First-line treatment of double-hit and triple-hit lymphomas: Survival and tolerance data from a retrospective multicenter French study.
Aged
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Central Nervous System
/ pathology
Combined Modality Therapy
Drug Evaluation
Female
Follow-Up Studies
France
/ epidemiology
Gastrointestinal Diseases
/ chemically induced
Genes, bcl-2
Genes, myc
Hematologic Diseases
/ chemically induced
Hematopoietic Stem Cell Transplantation
Humans
In Situ Hybridization, Fluorescence
Kaplan-Meier Estimate
Lymphoma, Large B-Cell, Diffuse
/ drug therapy
Male
Middle Aged
Progression-Free Survival
Proto-Oncogene Proteins c-bcl-6
/ genetics
Remission Induction
Retrospective Studies
Salvage Therapy
Transplantation Conditioning
Transplantation, Autologous
Journal
American journal of hematology
ISSN: 1096-8652
Titre abrégé: Am J Hematol
Pays: United States
ID NLM: 7610369
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
received:
13
09
2020
revised:
05
12
2020
accepted:
08
12
2020
pubmed:
12
12
2020
medline:
18
3
2021
entrez:
11
12
2020
Statut:
ppublish
Résumé
Historically, double or triple hit lymphoma (DHL and THL) have poor outcomes with conventional chemotherapy, but there is currently no guideline. We report the French experience in managing DHL and THL in first line using collective data on both survival and tolerance. All consecutive patients with newly diagnosis of large B-cell lymphoma with MYC, BCL2, and/or BCL6 rearrangements, as determined by FISH between January 2013 and April 2019 were included. Based on the eligibility criteria, 160 patients were selected among the 184 patients identified. With a median follow-up of 32 months, 2- and 4-year progression free survival (PFS) rates were 40% and 28% with R-CHOP compared with 57% and 52% with intensive chemotherapy (P = .063). There was no difference in overall survival (OS). For advanced stages, PFS was significantly longer with intensive chemotherapy than with R-CHOP (P = .029). There was no impact of autologous stem cell transplantation among patient in remission. For patients with central nervous system (CNS) involvement, the 2-year PFS and OS rate was 21% and 39%, vs 57% and 75% without CNS disease (P = .007 and P < .001). By multivariate analysis, elevated IPI score and CNS disease were strongly and independently associated with a poorer survival, whereas treatment was not significantly associated with OS. This is the largest series reporting the treatment of DHL and THL in Europe. The PFS was significantly longer with an intensive regimen for advanced stage, but no difference in OS, supporting the need for a prospective randomized trial.
Substances chimiques
BCL6 protein, human
0
Proto-Oncogene Proteins c-bcl-6
0
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
302-311Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
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