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Stem cell transplantation produces poor outcomes in double-hit, double-expressor lymphomas
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Autologous stem-cell transplantation conferred inferior outcomes to patients with double-hit and double-expressor lymphomas, according to study results.
Outcomes are poor for patients with double-hit and double-expressor lymphomas — subtypes of diffuse large B-cell lymphoma — who undergo standard chemoimmunotherapy. Researchers recommend investigational strategies to improve outcomes in those patients.
Limited data exist regarding outcomes of patients with relapsed or refractory double-hit lymphoma or double-expressor lymphoma who proceed to autologous stem cell transplantation, Alex F. Herrera, MD, assistant professor in the department of hematology and hematopoietic cell transplantation and hematologist/oncologist at City of Hope National Medical Center in Duarte, California, and colleagues wrote.
Herrera and colleagues performed a retrospective study of 117 patients who underwent autologous stem cell transplantation for chemotherapy-sensitive relapsed or refractory diffuse large B-cell lymphoma at City of Hope or Dana-Farber Cancer Institute/Brigham and Women’s Hospital.
All patients underwent immunohistochemistry for MYC, BCL2 and BCL6, and fluorescence in situ hybridization for MYC. Median follow-up was 45 months.
Forty-four percent of patients in the study had double expressor lymphoma, and 10% had double-hit lymphoma. For the entire cohort, 4-year PFS was 54% (95% CI, 44-63) and 4-year OS was 62% (95% CI, 52-71). Patients treated at the two centers achieved similar PFS and OS.
Patients with double-expressor lymphomas achieved shorter PFS than those without MYC/BCL2 coexpression (48% vs. 59%).
Patients with double-hit lymphoma achieved shorter PFS than those without double-hit lymphoma (28% vs. 57%). Patients with double-hit lymphoma also achieved shorter OS than patients without double-hit lymphoma (25% vs. 66%).
“Overall, despite being a retrospective series with a high attrition rate based on tissue availability, the central review of pathology, uniform assessment of double-hit and double-expressor features and mature follow-up of 45 months makes this a thought-provoking and timely paper,” Sonali M. Smith, MD, associate professor of medicine and director of the lymphoma program at The University of Chicago, wrote in an accompanying editorial. “The observation that a subset of patients with these features who also have chemotherapy-sensitive disease may benefit from [stem cell transplantation] will be useful to some practitioners, but the overall worse outcomes for patients with double-hit and double-expressor biology warrants dedicated study of these entities in both treatment-naive and relapsed settings.” – by Andy Polhamus
Disclosure: Smith reports consultant or advisory roles with AbbVie, Genentech, Genmab, Gilead Sciences, Immunogenix, Juno Therapeutics, NanoString Technologies, Pharmacyclics, Portola Pharmaceuticals, Seattle Genetics and TG Therapeutics. Herrera reports travel and expenses from Bristol-Myers Squibb, as well as research funding from Genentech, Immune Design, Pharmacyclics, Seattle Genetics and Sequenta. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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