MYC+ diffuse large B-cell lymphoma is not salvaged by classical R-ICE or R-DHAP followed by HDT/ASCT. A bio-CORAL report
Menée sur 161 patients atteints d'un lymphome diffus à grandes cellules B réfractaire ou récidivant et inclus dans l'essai CORAL, cette étude évalue l'association entre la présence d'un réarrangement du gène MYC et la survie des patients recevant un traitement R-ICE ou R-DHAP suivi par une greffe autologue de cellules souches
Approximately 5-10% of diffuse large B-cell lymphomas (DLBCL) harbor a 8q24/MYC rearrangement (MYC+). We determined the prognostic significance of MYC rearrangement in patients with relapsed/refractory DLBCL included in CORAL and prospectively treated by R-ICE or R-DHAP followed by high-dose therarpy and autologous stem cell transplantation. Twenty-eight (17%) of the 161 patients analyzed presented a MYC+ rearrangement, targeted as either simple hit (25%) or complex hits (n=75%) including MYC/BCL2, MYC/BCL6, and MYC/BCL2/BCL6. Results were statistically highly concordant in matched primary and relapsed biopsies (n=45). Compared to the MYC- DLBCL patients, the MYC+ DLBCL patients presented with a more elevated LDH level (p=.0006) and a more advanced aaIPI (p=.0039). The 4-year PFS and OS were significantly lower in the MYC+ DLBCL patients than those in the MYC- DLBCL patients, with rates of 18% vs. 42% (p=.0322), and of 29% vs. 62% (p=.0113), respectively. Type of treatment, R-DHAP or R-ICE had no impact on survivals, with 4-year PFS rates of 17% vs. 19% and 4-year OS rates of 26% vs. 31%. In conclusion, MYC rearrangement is an early event in DLBCL. MYC+ DLBCL patients have a significant inferior prognosis than MYC- DLBCL patients. Their outcome was not influenced by the proposed salvage therapy.
Blood , résumé, 2012