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Kuhlman JJ, Moustafa MA, Jiang L, Iqbal M, Seegobin K, Wolcott Z, Ayala E, Ansell S, Rosenthal A, Paludo J, Micallef I, Johnston P, Inwards D, Habermann T, Kharfan-Dabaja M, Witzig TE, Nowakowski GS, Tun HW. Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience. Clin Lymphoma Myeloma Leuk 2022; 22:e815-e825. [PMID: 35534379 DOI: 10.1016/j.clml.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting. MATERIALS AND METHODS Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings. RESULTS Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival. CONCLUSION L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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Affiliation(s)
| | | | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Karan Seegobin
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Zoe Wolcott
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Steve Ansell
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ
| | - Jonas Paludo
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Ivana Micallef
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Patrick Johnston
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - David Inwards
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Thomas Habermann
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Thomas E Witzig
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Han W Tun
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL.
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Modi D, Kim S, Surapaneni M, Ayash L, Alavi A, Ratanatharathorn V, Deol A, Uberti JP. R-BEAM versus Reduced-Intensity Conditioning Regimens in Patients Undergoing Allogeneic Stem Cell Transplantation for Relapsed Refractory Diffuse Large B Cell Lymphoma. Biol Blood Marrow Transplant 2020; 26:683-90. [PMID: 31682979 DOI: 10.1016/j.bbmt.2019.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/27/2019] [Accepted: 10/21/2019] [Indexed: 01/12/2023]
Abstract
Allogeneic stem cell transplant (alloSCT) is considered in diffuse large B cell lymphoma (DLBCL) patients with chemorefractory disease or who have relapsed after autologous SCT. Here we present the first report of alloSCT using the R-BEAM (rituximab, carmustine, etoposide, cytarabine, melphalan) conditioning regimen in DLBCL patients. We retrospectively compared long-term alloSCT outcomes of DLBCL patients who received either R-BEAM (n = 47) or reduced-intensity conditioning (RIC) regimens (n = 23). Seventy patients (median age, 53 years) with DLBCL received alloSCT between January 2005 and December 2017. The median number of pretransplant therapies was 3, and 17 patients (24%) received prior autologous SCT. All received rituximab as a frontline or salvage therapy before alloSCT. The donor was unrelated in 42 patients (60%), and peripheral blood stem cells were commonly used (96%). The 6-month cumulative incidence of grades III to IV acute graft-versus-host disease (GVHD) was 36.2% and 8.7% for R-BEAM and RIC, respectively (P = .03). Median follow-up of surviving patients after R-BEAM and RIC was 3.1 and 5.5 years, respectively. Three-year overall survival (OS) after R-BEAM and RIC was 34.4% and 43.4%, respectively (P = .48). At 3 years, R-BEAM was associated with a similar relapse rate (25.5% versus 26.1%, P = .96), nonrelapse mortality (NRM; 39.7% versus 39.1%, P = .98), and relapse-free survival (RFS; 34.8% versus 34.7%, P = .75) compared with RIC. In multivariable analysis lower Karnofsky performance score was associated with lower OS (hazard ratio, .96; P = .05), whereas chemorefractory disease was associated with a higher relapse risk (hazard ratio, 8.8; P = .04). No difference in OS, relapse, NRM, or RFS was noticed between R-BEAM and RIC. R-BEAM regimen seems to be feasible and results in equivalent rates of long-term OS, relapse, NRM, and RFS compared with RIC. However, a significantly higher rate of severe acute GVHD was noticed.
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