MYC+ diffuse large B-cell lymphoma is not salvaged by classical R-ICE or R-DHAP followed by BEAM plus autologous stem cell transplantation.

Approximately 5-10% of diffuse large Bcell lymphomas (DLBCL) harbor a 8q24/ MYC rearrangement (MYc+). We determined the prognostic significance of MYC rearrangement in patients with relapsed/refractory DLBCL prospectively treated by R-ICE or R-DHAP followed by highdose therapy and autologous stem cell transplantation. Twenty-eight (17%) of the 161 patients analyzed presented a MYc+ rearrangement, targeted as either simple hit (25%) or complex hits (n=75%) including MYCIBCL2, MYCIBCL6, and MYC/ BCL2/BCL6. Results were statistically highly concordant in matched primary and relapsed biopsies (n = 45). Compared to the MYc- DLBCL patients, the MYc+ DLBCL patients presented with a more elevated lactico-deshydrogenase level (P = .0006) and a more advanced age adjusted international prognostic index (P = .0039). The 4-year PFS and OS were significantly lower in the MYc+ DLBCL patients than those in the MYcDLBCL patients, with rates of 18% vs 42% (P = .0322), and of 29% vs 62% (P = .0113), respectively. Type of treatment, R-DHAP or R-ICE, had no impact on survivals, with 4-year PFS rates of 17% vs 19% and 4-year OS rates of 26% vs 31%. In conclusion, MYC rearrangement is an early event in DLBCL MYc+ DLBCL patients have a significant inferior prognosis than MYc- DLBCL patients. Their outcome was not influenced by the proposed salvage therapy. (Blood. 2012; 119(20):4619-4624) [ABSTRACT FROM AUTHOR]