Chen Andy I, Leonard Jessica T, Okada Craig Y, Gay Nathan D, Chansky Kari, Fan Guang, Dunlap Jennifer B, Raess Philipp W, Braziel Rita M, Stentz Alex, Maziarz Richard T
a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.
b Cancer Research and Biostatistics , Seattle , WA , USA.
Leuk Lymphoma. 2018 Aug;59(8):1884-1889. doi: 10.1080/10428194.2017.1406085. Epub 2017 Dec 3.
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.
伴有MYC和BCL2重排的高级别B细胞淋巴瘤（双打击）采用标准R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松）治疗时预后较差。我们在此报告了2010年至2015年间对36例初治双打击淋巴瘤（DHL）患者采用DA-EPOCH-R（剂量调整的依托泊苷、泼尼松、长春新碱、环磷酰胺、阿霉素、利妥昔单抗）方案治疗，随后进行BEAM（卡莫司汀、依托泊苷、阿糖胞苷、美法仑）自体移植的治疗方案。42%的病例存在高风险国际预后指数（IPI）。中位随访38个月时，2年无进展生存期（PFS）和总生存期（OS）分别为69%（95%可信区间54-84%）和71%（95%可信区间56-86%）。8例诱导治疗无效，1年总生存率为20%，且无因素可预测原发性难治性疾病。28例缓解者中，17例进行了移植，11例进行观察，主要原因是年龄和合并症。通过诊断后24周的标志性分析，移植组与观察组的2年PFS和OS分别为94%（95%可信区间83-100%）和79%（95%可信区间52-100%）（PFS和OS的P值均为0.59）。在我们的系列研究中，巩固性移植无显著益处，原发性难治性DHL需要新的治疗方法。
