Relapsed or Refractory Double-Expressor and Double-Hit Lymphomas Have Inferior Progression-Free Survival After Autologous Stem-Cell Transplantation
Relapsed or Refractory Double-Expressor and Double-Hit Lymphomas Have Inferior Progression-Free Survival After Autologous Stem-Cell Transplantation
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DOI：
10.1200/jco.2016.68.2740
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发表时间：
2017-01-01
影响因子：
45.3
通讯作者：
Armand, Philippe
中科院分区：
文献类型：
--
作者：
Herrera, Alex F.;Mei, Matthew;Armand, Philippe
目的双打击淋巴瘤（DHL）和双表达淋巴瘤（DEL）是弥漫性大B细胞淋巴瘤（DLBCL）的亚型，与标准化学免疫治疗后的不良结局相关。接受自体干细胞移植（ASCT）的复发性或难治性（rel/ref）DEL或DHL患者的结局数据有限。我们回顾性研究了DEL和DHL状态对ASCT结果的预后影响，在患者与rel/ref DLBCL.MethodsPatients化疗敏感的rel/ref DLBCL谁接受ASCT在两个机构，并在其中存档肿瘤材料是可供招募。对MYC、BCL 2和BCL 6进行免疫组化，并对MYC进行荧光原位杂交（FISH）。在MYC重排或拷贝获得的情况下，BCL 2和BCL 6的FISH也performed.ResultsA共117例患者包括; 44%有DEL和10%有DHL。DEL和DHL与较差的无进展生存期（PFS）相关，而DHL与较差的总生存期（OS）相关。DEL患者与非DEL患者相比，4年PFS分别为48%和59%（P = .049），4年OS为56% vs 67%（P = .10）;与非DHL患者相比，DHL患者的4年PFS为28% vs 57%（P = .013），4年OS为25% vs 61%（P = .002）。少数同时发生DEL和DHL的患者结局较差（4年PFS，0%）。在多变量模型中，DEL和DHL独立与较差的PFS，而DHL和部分反应（v完全反应）在移植与较差的OS.ConclusionDEL和DHL都与较差的结果ASCT后，与rel/ref DLBCL患者。虽然ASCT仍然是一种潜在的治愈方法，但这些患者，特别是DHL患者，是一个高风险的亚群，应针对标准ASCT以外的研究策略。(C)2016年美国临床肿瘤学会
PurposeDouble-hit lymphomas (DHLs) and double-expressor lymphomas (DELs) are subtypes of diffuse large B-cell lymphoma (DLBCL) associated with poor outcomes after standard chemoimmunotherapy. Data are limited regarding outcomes of patients with relapsed or refractory (rel/ref) DEL or DHL who undergo autologous stem-cell transplantation (ASCT). We retrospectively studied the prognostic impact of DEL and DHL status on ASCT outcomes in patients with rel/ref DLBCL.MethodsPatients with chemotherapy-sensitive rel/ref DLBCL who underwent ASCT at two institutions and in whom archival tumor material was available were enrolled. Immunohistochemistry for MYC, BCL2, and BCL6 and fluorescence in situ hybridization (FISH) for MYC were performed. In cases with MYC rearrangement or copy gain, FISH for BCL2 and BCL6 was also performed.ResultsA total of 117 patients were included; 44% had DEL and 10% had DHL. DEL and DHL were associated with inferior progression-free survival (PFS), and DHL was associated with poorer overall survival (OS). The 4-year PFS in patients with DEL compared with those with non-DEL was 48% versus 59% (P = .049), and the 4-year OS was 56% versus 67% (P = .10); 4-year PFS in patients with DHL compared with those with non-DHL was 28% versus 57% (P = .013), and 4-year OS was 25% versus 61% (P = .002). The few patients with concurrent DEL and DHL had a poor outcome (4-year PFS, 0%). In multivariable models, DEL and DHL were independently associated with inferior PFS, whereas DHL and partial response (v complete response) at transplant were associated with inferior OS.ConclusionDEL and DHL are both associated with inferior outcomes after ASCT in patients with rel/ref DLBCL. Although ASCT remains a potentially curative approach, these patients, particularly those with DHL, are a high-risk subset who should be targeted for investigational strategies other than standard ASCT. (C) 2016 by American Society of Clinical Oncology