Negative impact of concurrent overexpression of MYC and BCL2 in patients with advanced diffuse large B-cell lymphoma treated with dose-intensified immunochemotherapy

Abstract

Co-expression of MYC and BCL2 proteins in diffuse large B-cell lymphoma (DLBCL), or ‘double-expressor lymphoma’ (DEL), results in poor patient prognosis, but the significance of DEL when aggressive treatments are applied remains uncertain. We performed a retrospective analysis of 40 patients with de novo DLBCL, who were categorized as being at high/high-intermediate risk according to the age-adjusted International Prognostic Index. Patients underwent an R-Double-CHOP regimen, a dose-intensified immunochemotherapy with or without consolidative high-dose chemotherapy followed by autologous stem cell transplantation. According to immunohistochemical analysis, 10 (25%) patients were categorized as having DEL, showing positivity for MYC (≥40%) and BCL2 (≥50%). The 3 year progression-free survival and overall survival of the DEL group were significantly worse compared with those of the non-DEL group (30% vs. 63%, p = 0.019 and 40% vs. 82%, p = 0.006, respectively). These results suggest that advanced DEL may need discrete treatment strategies.

Keywords:

• BCL2
• diffuse large B-cell lymphoma
• double-expressor lymphoma
• high-dose chemotherapy
• MYC

Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing. In addition, the authors would like to thank Ms. E. I. and Mr. M. I. for providing excellent technical assistance.

K.M. received lecture fees from Chugai Pharmaceutical Co. Ltd, and Kyowa Hakko Kirin Co., Ltd. N.I. received lecture fees and honoraria from Bristol-Myers K.K. Y.H. received lecture fees from Chugai Pharmaceutical Co. Ltd and Kyowa Hakko Kirin Co., Ltd. M.T. received research funding from Chugai Pharmaceutical Co. Ltd, Kyowa Hakko Kirin Co., Ltd, Bristol-Myers K.K., Shionogi & Co., and Nippon Kayaku Co.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://dx.doi.org/10.3109/10428194.2016.1167205.