Double hit lymphoma: the MD A nderson C ancer C enter clinical experience

• Published in: British journal of haematology 2014-09, Vol.166 (6), p.891-901
• Main Authors: Oki, Yasuhiro, Noorani, Mansoor, Lin, Pei, Davis, Richard E., Neelapu, Sattva S., Ma, Long, Ahmed, Mohamed, Rodriguez, Maria Alma, Hagemeister, Fredrick B., Fowler, Nathan, Wang, Michael, Fanale, Michelle A., Nastoupil, Loretta, Samaniego, Felipe, Lee, Hun J., Dabaja, Bouthaina S., Pinnix, Chelsea C., Medeiros, Leonard J., Nieto, Yago, Khouri, Issa, Kwak, Larry W., Turturro, Francesco, Romaguera, Jorge E., Fayad, Luis E., Westin, Jason R.
• Format: Article
• Language: English
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.12982

We report our experience with 129 cases of double hit lymphoma ( DHL ), defined as B‐cell lymphoma with translocations and/or extra signals involving MYC plus BCL 2 and/or BCL 6 . All cases were reviewed for histopathological classification. Median age was 62 years (range, 18–85), 84% of patients had advanced‐stage disease, and 87% had an International Prognostic Index score ≥2. Fourteen patients (11%) had a history of low‐grade follicular lymphoma. MYC translocation was present in 81%, and extra signals of MYC in 25% of patients. IGH ‐ BCL 2 translocation was present in 84% and extra signals of BCL 2 in 12% of patients. Two‐year event‐free survival ( EFS ) rates in all patients and patients who received R‐ CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), R‐ EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), and R‐Hyper CVAD / MA (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, alternating with cytarabine plus methotrexate) were 33%, 25%, 67% and 32%, respectively. In patients achieving complete response with initial therapy ( n  = 71), 2‐year EFS rates in patients who did ( n  = 23) or did not ( n  = 48) receive frontline stem cell transplantation were 68% and 53%, respectively ( P  = 0·155). The cumulative incidence of central nervous system involvement was 13% at 3 years. Multivariate analysis identified performance status ≥2 and bone marrow involvement as independent adverse prognostic factors for EFS and OS . Further research is needed to identify predictive and/or targetable biological markers and novel therapeutic approaches for DHL patients.