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Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics. Blood advances Torka, P. n., Kothari, S. K., Sundaram, S. n., Li, S. n., Medeiros, L. J., Ayers, E. C., Landsburg, D. J., Bond, D. A., Maddocks, K. J., Giri, A. n., Hess, B. n., Pham, L. Q., Advani, R. n., Liu, Y. n., Barta, S. K., Vose, J. M., Churnetski, M. C., Cohen, J. B., Burkart, M. n., Karmali, R. n., Zurko, J. n., Mehta, A. n., Olszewski, A. J., Lee, S. n., Hill, B. T., Burns, T. F., Lansigan, F. n., Rabinovich, E. n., Peace, D. n., Groman, A. n., Attwood, K. n., Hernandez-Ilizaliturri, F. J. 2020; 4 (2): 253–62

Abstract

There is a paucity of data regarding outcomes and response to standard therapy in patients with limited-stage (LS) agressive B-cell lymphoma (LS-ABCL) who harbor MYC rearrangement (MYC-R) with or without BCL2 and/or BCL6 rearrangements. We conducted a multicenter retrospective study of MYC-R LS-ABCL patients who received either rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), or more intensive immunochemotherapy (IIC) plus or minus consolidative involved-field radiation therapy (IFRT). One hundred four patients from 15 academic centers were included. Forty four patients (42%) received R-CHOP, of whom 52% had IFRT. Sixty patients (58%) received IIC, of whom 40% had IFRT. Overall response rate was 91% (84% complete response [CR]; 7% partial response). Patients with double-hit lymphoma (DHL; n = 40) had a lower CR rate compared with patients with MYC-R only (75% vs 98%; P = .003). CR rate was higher in the IFRT vs no-IFRT group (98% vs 72%; P < .001). Median follow-up was 3.2 years; 2-year progression-free survival (PFS) and overal survival (OS) were 78% and 86% for the entire cohort, and 74% and 81% for the DHL patients, respectively. PFS and OS were similar across treatment groups (IFRT vs no IFRT, R-CHOP vs IIC) in the entire cohort and in DHL patients. Our data provide a historical benchmark for MYC-R LS-ABCL and LS-DHL patients and show that outcomes for this population may be better than previously recognized. There was no benefit of using IIC over R-CHOP in patients with MYC-R LS-ABCL and LS-DHL.

View details for DOI 10.1182/bloodadvances.2019000875

View details for PubMedID 31945157