Clinical significance of co-expression of MYC and BCL2 protein in aggressive B-cell lymphomas treated with a second line immunochemotherapy

Abstract

The clinical significance of concurrent expression of MYC and BCL2 protein, known as “double-expressor lymphoma” (DEL), among patients with relapsed or refractory aggressive B-cell lymphomas, remains unclear. A retrospective analysis was performed of 38 patients treated with a salvage treatment consisting of rituximab, ifosfamide, etoposide, cytarabine and dexamethasone followed by consolidative high-dose chemotherapies. A total of 17 cases (45%) were categorized as DEL using immunohistochemical assay with a cut-off value of positivity of 40% for MYC and 50% for BCL2, respectively. DEL was associated with a lower overall response rate (35% vs 71%, p = 0.0481), worse 2-year progression-free survival (9% vs 67%, p = 0.001) and overall survival (35% vs 71%, p = 0.037). This analysis suggests that DEL is common among patients with relapsed/refractory aggressive B-cell lymphomas and that such patients require novel treatment strategies.

Keywords:

• Diffuse large B-cell lymphoma
• BCL2
• MYC
• relapse
• refractory counts

Acknowledgments

The authors would like to thank Eiko Ishizuka and Akiko Hirama for their excellent technical assistance. K. Miura received lecture fees from Chugai Pharmaceutical Co. Ltd, and Kyowa Hakko Kirin Co., Ltd. N. Iriyama received lecture fees and honoraria from Bristol-Myers K.K. Y. Hatta received lecture fee from Chugai Pharmaceutical Co. Ltd and Kyowa Hakko Kirin Co., Ltd. M. Takei received research funding from Chugai Pharmaceutical Co. Ltd, Kyowa Hakko Kirin Co., Ltd, Nippon Kayaku Co., Ltd., Bristol-Myers K.K., Shionogi & Co., Ltd.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://dx.doi.org/10.3109/10428194.2015.1096352