Outcomes of Patients With Double-Hit Lymphoma Who Achieve First Complete Remission

Abstract

Purpose Patients with double-hit lymphoma (DHL) rarely achieve long-term survival following disease relapse. Some patients with DHL undergo consolidative autologous stem-cell transplantation (autoSCT) to reduce the risk of relapse, although the benefit of this treatment strategy is unclear. Methods Patients with DHL who achieved first complete remission following completion of front-line therapy with either rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or intensive front-line therapy, and deemed fit for autoSCT, were included. A landmark analysis was performed, with time zero defined as 3 months after completion of front-line therapy. Patients who experienced relapse before or who were not followed until that time were excluded. Results Relapse-free survival (RFS) and overall survival (OS) rates at 3 years were 80% and 87%, respectively, for all patients (n = 159). Three-year RFS and OS rates did not differ significantly for autoSCT (n = 62) versus non-autoSCT patients (n = 97), but 3-year RFS was inferior in patients who received R-CHOP compared with intensive therapy (56% v 88%; P = .002). Three-year RFS and OS did not differ significantly for patients in the R-CHOP or intensive therapy cohorts when analyzed by receipt of autoSCT. The median OS following relapse was 8.6 months. Conclusion In the largest reported series, to our knowledge, of patients with DHL to achieve first complete remission, consolidative autoSCT was not associated with improved 3-year RFS or OS. In addition, patients treated with R-CHOP experienced inferior 3-year RFS compared with those who received intensive front-line therapy. When considered in conjunction with reports of patients with newly diagnosed DHL, 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.

Fig 1.

(A) Relapse--free survival and (B) overall survival for all patients.

Fig 2.

(A) Relapse-free survival and (B) overall survival for all patients by receipt of autologous stem cell transplantation (autoSCT).

Fig 3.

(A) Relapse-free survival and (B) overall survival by front-line regimen, (C) relapse-free survival and (D) overall survival by intensive front-line regimen versus rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and (E) relapse-free survival and (F) overall survival by front-line regimen and receipt of autologous stem-cell transplantation (autoSCT). DA-EPOCH-R, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin; R-CODOX-M/IVAC, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine; R-hyperCVAD, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine.

Fig 4.

Postrelapse overall survival.