Page 215 - Haematologica May 2020

Impact of MYC increased copy number in DLBCL
Among intensified regimens, in MYC-T and MYC-AMP subgroups, patients treated with R-DA-EPOCH showed an advantage in ORR compared to patients treated with GMALL B-ALL/NHL 2002 protocol or R-CHOP followed by ASCT (ORR 82% vs. 36%, P=0.04), and a trend toward a better survival was also seen (2.5-year OS of 81% vs. 46%, P=0.08) (Figure 4). Five patients initially considered fit for curative treatment and tested by FISH, were even- tually treated with palliative care due to rapidly worsening clinical conditions. Palliative regimens were single-agent cyclophosphamide for three patients, and single-agent vincristine for two patients; among these five patients, three had MYC-T (1 double-hit MYC-T/BCL2-T, 2 single-
hit lymphomas), one MYC-ICN≤4, and one MYC-ICN>4. They experienced a dismal outcome irrespective of MYC status (median survival of 2 months for the MYC-T group and 1 month for each of the other 2 patients, P=0.7) (data not shown).
Finally, we analyzed the impact of BCL2 and BCL6 numerical and structural aberrations on the outcome of patients with numerical aberrations of MYC (MYC- ICN/MYC-AMP). BCL2-ICN did not influence patient sur- vival, which was very similar to patients with wild-type (WT) BCL2 (2.5-year OS 70% vs. 69%, respectively). However, BCL2-T negatively influenced patient outcome compared to BCL2-WT and BCL2-ICN patients (2.5-year
P=0.08
Figure 4. Analysis of response to treatment with R-DA- EPOCH. In the MYC-T and MYC-AMP subgroups, patients treated with R-DA-EPOCH showed an advantage in ORR and trend toward a better survival compared to patients treated with GMALL B-ALL/NHL 2002 protocol or R- CHOP followed by autologous stem cell transplantation (ASCT).
P=0.04
Figure 5. Negative impact of BCL2 translocation on the outcome of patients with MYC-ICN. BCL2-ICN did not influence survival of patients with MYC-ICN, whereas BCL2-T negatively influenced the outcome of these patients compared to BCL2-WT and BCL2-ICN patients. Notably, among patients with MYC-ICN and BCL2-T, the group with >4 copies had a significantly worse prognosis than patients with ≤4 copies [median overall survival (OS) of 11 months compared to a 2.5-year OS of 75%, P=0.004] (data not shown).
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