TY - JOUR
T1 - Outcomes of DA-EPOCH-R induction plus autologous transplant consolidation for double hit lymphoma
AU - Chen, Andy I.
AU - Leonard, Jessica T.
AU - Okada, Craig Y.
AU - Gay, Nathan D.
AU - Chansky, Kari
AU - Fan, Guang
AU - Dunlap, Jennifer B.
AU - Raess, Philipp W.
AU - Braziel, Rita M.
AU - Stentz, Alex
AU - Maziarz, Richard T.
N1 - Publisher Copyright:
© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2018/8/3
Y1 - 2018/8/3
N2 - 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 (p =.59 for both PFS and OS). There was no significant benefit to consolidative transplant in our series, and primary refractory DHL needs novel approaches.
AB - 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 (p =.59 for both PFS and OS). There was no significant benefit to consolidative transplant in our series, and primary refractory DHL needs novel approaches.
KW - Double hit lymphoma
KW - EPOCH-R
KW - autologous transplant
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U2 - 10.1080/10428194.2017.1406085
DO - 10.1080/10428194.2017.1406085
M3 - Article
C2 - 29199519
AN - SCOPUS:85036496307
SN - 1042-8194
VL - 59
SP - 1884
EP - 1889
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 8
ER -