Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics

Pallawi Torka*, Shalin K. Kothari, Suchitra Sundaram, Shaoying Li, L. Jeffrey Medeiros, Emily C. Ayers, Daniel J. Landsburg, David A. Bond, Kami J. Maddocks, Anshu Giri, Brian Hess, Luu Q. Pham, Ranjana Advani, Yang Liu, Stefan Klaus Barta, Julie M. Vose, Michael C. Churnetski, Jonathon B. Cohen, Madelyn Burkart, Reem KarmaliJoanna Zurko, Amitkumar Mehta, Adam J. Olszewski, Sarah Lee, Brian T. Hill, Timothy F. Burns, Frederick Lansigan, Emma Rabinovich, David Peace, Adrienne Groman, Kristopher Attwood, Francisco J. Hernandez-Ilizaliturri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

There is a paucity of data regarding outcomes and response to standard therapy in patients with limited-stage (LS) agressive B-cell lymphoma (LS-ABCL) who harbor MYC rearrangement (MYC-R) with or without BCL2 and/or BCL6 rearrangements. We conducted a multicenter retrospective study of MYC-R LS-ABCL patients who received either rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), or more intensive immunochemotherapy (IIC) plus or minus consolidative involved-field radiation therapy (IFRT). One hundred four patients from 15 academic centers were included. Forty four patients (42%) received R-CHOP, of whom 52% had IFRT. Sixty patients (58%) received IIC, of whom 40% had IFRT. Overall response rate was 91% (84% complete response [CR]; 7% partial response). Patients with double-hit lymphoma (DHL; n = 40) had a lower CR rate compared with patients with MYC-R only (75% vs 98%; P = .003). CR rate was higher in the IFRT vs no-IFRT group (98% vs 72%; P<.001). Median follow-up was 3.2 years; 2-year progression-free survival (PFS) and overal survival (OS) were 78% and 86% for the entire cohort, and 74% and 81% for the DHL patients, respectively. PFS and OS were similar across treatment groups (IFRT vs no IFRT, R-CHOP vs IIC) in the entire cohort and in DHL patients. Our data provide a historical benchmark for MYC-R LS-ABCL and LS-DHL patients and show that outcomes for this population may be better than previously recognized. There was no benefit of using IIC over R-CHOP in patients with MYC-R LS-ABCL and LS-DHL.

Original languageEnglish (US)
Pages (from-to)253-262
Number of pages10
JournalBlood Advances
Volume4
Issue number2
DOIs
StatePublished - Jan 28 2020

Funding

This work was supported by a biostatistics shared resource supported by a Roswell Park Comprehensive Cancer Center support grant from the National Institutes of Health, National Cancer Institute (P30CA016056). Conflict-of-interest disclosure: K.J.M. has received research support from Bristol-Myers Squibb, Merck, Pharmacyclics, and Novartis, and has been an advisory board member for Pharmacy-clics, Celgene, Teva, Seattle Genetics, AstraZeneca, and Bayer. R.K. has received research support from Kite/Gilead, Celgene/ Juno, Takeda, and Bristol-Myers Squibb; has been an advisory board member for Kite/Gilead and Celgene/Juno; and has been on speakers’ bureaus for Kite/Gilead and AstraZeneca. A.J.O. has received research support from Genentech/Roche, Spectrum Pharmaceuticals, and TG Pharmaceuticals. B.H. has received research support and consulting remuneration from Genentech. D.P. has equity holdings in Bristol-Myers Squibb and Merck, and has received associate research funding from Celgene and ER Squibb and Sons. The remaining authors declare no competing financial interests.

ASJC Scopus subject areas

  • Hematology

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