COO remains a major and independent factor in relapsed/refractory DLBCL, with a better response to R-DHAP in GCB-like DLBCL. This needs confirmation by a prospective study.

Approximately 5-10% of diffuse large Bcell lymphomas (DLBCL) harbor a 8q24/ MYC rearrangement (MYC ؉ ). We determined the prognostic significance of MYC rearrangement in patients with relapsed/ refractory DLBCL prospectively treated by R-ICE or R-DHAP followed by highdose therapy and autologous stem cell transplantation. Twenty-eight (17%) of the 161 patients analyzed presented a MYC ؉ rearrangement, targeted as either simple hit (25%) or complex hits (n‫)%57؍‬ including MYC/BCL2, MYC/BCL6, and MYC/ BCL2/BCL6. Results were statistically highly concordant in matched primary and relapsed biopsies (n ‫؍‬ 45). Compared to the MYC ؊ DLBCL patients, the MYC ؉ DLBCL patients presented with a more elevated lactico-deshydrogenase level (P ‫؍‬ .0006) and a more advanced age adjusted international prognostic index (P ‫؍‬ .0039). The 4-year PFS and OS were significantly lower in the MYC ؉ DLBCL patients than those in the MYC ؊ DLBCL patients, with rates of 18% vs 42% (P ‫؍‬ .0322), and of 29% vs 62% (P ‫؍‬ .0113), respectively. Type of treatment, R-DHAP or R-ICE, had no impact on survivals, with 4-year PFS rates of 17% vs 19% and 4-year OS rates of 26% vs 31%. In conclusion, MYC rearrangement is an early event in DLBCL. MYC ؉ DLBCL patients have a significant inferior prognosis than MYC ؊ DLBCL patients. Their outcome was not influenced by the proposed salvage therapy.