Outcomes of DA-EPOCH-R induction plus autologous transplant consolidation for double hit lymphoma

Andy I. Chen, Jessica T. Leonard, Craig Y. Okada, Nathan D. Gay, Kari Chansky, Guang Fan, Jennifer B. Dunlap, Philipp W. Raess, Rita M. Braziel, Alex Stentz, Richard T. Maziarz

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1884-1889
Number of pages6
JournalLeukemia and Lymphoma
Volume59
Issue number8
DOIs
StatePublished - Aug 3 2018

Keywords

  • Double hit lymphoma
  • EPOCH-R
  • autologous transplant

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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