Impact of Double-Hit and Double-Expressor Phenotypes in Relapsed Aggressive B-Cell Lymphomas Treated With Autologous Hematopoietic Stem Cell Transplantation
Menée à partir de données portant sur 117 patients adultes atteints d'un lymphome diffus à grandes cellules B et ayant reçu une greffe autologue de cellules souches hématopoïétiques, cette étude multicentrique met en évidence une survie sans progression plus faible chez les patients dont le lymphome présente une co-expression de MYC et BCL2 ou un réarrangement chromosomique impliquant les gènes MYC, BCL2 et/ou BCL6
For over two decades, the use of high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autoHCT) has been the standard of care for relapsed aggressive B-cell lymphomas. The iconic Parma trial, conducted before rituximab-based initial therapy, showed that patients with aggressive B-cell lymphoma with chemotherapy-sensitive disease had a superior event-free survival with high-dose chemotherapy and autologous bone marrow transplantation compared with salvage chemotherapy alone (46% v 12%), and firmly established transplantation as the salvage modality of choice. However, in the current era of chemoimmunotherapy, autoHCT benefits an arguably smaller population, and its role has been debated and discussed in numerous manuscripts and forums. The Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) prospective trial showed that relapse within 12 months of rituximab plus anthracycline-based chemotherapy was associated with a 3-year event-free survival of less than 20% after transplantation, and substantially dampened enthusiasm for autoHCT as the de facto standard of care. Registry data have countered the CORAL results, and it has been proposed that chemotherapy sensitivity to salvage regimens may trump the negative impact of early relapse; debates on optimal management of relapsed disease have persisted. Traditional predictors of adverse outcome after autoHCT are primarily clinical, and include second-line International Prognostic Index, chemotherapy sensitivity via metabolic imaging, early relapse (< 12 months), primary refractory disease, or prior rituximab exposure.
Journal of Clinical Oncology , éditorial en libre accès, 2016