Allogeneic: Adult
Double-Expressor Lymphoma Is Associated with Poor Outcomes after Allogeneic Hematopoietic Cell Transplantation

https://doi.org/10.1016/j.bbmt.2017.10.013Get rights and content
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Highlights

  • Patients with double-expressor lymphoma (DEL) showed poor outcomes after allogeneic hematopoietic cell transplantation due to early disease progression.

  • Even in patients with DEL had chemosensitive disease at transplantation, the 2-year progression-free survival rate was only 27%.

  • The dismal outcomes associated with DEL were not explained by the overexpression of PD-L1 protein in lymphoma cells.

  • Innovative strategies are needed to improve the outcomes of patients with DEL who undergo allogeneic hematopoietic cell transplantation.

Abstract

Double-expressor lymphoma (DEL) is a diffuse large B cell lymphoma that exhibits co-expression of MYC and BCL2 proteins by immunohistochemistry. Patients with double-expressor lymphoma have a poor prognosis after standard chemoimmunotherapy or after high-dose chemotherapy with autologous transplantation, but the prognostic impact of DEL after allogeneic hematopoietic cell transplantation has not been well characterized. We retrospectively analyzed 60 consecutive patients with de novo diffuse large B cell lymphoma or transformed follicular lymphoma who underwent allogeneic transplantation at our center and had available immunohistochemistry data. Thirty-seven patients (62%) had DEL. The 2-year progression-free and overall survival rates were lower in patients with DEL than in those without DEL (20% versus 78%; overall P <.001 and 46% versus 77%; overall P = .016, respectively). The cumulative incidence of disease progression at 2 years was higher in patients with DEL (60% versus 13%; overall P = .005). The cumulative incidence of nonrelapse mortality did not differ statistically in the 2 groups. Even in patients with DEL and chemosensitive disease at transplantation, the 2-year progression-free survival rate was only 27% due to early disease progression. Multivariate analysis showed associations between DEL and increased risks of progression-free survival events (hazard ratio [HR], 4.58; 95% confidence interval [CI], 2.07-10.2; P <.001), overall mortality (HR, 2.29; 95% CI, 1.03-5.09; P = .042) and disease progression (HR, 3.60; 95% CI, 1.38-9.44; P = .009). Patients with DEL had poor outcomes after allogeneic transplantation. Innovative strategies are needed to improve outcomes in this population.

Key Words

Double-expressor lymphoma
Allogeneic transplantation
Outcome
Diffuse large B-cell lymphoma
MYC
BCL2

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Financial disclosure: See Acknowledgments on page 299.