Double-Expressor Lymphoma Is Associated with Poor Outcomes after Allogeneic Hematopoietic Cell Transplantation

Abstract

Double-expressor lymphoma (DEL) is a diffuse large B cell lymphoma that exhibits co-expression of MYC and BCL2 proteins by immunohistochemistry. Patients with double-expressor lymphoma have a poor prognosis after standard chemoimmunotherapy or after high-dose chemotherapy with autologous transplantation, but the prognostic impact of DEL after allogeneic hematopoietic cell transplantation has not been well characterized. We retrospectively analyzed 60 consecutive patients with de novo diffuse large B cell lymphoma or transformed follicular lymphoma who underwent allogeneic transplantation at our center and had available immunohistochemistry data. Thirty-seven patients (62%) had DEL. The 2-year progression-free and overall survival rates were lower in patients with DEL than in those without DEL (20% versus 78%; overall P <.001 and 46% versus 77%; overall P = .016, respectively). The cumulative incidence of disease progression at 2 years was higher in patients with DEL (60% versus 13%; overall P = .005). The cumulative incidence of nonrelapse mortality did not differ statistically in the 2 groups. Even in patients with DEL and chemosensitive disease at transplantation, the 2-year progression-free survival rate was only 27% due to early disease progression. Multivariate analysis showed associations between DEL and increased risks of progression-free survival events (hazard ratio [HR], 4.58; 95% confidence interval [CI], 2.07-10.2; P <.001), overall mortality (HR, 2.29; 95% CI, 1.03-5.09; P = .042) and disease progression (HR, 3.60; 95% CI, 1.38-9.44; P = .009). Patients with DEL had poor outcomes after allogeneic transplantation. Innovative strategies are needed to improve outcomes in this population.

Treatment Outcomes and Clinical Relevance in Patients With Double Expressor DLBCL

“…This result is consistent with the fact that DE-DLBCL is more aggressive than the non-DEL subtype. 3,6,[10][11][12][13][14][15][16] Conversely, the OS rate was significantly lower in the DEL group than in the non-DEL group. We found that 94% of R/R DE-DLBCL patients did not respond to salvage chemotherapy and died from progressive disease (PD).…”

A new conditioning regimen with chidamide, cladribine, gemcitabine and busulfan significantly improve the outcome of high‐risk or relapsed/refractory non‐Hodgkin's lymphomas

“…[23][24][25] T A B L E 3 Summary of published studies of ASCT for non-Hodgkin's lymphoma Multiple retrospective studies have shown that patients with coexpression of MYC and BCL-2 proteins in immunohistochemistry have poor outcomes, with long-term PFS ranging from 3% to 49.4%. [25][26][27] Despite having an international prognostic index (IPI)…”

Hematopoietic stem cell transplantation for diffuse large B‐cell lymphoma having 8q24/MYC rearrangement in Japan

“…Although FISH using a break‐apart probe for MYC ‐R was adopted in many studies, this method cannot detect the translocation partner of the MYC gene. Recently, several investigators reported that the prognosis of patients with MYC ‐R who received immunochemotherapy was affected by the translocation partner of MYC 34‐37 . Patients with MYC ‐ IG rearrangements had inferior survival to those with MYC ‐non‐ IG 36 .…”