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Clin Lymphoma Myeloma Leuk. 2015 Jun;15(6):341-8. doi: 10.1016/j.clml.2014.12.015. Epub 2015 Jan 3.

Outcome of Patients With Non-Hodgkin Lymphomas With Concurrent MYC and BCL2 Rearrangements Treated With CODOX-M/IVAC With Rituximab Followed by Hematopoietic Stem Cell Transplantation.

Author information

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.

KEYWORDS:

Aggressive B-cell lymphoma; BCLU; Double-hit lymphoma; Magrath protocol; allotransplant

PMID:
25656914
DOI:
10.1016/j.clml.2014.12.015
[Indexed for MEDLINE]

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