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Leuk Lymphoma. 2018 Aug;59(8):1884-1889. doi: 10.1080/10428194.2017.1406085. Epub 2017 Dec 3.

Outcomes of DA-EPOCH-R induction plus autologous transplant consolidation for double hit lymphoma.

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a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.
b Cancer Research and Biostatistics , Seattle , WA , USA.
c Department of Pathology , Oregon Health & Science University , Portland , OR , USA.


High-grade B cell lymphoma with MYC and BCL2 rearrangements (double hit) has a poor prognosis with standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). We report here a treatment algorithm of DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab) followed by BEAM (carmustine, etoposide, cytarabine, melphalan) autologous transplant in 36 cases of previously untreated double hit lymphoma (DHL) from 2010 to 2015. A high risk International Prognostic Index (IPI) was present in 42% of cases. At median follow-up of 38 months, the 2-year progression free survival (PFS) and overall survival (OS) were 69% (95% CI 54-84%) and 71% (95% CI 56-86%). Eight cases were refractory to induction with 1-year OS 20%, and no factors were predictive for primary refractory disease. Of 28 responders, 17 proceeded to transplant while 11 were observed, primarily due to age and co-morbidities. By 24-week landmark analysis after diagnosis, the 2-year PFS and OS were both 94% (95% CI 83-100%) vs 79% (95% CI 52-100%) for transplant vs observation (pā€‰=ā€‰.59 for both PFS and OS). There was no significant benefit to consolidative transplant in our series, and primary refractory DHL needs novel approaches.


Double hit lymphoma; EPOCH-R; autologous transplant

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