Progression of double‐hit lymphoma in the midst of R‐hyper CVAD

Muñoz, Javier; Vekaria, Mona; Hanbali, Amr; Janakiraman, Nalini

doi:10.1002/ajh.23206

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…DHL responds poorly to R-CHOP regimens, CODOX-M/IVAC regimens, and Hyper-CVAD chemotherapy [20]. Most patients following transformation are treated with standard doxorubicin containing combination chemotherapy regimens and a complete remission up to 40% has been reported [21].…”

Section: Discussionmentioning

confidence: 99%

Transformation of Follicular Lymphoma to Double Hit B-Cell Lymphoma Causing Hypercalcemia in a 69-Year-Old Female: A Case Report and Review of the Literature

Kapur

Levin

2014

Case Reports in Hematology

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Double hit B-cell lymphomas are rare tumors that are defined by a chromosomal breakpoint affecting the MYC/8q24 locus in combination with another recurrent breakpoint, mainly a t(14;18)(q32;q21) involving BCL2. These tumors mostly occur in adults and carry a very poor prognosis. Double hit lymphomas can occur de novo, or arise from transformation of follicular lymphoma. We report a case of a 69-year-old female with abdominal distention and progressively worsening weakness over six months. Patient presented with severe hypercalcemia and multiple intra-abdominal/pelvic masses. Histopathology results of the abdominal mass were compatible with a double hit B-cell lymphoma. However, bone marrow biopsy results showed a low grade follicular lymphoma, thus suggesting peripheral transformation of follicular lymphoma to double hit B-cell lymphoma. Patient was transferred to a tertiary care center and was started on combination chemotherapy (EPOCH: doxorubicin, etoposide, vincristine, cyclophosphamide, and prednisone). Our paper highlights not only transformation of follicular lymphoma to double hit B-cell lymphoma and the challenges encountered in diagnosing and treating these aggressive tumors, but also the association of new onset/worsening hypercalcemia in such patients.

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Section: Discussionmentioning

confidence: 99%

Transformation of Follicular Lymphoma to Double Hit B-Cell Lymphoma Causing Hypercalcemia in a 69-Year-Old Female: A Case Report and Review of the Literature

Kapur

Levin

2014

Case Reports in Hematology

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“…Furthermore, treatmentrelated issues and challenges of lymphomas are documented mainly for HIV-naïve adults. While radiotherapy and several chemotherapy regimens, including rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), CODOX-M/IVAC regimens, and R-hyper CVAD/MA (rituximab, hyper fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone, alternating with cytarabine plus methotrexate) and high-dose chemotherapy regimens with stem cell transplantation have been employed [7,14,[31][32][33][34], there is high resistance to intensive chemotherapy and radiotherapy. This results in poor outcomes, including suboptimal complete response, event-free survival and overall survival.…”

Section: • Dual Expression But Not Dual Rearrangements Of Myc and Bcl2mentioning

confidence: 99%

AIDS-Associated Pediatric High Grade B-cell Lymphoma with MYC and BCL2 Translocations

