IV disease. CODOX-M/IVAC+R was administered in 25 (78%) patients and 20 (80%) achieved a partial remission or better, of which 9 (36%) had a complete remission. Nineteen of the 32 (59%) patients underwent upfront hematopoietic cell transplantation. At a median follow-up of living patients of 26.4 months, 14 (44%) were alive in remission, 15 (47%) died, and 3 (9%) were alive in relapse. The 2-year progression-free survival (PFS) and overall survival (OS) of all patients were 41% and 53%, respectively. The sixteen patients treated with CODOX-M/IVAC+R followed by hematopoietic cell transplantation had a 2-year PFS of 60% and 2-year OS of 82%. CONCLUSION: Patients with double-hit lymphoma treated with CODOX-M/IVAC+R followed by hematopoietic cell transplantation can achieve durable remissions, although disease progression before transplantation remains a significant problem.
BACKGROUND: Double-hit lymphoma is characterized by the presence of concurrent MYC (myelocytomatosis oncogene) and BCL2 (B-cell lymphoma 2) gene rearrangements. Prognosis is poor with standard chemoimmunotherapy. Since 2003, the British Columbia Cancer Agency has used CODOX-M/IVAC+R (cyclophosphamide, vincristine, doxorubicin, methotrexate, cytarabine, ifosfamide, and etoposide, combined with rituximab) followed by consolidative hematopoietic cell transplantation as definitive treatment for double-hit lymphoma. PATIENTS AND METHODS: A retrospective review of the survival outcomes of patients with double-hit lymphoma treated at our institution was conducted. Thirty-two patients diagnosed with non-Hodgkin lymphoma with concurrent MYC and BCL2 translocations from 2003 to 2013 were identified. Cases with MYC or BCL2 amplification and those with overexpression in immunohistochemistry analysis were excluded. RESULTS: Median age at diagnosis was 53.0 years (range, 35.5-70.9 years), 23 (72%) were male, and 30 (94%) had stage III to IV disease. CODOX-M/IVAC+R was administered in 25 (78%) patients and 20 (80%) achieved a partial remission or better, of which 9 (36%) had a complete remission. Nineteen of the 32 (59%) patients underwent upfront hematopoietic cell transplantation. At a median follow-up of living patients of 26.4 months, 14 (44%) were alive in remission, 15 (47%) died, and 3 (9%) were alive in relapse. The 2-year progression-free survival (PFS) and overall survival (OS) of all patients were 41% and 53%, respectively. The sixteen patients treated with CODOX-M/IVAC+R followed by hematopoietic cell transplantation had a 2-year PFS of 60% and 2-year OS of 82%. CONCLUSION:Patients with double-hit lymphoma treated with CODOX-M/IVAC+R followed by hematopoietic cell transplantation can achieve durable remissions, although disease progression before transplantation remains a significant problem.
Authors: T Kobayashi; J Kuroda; I Yokota; K Tanba; T Fujino; S Kuwahara; R Isa; J Yamaguchi; E Kawata; T Akaogi; H Uchiyama; H Kaneko; N Uoshima; Y Kobayashi; S Teramukai; M Taniwaki Journal: Blood Cancer J Date: 2016-01-15 Impact factor: 11.037
Authors: Ellen D McPhail; Matthew J Maurer; William R Macon; Andrew L Feldman; Paul J Kurtin; Rhett P Ketterling; Rakhee Vaidya; James R Cerhan; Stephen M Ansell; Luis F Porrata; Grzegorz S Nowakowski; Thomas E Witzig; Thomas M Habermann Journal: Haematologica Date: 2018-06-14 Impact factor: 9.941