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MYC Rearrangement and Prognosis in Diffuse Large B-Cell Lymphoma
The poor overall survival (OS) associated with double-hit (DH) or triple-hit (TH) MYC rearrangement status plus BCL2 or BCL6 rearrangement is well recognized in diffuse large B-cell lymphoma (DLBCL). However, the prognostic relevance of isolated (single-hit) MYC rearrangement remains controversial.
To address this issue, investigators conducted an international, retrospective study involving 2383 DLBCL patients from prospective therapeutic trials or patient registries who received first-line immunochemotherapy with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) or an equivalent regimen and had biopsy samples available for analysis. Samples were assessed for MYC rearrangement with an immunoglobulin (Ig) versus non-Ig translocation partner and for BCL2 and BCL6 rearrangements.
A total of 264 patients (11%) had MYC rearrangements: 72 were isolated MYC rearrangements only, 113 were DH, 26 were TH, and 53 were undetermined. A strongly negative outcome was observed for DH or TH status when MYC was rearranged with an Ig translocation partner; most failures occurred within 1 year of treatment. At 2 years after DLBCL diagnosis, progression-free survival and OS did not differ significantly between patients with isolated MYC rearrangement and those without MYC rearrangement.
Comment
These results support routine analysis of MYC rearrangement in patients with newly diagnosed DLBCL, especially the germinal center B-cell subtype wherein most DH and TH MYC rearrangements are found. The results do not suggest a need to vary from standard induction R-CHOP for DLBCL patients with isolated MYC rearrangement, although reports from prospective clinical trials are needed. Given that the risks for early treatment failure and poor survival are reinforced by the presence of DH or TH, improved treatment approaches that go beyond R-CHOP are clearly needed.
Citation(s)
Author:
Rosenwald A et al.
Title:
Prognostic significance of MYC rearrangement and translocation partner in diffuse large B-cell lymphoma: A study by the Lunenburg Lymphoma Biomarker Consortium.
Source:
J Clin Oncol
2019
Sep
9; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Michael E. Williams, MD, ScM