TY - JOUR
T1 - Impact of initial chemotherapy regimen on outcomes for patients with double-expressor lymphoma
T2 - A multi-center analysis
AU - D’Angelo, Christopher R.
AU - Hanel, Walter
AU - Chen, Yi
AU - Yu, Menggang
AU - Yang, David
AU - Guo, Ling
AU - Karmali, Reem
AU - Burkart, Madelyn
AU - Ciccosanti, Colleen
AU - David, Kevin
AU - Risch, Zachary
AU - Murga-Zamalloa, Carlos
AU - Devata, Sumana
AU - Wilcox, Ryan
AU - Savani, Malvi
AU - Courville, Elizabeth L.
AU - Bachanova, Veronika
AU - Rabinovich, Emma
AU - Peace, David
AU - Osman, Fauzia
AU - Epperla, Narendranath
AU - Kenkre, Vaishalee P.
N1 - Funding Information:
This work was supported by an NIH NHLBI T32 training grant (5T32HL007899‐20) to Christopher R. D’Angelo.
Publisher Copyright:
© 2021 John Wiley & Sons Ltd.
PY - 2021/10
Y1 - 2021/10
N2 - Diffuse large B-cell lymphoma featuring overexpression of MYC and B-Cell Lymphoma 2 (double expressor lymphoma, DEL) is associated with poor outcomes. Existing evidence suggesting improved outcomes for DEL with the use of more intensive regimens than R-CHOP is restricted to younger patients and based on limited evidence from low patient numbers. We retrospectively evaluated the impact of intensive frontline regimens versus R-CHOP in a multicenter analysis across 7 academic medical centers in the United States. We collected 90 cases of DEL, 46 out of 90 patients (51%) received R-CHOP and 44/90 (49%) received an intensive regimen, which was predominantly DA-EPOCH-R. Treatment cohorts were evenly balanced for demographics and disease characteristics, though the intensive group had a higher lactate dehydrogenase (LDH, 326 vs. 230 U/L p = 0.06) and presence of B-symptoms (50% vs. 22%, p = 0.01) compared to the R-CHOP cohort. There was no difference in PFS (median 53 vs. 38 months, p = 0.49) or overall survival (67 vs. not reached months, p = 0.14) between the R-CHOP and intensive therapy cohorts, respectively. On multivariate analysis, intensive therapy was associated with a hazard ratio of 2.35 (95% CI 0.74–7.41), though this was not statistically significant. Additionally, a subgroup analysis of intermediate high-risk lymphoma defined by IPI ≥3 did not identify a difference in survival outcomes between regimens. We conclude that in our multi-center cohort there is no evidence supporting the use of intensive regimens over R-CHOP, suggesting that R-CHOP remains the standard of care for treating DEL.
AB - Diffuse large B-cell lymphoma featuring overexpression of MYC and B-Cell Lymphoma 2 (double expressor lymphoma, DEL) is associated with poor outcomes. Existing evidence suggesting improved outcomes for DEL with the use of more intensive regimens than R-CHOP is restricted to younger patients and based on limited evidence from low patient numbers. We retrospectively evaluated the impact of intensive frontline regimens versus R-CHOP in a multicenter analysis across 7 academic medical centers in the United States. We collected 90 cases of DEL, 46 out of 90 patients (51%) received R-CHOP and 44/90 (49%) received an intensive regimen, which was predominantly DA-EPOCH-R. Treatment cohorts were evenly balanced for demographics and disease characteristics, though the intensive group had a higher lactate dehydrogenase (LDH, 326 vs. 230 U/L p = 0.06) and presence of B-symptoms (50% vs. 22%, p = 0.01) compared to the R-CHOP cohort. There was no difference in PFS (median 53 vs. 38 months, p = 0.49) or overall survival (67 vs. not reached months, p = 0.14) between the R-CHOP and intensive therapy cohorts, respectively. On multivariate analysis, intensive therapy was associated with a hazard ratio of 2.35 (95% CI 0.74–7.41), though this was not statistically significant. Additionally, a subgroup analysis of intermediate high-risk lymphoma defined by IPI ≥3 did not identify a difference in survival outcomes between regimens. We conclude that in our multi-center cohort there is no evidence supporting the use of intensive regimens over R-CHOP, suggesting that R-CHOP remains the standard of care for treating DEL.
KW - double expressor lymphoma
KW - initial therapy
KW - retrospective clinical analysis
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U2 - 10.1002/hon.2902
DO - 10.1002/hon.2902
M3 - Article
C2 - 34347909
AN - SCOPUS:85111768372
SN - 0278-0232
VL - 39
SP - 473
EP - 482
JO - Hematological Oncology
JF - Hematological Oncology
IS - 4
ER -
