Double-hit Lymphomas Linked to Inferior Outcomes After ASCT

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Patients with double-hit lymphoma or double-expressor lymphoma have inferior outcomes following autologous stem cell transplantation.
Patients with double-hit lymphoma or double-expressor lymphoma have inferior outcomes following autologous stem cell transplantation.

Patients with double-hit lymphoma (DHL) or double-expressor lymphoma (DEL) have inferior outcomes following autologous stem cell transplantation (ASCT) compared with patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who do not harbor the chromosomal rearrangements that characterize those 2 subtypes, according to a study published in the Journal of Clinical Oncology.1

DHLs are a subtype of DBCL with concurrent MYC and BCL2 and/or BCL6 rearrangements, which comprise 2% to 10% of newly diagnosed DLBCL, while DELs are DLBCLs with co-expression of the MYC and BCL2 proteins by immunohistochemistry and comprise 21% to 34% of patients with newly diagnosed DLBCL.

Although previous research demonstrates that these DLBCL subtypes are associated with poor outcomes after standard chemoimmunotherapy, the outcomes of these patients who undergo ASCT remain unclear. Researchers retrospectively assessed the prognostic impact of DEL and DHL status on outcomes among patients with relapsed/refractory DLBCL who had undergone ASCT.

Investigators analyzed data from 117 patients with chemotherapy-sensitive relapsed/refractory DLBCL who underwent ASCT. Of those, 44% and 10% had DEL and DHL, respectively.

Patients with DEL and DHL had shorter progression-free survival, and those with DHL had poorer overall survival.

The investigators found that 4-year progression-free survival was 48% among patients with DEL versus 59% among those without (P = .049); the 4-year overall survival was 56% and 67%, respectively (P = .10).

Similarly, among patients with DHLs, 4-year progression-free survival and 4-year overall survival were 28% and 25% compared with 57% (P = .013) and 61% (P = .002) among those who did not have DHL, respectively.

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The few patients with both DEL and DHL had a 4-year progression-free survival of 0%.

The findings suggest that additional strategies beyond standard ASCT should be investigated in this subpopulation, particularly those with DHL.                                      

Reference

  1. Herrera AF, Mei M, Low L, et al. Relapsed or refractory double-expressor and double-hit lymphomas have inferior progression-free survival after autologous stem-cell transplantation. J Clin Oncol. 2016 Oct 17. doi: 10.1200/JCO.2016.68.2740 [Epub ahead of print]

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