Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics

• Authors: Pallawi Torka, Roswell Park Comprehensive Cancer Center; Shalin K. Kothari, Yale University; Suchitra Sundaram, Roswell Park Comprehensive Cancer Center; Shaoying Li, The University of Texas MD Anderson Cancer Center; L. Jeffrey Medeiros, The University of Texas MD Anderson Cancer Center; Emily C. Ayers, University of Pennsylvania; Daniel J. Landsburg, University of Pennsylvania; David A. Bond, Ohio State University; Kami J. Maddocks, Ohio State University; Anshu Giri, Medical University of South Carolina; Brian Hess, Medical University of South Carolina; Luu Q. Pham, Stanford University; Ranjana Advani, Stanford University; Yang Liu, Emory University; Stefan Klaus Barta, Fox Chase Cancer Center; Julie M. Vose, University of Nebraska Medical Center; Michael C. Churnetski, Emory University; Jonathon Cohen, Emory University; Madelyn Burkart, Northwestern University; Reem Karmali, Northwestern University; Joanna Zurko, University of Alabama Birmingham; Amitkumar Mehta, University of Alabama Birmingham; Adam J. Olszewski, Brown University; Sarah Lee, Cleveland Clinic Foundation; Brian T. Hill, Cleveland Clinic Foundation; Timothy F. Burns, Dartmouth Hitchcock Medical Center; Frederick Lansigan, Dartmouth Hitchcock Medical Center; Emma Rabinovich, University of Illinois; David Peace, University of Illinois; Adrienne Groman, Roswell Park Comprehensive Cancer Center; Kristopher Attwood, Roswell Park Comprehensive Cancer Center; Francisco J. Hernandez-Ilizaliturri, Roswell Park Comprehensive Cancer Center
• Journal Title: Blood Advances
• Volume: Volume 4, Number 2
• Publisher: American Society of Hematology | 2020-01-28, Pages 253-262
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1182/bloodadvances.2019000875
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; DOUBLE-HIT LYMPHOMA; SOUTHWEST-ONCOLOGY-GROUP; PLUS RADIOTHERAPY; ELDERLY-PATIENTS; POOR-PROGNOSIS; INVOLVED-FIELD; R-CHOP; RITUXIMAB; MYC; CHEMOTHERAPY

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.