Faculty Collaboration Database

Outcomes of Patients With Double-Hit Lymphoma Who Achieve First Complete Remission. J Clin Oncol 2017 Jul 10;35(20):2260-2267

Date

05/06/2017

Pubmed ID

28475457

Pubmed Central ID

PMC6366297

DOI

10.1200/JCO.2017.72.2157

Scopus ID

2-s2.0-85023764940 (requires institutional sign-in at Scopus site)   124 Citations

Abstract

Purpose Patients with double-hit lymphoma (DHL) rarely achieve long-term survival following disease relapse. Some patients with DHL undergo consolidative autologous stem-cell transplantation (autoSCT) to reduce the risk of relapse, although the benefit of this treatment strategy is unclear. Methods Patients with DHL who achieved first complete remission following completion of front-line therapy with either rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or intensive front-line therapy, and deemed fit for autoSCT, were included. A landmark analysis was performed, with time zero defined as 3 months after completion of front-line therapy. Patients who experienced relapse before or who were not followed until that time were excluded. Results Relapse-free survival (RFS) and overall survival (OS) rates at 3 years were 80% and 87%, respectively, for all patients (n = 159). Three-year RFS and OS rates did not differ significantly for autoSCT (n = 62) versus non-autoSCT patients (n = 97), but 3-year RFS was inferior in patients who received R-CHOP compared with intensive therapy (56% v 88%; P = .002). Three-year RFS and OS did not differ significantly for patients in the R-CHOP or intensive therapy cohorts when analyzed by receipt of autoSCT. The median OS following relapse was 8.6 months. Conclusion In the largest reported series, to our knowledge, of patients with DHL to achieve first complete remission, consolidative autoSCT was not associated with improved 3-year RFS or OS. In addition, patients treated with R-CHOP experienced inferior 3-year RFS compared with those who received intensive front-line therapy. When considered in conjunction with reports of patients with newly diagnosed DHL, which demonstrate lower rates of disease response to R-CHOP compared with intensive front-line therapy, our findings further support the use of intensive front-line therapy for this patient population.

Author List

Landsburg DJ, Falkiewicz MK, Maly J, Blum KA, Howlett C, Feldman T, Mato AR, Hill BT, Li S, Medeiros LJ, Torka P, Hernandez-Ilizaliturri F, Reddy NM, Singavi A, Fenske TS, Chavez JC, Kaplan JB, Behdad A, Petrich AM, Bast MA, Vose JM, Olszewski AJ, Costa C, Lansigan F, Gerson JN, Barta SK, Calzada O, Cohen JB, Lue JK, Amengual JE, Rivera X, Persky DO, Peace DJ, Nathan S, Cassaday RD

Author

Timothy Fenske MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
Cyclophosphamide
Cytarabine
Dexamethasone
Disease-Free Survival
Doxorubicin
Etoposide
Female
Humans
Ifosfamide
Lymphoma, B-Cell
Male
Methotrexate
Middle Aged
Prednisone
Proto-Oncogene Proteins c-bcl-2
Proto-Oncogene Proteins c-bcl-6
Proto-Oncogene Proteins c-myc
Recurrence
Remission Induction
Rituximab
Stem Cell Transplantation
Survival Rate
Transplantation, Autologous
Vincristine