The Role of MYC and BCL-2 Double Expression the in DLBCL Patients with Advanced Stage and Elevated LDH Who Received Upfront ASCT after R-CHOP

Abstract

Diffuse large B-cell lymphoma (DLBCL) with MYC and BCL2 protein concurrent expression, double- expressor lymphoma (DEL), by immunohistochemistry (IHC) was related with poor prognosis. To investigate the role of upfront autologous hematopoietic stem cell transplantation (ASCT) in double-expresser lymphoma, we retrospectively evaluated 44 DLBCL patients with advanced stage and elevated LDH who received upfront ASCT. We used the cut off value of BCL2 was 50% and c-MYC was 40%. All patients were treated with frontline rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy.Median age of 44 patients was 52.0 years (range, 23 ~ 64 years). Two-year overall survival (OS) was 83.3% and progression free survival (PFS) was 76.6%. Double-expressor lymphoma (DEL) were detected 14 patients (31.8%). Two-year OS of the patients with DEL was 77.4%, non-DEL was 86.6%. Two-year PFS of the patients with DEL was 77.9% and non-DEL was 80.9%. Eleven (25.0%) patients were germinal center B-cell (GCB) subtype and 33 (75.0%) patients were non-GCB subtype. There was no survival difference between GCB and non-GCB subtype (Figure 1A, 1B). In the patients with GCB subtype, 2 (18.2%) patients were classified to DEL. OS and PFS were not different according to DEL. Among non-GCB subtype, the patients with DEL (n=12) showed the comparable OS and PFS compared to the patient with non-DEL (n=21). Two-year OS of DEL patients was 73.3%, non-DEL was 90.9%. Two-year PFS of DEL patients was 74.1 %, non-DEL was 82.6 (Figure 2A. 2B).In conclusion, MYC and BCL2 concurrent expression did not show the poor outcome among the high risk DLBCL patients treated with upfront ASCT regardless of molecular classification. It will be need to investigate the role of ASCT in these group of patients. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.