title: Impact of induction regimen and stem cell transplantation on outcomes in double-hit lymphoma: a multicenter retrospective analysis.
abstract: Patients with double-hit lymphoma (DHL), which is characterized by rearrangements of MYC and either BCL2 or BCL6, face poor prognoses. We conducted a retrospective multicenter study of the impact of baseline clinical factors, induction therapy, and stem cell transplant (SCT) on the outcomes of 311 patients with previously untreated DHL. At median follow-up of 23 months, the median progression-free survival (PFS) and overall survival (OS) rates among all patients were 10.9 and 21.9 months, respectively. Forty percent of patients remain disease-free and 49% remain alive at 2 years. Intensive induction was associated with improved PFS, but not OS, and SCT was not associated with improved OS among patients achieving first complete remission (P = .14). By multivariate analysis, advanced stage, central nervous system involvement, leukocytosis, and LDH >3 times the upper limit of normal were associated with higher risk of death. Correcting for these, intensive induction was associated with improved OS. We developed a novel risk score for DHL, which divides patients into high-, intermediate-, and low-risk groups. In conclusion, a subset of DHL patients may be cured, and some patients may benefit from intensive induction. Further investigations into the roles of SCT and novel agents are needed.
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL;
authors.forename: Adam M
authors.initials: AM
authors.lastname: Petrich
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL;
authors.forename: Mitul
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authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL;
authors.forename: Borko
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authors.lastname: Jovanovic
authors.affiliation: Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA;
authors.forename: Jorge J
authors.initials: JJ
authors.lastname: Castillo
authors.affiliation: Division of Hematology/Oncology and.
authors.forename: Saurabh
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authors.lastname: Rajguru
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI;
authors.forename: David T
authors.initials: DT
authors.lastname: Yang
authors.affiliation: Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH;
authors.forename: Khushboo A
authors.initials: KA
authors.lastname: Shah
authors.affiliation: Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH;
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Whyman
authors.affiliation: Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH;
authors.forename: Frederick
authors.initials: F
authors.lastname: Lansigan
authors.affiliation: Departments of Immunology and Medicine, Roswell Park Cancer Institute, Buffalo, NY;
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Hernandez-Ilizaliturri
authors.affiliation: Department of Oncology, Albert-Einstein Cancer Center-Montefiore Medical Center, Bronx, NY;
authors.forename: Lisa X
authors.initials: LX
authors.lastname: Lee
authors.affiliation: Department of Oncology, Albert-Einstein Cancer Center-Montefiore Medical Center, Bronx, NY;
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Barta
authors.affiliation: Hematology & Oncology, Rush University Medical Center, Chicago, IL;
authors.forename: Shruthi
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authors.lastname: Melinamani
authors.affiliation: Hematology & Oncology, Rush University Medical Center, Chicago, IL;
authors.forename: Reem
authors.initials: R
authors.lastname: Karmali
authors.affiliation: Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL;
authors.forename: Camille
authors.initials: C
authors.lastname: Adeimy
authors.affiliation: Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL;
authors.forename: Scott
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authors.lastname: Smith
authors.affiliation: Division of Hematology/Oncology, Advocate Lutheran General Hospital, Park Ridge, IL;
authors.forename: Neil
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authors.lastname: Dalal
authors.affiliation: Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, IL;
authors.forename: Chadi
authors.initials: C
authors.lastname: Nabhan
authors.affiliation: Department of Medicine, Section of Hematology-Oncology, University of Illinois at Chicago, Chicago, IL;
authors.forename: David
authors.initials: D
authors.lastname: Peace
authors.affiliation: Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE;
authors.forename: Julie
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authors.lastname: Vose
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA;
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Evens
authors.affiliation: Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Namrata
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authors.affiliation: Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY;
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.affiliation: Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA;
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Landsburg
authors.affiliation: Division of Hematology/Oncology, Hackensack University Medical Center, Hackensack, NJ; Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ;
authors.forename: Christina
authors.initials: C
authors.lastname: Howlett
authors.affiliation: Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Hematology/Oncology, Hackensack University Medical Center, Hackensack, NJ;
authors.forename: Anthony
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authors.lastname: Mato
authors.affiliation: Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL;
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authors.lastname: Jaglal
authors.affiliation: Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL;
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authors.initials: JC
authors.lastname: Chavez
authors.affiliation: Division of Hematology/Oncology and.
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authors.affiliation: Division of Hematology/Oncology and.
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authors.affiliation: Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN;
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authors.lastname: Li
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA;
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authors.lastname: Handler
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA;
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA; Division of Hematology, The Ohio State University-James Comprehensive Cancer Center, Columbus, OH;
authors.forename: Jonathon B
authors.initials: JB
authors.lastname: Cohen
authors.affiliation: Division of Hematology, The Ohio State University-James Comprehensive Cancer Center, Columbus, OH;
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authors.initials: KA
authors.lastname: Blum
authors.affiliation: Leukemia/BMT Program of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada;
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authors.affiliation: Leukemia/BMT Program of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada;
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authors.initials: HL
authors.lastname: Sun
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
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authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
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authors.affiliation: Department of Pathology, MD Anderson Cancer Center, Houston, TX; and.
authors.forename: Jesse
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authors.affiliation: Department of Pathology, MD Anderson Cancer Center, Houston, TX; and.
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
authors.affiliation: Department of Pathology and.
authors.forename: Aliyah R
authors.initials: AR
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authors.affiliation: Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA.
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mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016896:Treatment Outcome; D055815:Young Adult