Outcomes in Patients With Double-Hit Lymphoma After First Complete Remission


Key Points

  • In patients with double-hit lymphoma after first complete remission, no significant difference in relapse-free or overall survival was observed for consolidative autologous stem cell transplantation vs no autologous stem cell transplantation.
  • Front-line R-CHOP was associated with reduced relapse-free survival vs intensive therapy.

In an analysis reported in the Journal of Clinical Oncology, Landsburg et al found no significant benefit of consolidative autologous stem cell transplantation in patients with double-hit lymphoma after first complete remission. They also found evidence of poorer outcome with front-line R-CHOP (rituximab [Rituxan] plus cyclophosphamide, doxorubicin, vincristine, and prednisone) vs intensive front-line therapy.

Study Details

The analysis included 159 patients (aged 18 to 62 years) from 19 U.S. centers who were diagnosed between January 2006 and December 2015 and who had an overall condition deemed fit for autologous stem cell transplantation by local investigators. Among them, 62 received consolidative autologous stem cell transplantation and 97 did not; 35 received front-line R-CHOP and 124 received intensive therapy. Intensive therapy consisted of dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), R-hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine), or R-CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine). A landmark analysis was performed with time 0 defined as 3 months after completion of front-line therapy; patients experiencing relapse before this time or who were not followed up to that time were excluded from analysis.

Relapse-Free and Overall Survival

Among all patients, 3-year rates were 80% for relapse-free survival and 87% for overall survival; median overall survival following relapse was 8.6 months. There were no differences between patients not receiving vs receiving autologous stem cell transplantation in 3-year relapse-free survival (75% vs 89%, P = .12) or 3-year overall survival (85% vs 91%, P = .74). Three-year relapse-free survival was 56% among patients receiving front-line R-CHOP vs 88% among those receiving intensive therapy (P = .002), and 3-year overall survival was 77% vs 90% (P = .13).

Analysis according to receipt of R-CHOP or intensive therapy among patients with or without autologous stem cell transplantation showed a significant difference in relapse-free survival (P = .003), reflecting a lower rate in patients receiving R-CHOP/no autologous stem cell transplantation vs intensive therapy/no autologous stem cell transplantation (P = .003) and intensive therapy /autologous stem cell transplantation (P = .001). Intergroup comparisons showed similar 3-year overall survival (P = .50).

The investigators concluded: “In the largest reported series, to our knowledge, of patients with [double-hit lymphoma] to achieve first complete remission, consolidative [autologous stem cell transplantation] was not associated with improved 3-year [relapse-free survival] or [overall survival]. In addition, patients treated with R-CHOP experienced inferior 3-year [relapse-free survival] compared with those who received intensive front-line therapy. When considered in conjunction with reports of patients with newly diagnosed [double-hit lymphoma], which demonstrate lower rates of disease response to R-CHOP compared with intensive front-line therapy, our findings further support the use of intensive front-line therapy for this patient population.”

Daniel J. Landsburg, MD, of the University of Pennsylvania, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.