Mz¹,

Ramdial²,

Jb³

et al. 2017

J AIDS Clin Res

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Abstract"Double hit" lymphomas (DHLs) are now included as a distinct entity in the 2016 revised World Health Classification of lymphoid neoplasms under the rubric "High-grade B-cell lymphoma (HGBCL), with MYC and BCL2 and/or BCL6 translocations". While DHL/HGBCL with MYC and BCL2 translocations accounts for approximately 10% of all lymphomas with the phenotypic and immunophenotypic features of diffuse large B-cell lymphoma (DLBCL), to date, the entity is unreported in children <12 years and in patients with AIDS. In reporting a DHL/HGBCL with MYC and BCL2 translocations in a 10 year old boy, we contextualize, for the first time, its occurrence and clinicopathological profile in the context of pediatric HIV infection and AIDS. In so doing, the defining features of DHL/ HGBCL with MYC and BCL2 translocations in the updated 2016 WHO classification are discussed. In addition, the clinicopathological features and therapeutic approaches in children and adults and related challenges thereof, are highlighted. Finally, the spectrum of AIDS-associated lymphomas in children and adults are tabulated and the associated diagnostic and therapeutic challenges are addressed briefly.Citation: Msimang MZ, Ramdial PK, Kuppusamy JB, Nargan K, Sheik-Gafoor MH (2017) anterior colonic resection with colo-anal anastomosis and covering ileostomy was successfully undertaken, but the patient developed sepsis and required a relaparotomy for resection of necrotic colonic tissue. On recovery he received radiotherapy and further chemotherapy, but responded poorly and demised from multi-organ failure. Pathological featuresGross features: The lower anterior resection specimen measured 38 × 8 cm ( Figure 1A) and contained a 14 × 9 × 7 cm exophytic, creamwhite, fleshy tumor ( Figure 1B) with hemorrhagic foci, 12 cm and 3 cm from the proximal and distal excision margins, respectively. The proximal and circumferential resection margins were tumor-free. The microscopic findings confirmed an ulcerative, invasive malignancy with transmural involvement and a diffusely infiltrative pattern ( Figure 1C). The pleomorphic tumor cells were large with scant eosinophilic cytoplasm, indistinct cell borders and large, vesicular nuclei with distinctive nuclear membranes and prominent nucleoli ( Figure 1D). Brisk mitotic activity was evident. Immunohistochemically, there was bright and diffuse CD45 (Figure 2A), CD20 ( Figure 2B), BCL2 ( Figure 2C), BCL6 ( Figure 2D) and CD10 ( Figure 2E) immunopositivity. In addition, there was patchy MUM-1 ( Figure 3A) and approximately 60%, variable nuclear and cytoplasmic C-MYC immunopositivity ( Figure 3B) and a Ki-67 proliferation index of >90% ( Figure 3C). T-lymphocyte and terminal deoxynucleotidyl transferase immunomarkers were negative. Epstein Barr virus (EBV)-encoded small RNA (EBER) positivity ( Figure 3D) was confirmed on chromogen in-situ hybridization investigation.

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Efficacy of dose-adjusted EPOCH plus rituximab/R-CHOP regimens and the prognosis analysis in patients with MYC, BCL2/BCL6 gene copy number gain lymphoma and double-hit lymphoma: results from a single institution retrospective clinical study

Ma¹,

Chang²,

Li³

et al. 2019

CMAR

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Purpose To compare the efficacy of rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) with traditional rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimens in double-hit lymphoma (DHL) and gene copy number gain (CNG) lymphoma and to contrast the prognosis of these two disease types. Methods We retrospectively examined 127 cases of newly diagnosed diffuse large B-cell lymphoma (DLBCL), and used fluorescence in situ hybridization (FISH) to detect genetic abnormalities in MYC, BCL2, and BCL6 . Results In the two schemes, the 2-year progression-free survival (PFS) was higher for R-DA-EPOCH group than for R-CHOP (79.8% vs 57.5%, P =0.002), this advantage was also reflected in 2-year overall survival (OS) (81.6% vs 58.5%, P =0.002). In double CNG patients, R-DA-EPOCH regimen was significantly better than R-CHOP ( P =0.007 for PFS, P =0.010 for OS), and R-DA-EPOCH has the same advantage in DHL patients ( P =0.001 for PFS, P =0.047 for OS). For the two disease types, the PFS for DHL was inferior to that for double CNG (52.9% vs 72.4%, P =0.008), while the OS was not significantly different ( P =0.050). Subgroup analysis showed that the PFS for double CNG with MYC and BCL2 was superior to that for DHL with MYC and BCL2 ( P =0.043), this trend is also seen in double CNG and DHL with MYC and BCL6 ( P =0.036). However, the OS was not significantly different between the two subgroups. Multivariate analyses showed that in DLBCL patients with genetic abnormality detected by FISH, the treatment and disease types were independent prognostic factors. The adverse reaction rates were similar in R-DA-EPOCH and R-CHOP ( P >0.05). Conclusion Our retrospective study shows that DHL has a poorer prognosis than double CNG. Based on its improved lifetime and good tolerance, R-DA-EPOCH is a promising regimen for DHL or double CNG, which is expected to become the first-line treatment for high-risk DLBCL types based on more clinical research.

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Progression of double‐hit lymphoma in the midst of R‐hyper CVAD

Cited by 3 publications

References 13 publications

Transformation of Follicular Lymphoma to Double Hit B-Cell Lymphoma Causing Hypercalcemia in a 69-Year-Old Female: A Case Report and Review of the Literature

Transformation of Follicular Lymphoma to Double Hit B-Cell Lymphoma Causing Hypercalcemia in a 69-Year-Old Female: A Case Report and Review of the Literature

AIDS-Associated Pediatric High Grade B-cell Lymphoma with MYC and BCL2 Translocations

<p>Efficacy of dose-adjusted EPOCH plus rituximab/R-CHOP regimens and the prognosis analysis in patients with <em>MYC</em>, <em>BCL2/BCL6</em> gene copy number gain lymphoma and double-hit lymphoma: results from a single institution retrospective clinical study</p>

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