DOUBLE-EXPRESSOR LYMPHOMAS DO NOT HAVE INFERIOR OUTCOME AFTER AUTOLOGOUS STEM-CELL TRANSPLANT IN THE FIRST LINE TREATMENT

Introduction: Small subgroup of double-hit (DH) or larger one of double-expression (DE) diffuse large B-cell lymphomas (DLBCL) were shown to have worse outcome compared to non-DH and non-DE lymphomas. It has been demonstrated that intensive treatment and high-dose therapy (HDT) with ASCT could improve the results compared to standard treatment. Relapsed/refractory DE DLBCL have however still inferior PFS after ASCT (Herrera, JCO 2016). We have performed the analysis of DE DLBCL patients (pts.) who were transplanted as part of the first-line treatment and compared them to the transplanted non-DE DLBCL pts. Methods: Eligible for the analysis were consecutive pts. with DLBCL not otherwise specified, diagnosed in single center between 2002 and 2015, treated with rituximab and anthracycline-based chemotherapy who underwent HDT and ASCT as part of the first-line therapy either planned (R-MegaCHOP/ESHAP/BEAM or PET-RIMCEB study GovTrial No: NCT00558220) or pts. who underwent ASCT because of partial remission (PR) only at the end of the induction. Only pts with tissue blocks available for histopathological review (VC, RJ, JS, LB) were eligible for analysis. Cell of origin (COO) was examined by immunohistochemistry (Hans 2004); for MYC and BCL2, all patient were scored semiquantitatively in 10% increments with cutoff values of 40% for MYC and 70% for BCL2. Pearson chi-square, Mann-Whitney, Kaplan-Meier and log rank tests were used. Results: The cohort consists out of 67 pts. with median age 49 years (21-69), 61% men, high LDH in 90%, intermediate-high and high aa-IPI risk resp. in 54% and 37% pts. resp. (there were only 7% low/low-intermediate risk pts). There were 52% of non-GCB and 48% of GCB patients, and 24% of DE and 76% of nonDE. ASCT was planned in 73% of patients (66% with MegaCHOP/+-ESHAP regimen) and response driven (PR only) after R-CHOP induction in 27% pts. PET before ASCT was performed in all pts. and was negative in 69%, positive in 25% and inconclusive in 6% pts. With median follow-up 6.5 years, the 7-year probability of PFS and OS was 76% and 81%. There was no PFS difference between DE and non-DE (HR 1.3; 0.44-4.01; p ns; 63.8% vs 78.2%, at 7 y) nor OS difference (HR 0.51; 95% CI 0.17-1.93; p ns; 86.5% vs 77.9%, at 7 y) (Figure 1). There was also no PFS difference between GCB and non-GCB (HR 1.02; 95% CI 0.39-2.66; p ns; 75% vs 74.8% at 7 y) nor OS difference (HR 1.6; 95% CI 0.56-4.61; p ns; 74.9% vs 85% at 7 y). In this cohort, preASCT PET positivity was not predictive for significantly worse PFS (HR 1.59; 95% CI 0.52-5.55; p ns; 70.6% vs 78.9% at 7 y) or OS (HR 1.45; 95% CI 0.42-5.75; p ns; 76.5% vs 84.1% at 7 y). Keywords: “double-hit” lymphomas; autologous stem-cell transplantation (ASCT); diffuse large B-cell lymphoma (DLBCL)