Treatment options for double-hit diffuse large B-cell lymphoma

This study looked at the best treatment options for patients with double-hit diffuse large B-cell lymphoma. The study concluded that patients with double-hit lymphoma have better outcomes when treated with more intense regimens.

Diffuse large B-cell lymphoma (DLBCL) is a common type of non-Hodgkin lymphoma. There are three genes which are commonly mutated in DLBCL. These genes are MYC, BCL2 and BCL6. Double-hit lymphoma (DHL) is a type of DLBCL where MYC and either BCL2 or BCL6 are mutated. DHL is more aggressive than traditional DLBCL.

Patients with DHL generally have poor outcomes when treated with traditional DLBCL treatment. Traditional DLBCL treatment is R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone). More aggressive treatment might be more effective. There is no expert agreement on the best form of treatment for DHL. More research is needed to determine the most effective treatment for DHL. 

This study reviewed many previous articles about DHL treatment.

One study compared R-CHOP and more intensive regimens. These intensive regimens included R-Hyper CVAD (rituximab plus cyclophosphamide, vincristine, doxorubicin, methotrexate, cytarabine, and dexamethasone), R-EPOCH (rituximab plus etoposide, prednisone, vincristine, hydroxydaunorubicin), or R-CODOX-M/IVAC (rituximab plus cyclophosphamide, doxorubicin, vincristine, methotrexate, etoposide, cytarabine).

The average progression free survival (time from treatment to disease progression) was significantly longer in all of the intensive treatments (26.6 months) compared to the R-CHOP group (7.8 months). There was no difference between the intensive regimens.

Another study compared R-EPOCH, R-Hyper CVAD, and R-CHOP. The study found that patients treated with R-EPOCH had significantly better overall survival (time from treatment to death from any cause) than those treated with R-CHOP.

The complete response rate (percentage of patients who have no detectable cancer) is significantly better for the more intense regimens. The complete response rate was 68% for the R-EPOCH regimen. The complete response rate was 70% for the R-Hyper CVAD treatment. The complete response rate was 20% for the R-CHOP group. 

The authors suggested that patients with double-hit diffuse large B-cell lymphoma may benefit from more intensive regimens rather than standard therapy.