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Li S, Saksena A, Desai P, Xu J, Zuo Z, Lin P, Tang G, Yin CC, Seegmiller A, Jorgensen JL, Miranda RN, Reddy NM, Bueso-Ramos C, Medeiros LJ. Prognostic impact of history of follicular lymphoma, induction regimen and stem cell transplant in patients with MYC/BCL2 double hit lymphoma. Oncotarget 2018; 7:38122-38132. [PMID: 27203548 PMCID: PMC5122376 DOI: 10.18632/oncotarget.9473] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/26/2016] [Indexed: 12/27/2022] Open
Abstract
MYC/BCL2 double hit lymphoma (DHL) has been the subject of many studies; however, no study has systemically compared the clinicopathologic features and prognostic factors between patients with de novo disease versus those with a history of follicular lymphoma (FL). In addition, the prognostic importance of several other issues remains controversial in these patients. In this retrospective study, we assess 157 patients with MYC/BCL2 DHL including 108 patients with de novo disease and 49 patients with a history of FL or rarely other types of low-grade B-cell lymphoma. Patients received induction chemotherapy regimens including 61 R-CHOP, 31 R-EPOCH, 29 R-Hyper-CVAD, and 23 other regimens. Thirty-nine patients received a stem cell transplant (SCT) including 31 autologous and 8 allogeneic. Sixty-two patients achieved complete remission (CR) after induction chemotherapy. Median overall survival (OS) was 19 months. Clinicopathologic features were similar between patients with de novo tumors versus those with a history of FL (P > 0.05). Using multivariate analysis, achieving CR, undergoing SCT, stage and the International Prognostic Index were independent prognostic factors for OS. Stem cell transplantion was associated with improved OS in patients who failed to achieve CR, but not in patients who achieved CR after induction chemotherapy. In conclusion, patients with MYC/BCL2 DHL who present with de novo disease and patients with a history of FL have a similarly poor prognosis. Achievement of CR, regardless of the induction chemotherapy regimen used, is the most important independent prognostic factor. Patients who do not achieve CR after induction chemotherapy may benefit from SCT.
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Affiliation(s)
- Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Annapurna Saksena
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Parth Desai
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhuang Zuo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pei Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam Seegmiller
- Division of Hematopathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey L Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Takahashi H, Miura K, Nakagawa M, Sugitani M, Amano Y, Kurita D, Sakagami M, Ohtake S, Uchino Y, Kodaira H, Iriyama N, Kobayashi S, Hojo A, Kobayashi Y, Hirabayashi Y, Kusuda M, Hatta Y, Nakayama T, Takei M. Negative impact of concurrent overexpression of MYC and BCL2 in patients with advanced diffuse large B-cell lymphoma treated with dose-intensified immunochemotherapy. Leuk Lymphoma 2016; 57:2784-2790. [DOI: 10.3109/10428194.2016.1167205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Miura K, Takahashi H, Nakagawa M, Izu A, Sugitani M, Kurita D, Sakagami M, Ohtake S, Uchino Y, Hojo A, Kodaira H, Yagi M, Kobayashi Y, Iriyama N, Kobayashi S, Kiso S, Hirabayashi Y, Hatta Y, Takei M. Clinical significance of co-expression of MYC and BCL2 protein in aggressive B-cell lymphomas treated with a second line immunochemotherapy. Leuk Lymphoma 2015; 57:1335-41. [PMID: 26390147 DOI: 10.3109/10428194.2015.1096352] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical significance of concurrent expression of MYC and BCL2 protein, known as "double-expressor lymphoma" (DEL), among patients with relapsed or refractory aggressive B-cell lymphomas, remains unclear. A retrospective analysis was performed of 38 patients treated with a salvage treatment consisting of rituximab, ifosfamide, etoposide, cytarabine and dexamethasone followed by consolidative high-dose chemotherapies. A total of 17 cases (45%) were categorized as DEL using immunohistochemical assay with a cut-off value of positivity of 40% for MYC and 50% for BCL2, respectively. DEL was associated with a lower overall response rate (35% vs 71%, p = 0.0481), worse 2-year progression-free survival (9% vs 67%, p = 0.001) and overall survival (35% vs 71%, p = 0.037). This analysis suggests that DEL is common among patients with relapsed/refractory aggressive B-cell lymphomas and that such patients require novel treatment strategies.
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Affiliation(s)
- Katsuhiro Miura
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Hiromichi Takahashi
- a Division of Hematology and Rheumatology , Department of Medicine ;,b Division of Laboratory Medicine , Department of Pathology of Microbiology
| | - Masaru Nakagawa
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Asami Izu
- c Department of Pathology , Nihon University School of Medicine , Tokyo , Japan
| | - Masahiko Sugitani
- c Department of Pathology , Nihon University School of Medicine , Tokyo , Japan
| | - Daisuke Kurita
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Masashi Sakagami
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Shimon Ohtake
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Yoshihito Uchino
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Atsuko Hojo
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Hitomi Kodaira
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Mai Yagi
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Yujin Kobayashi
- a Division of Hematology and Rheumatology , Department of Medicine
| | | | - Sumiko Kobayashi
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Satomi Kiso
- a Division of Hematology and Rheumatology , Department of Medicine
| | | | - Yoshihiro Hatta
- a Division of Hematology and Rheumatology , Department of Medicine
| | - Masami Takei
- a Division of Hematology and Rheumatology , Department of Medicine
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