Treatment options for double-hit lymphoma patients

This study compared the effectiveness of different intensities of chemotherapy in double-hit lymphoma. This study concluded that the chemotherapy combination R-EPOCH was associated with improved time to disease progression.

Roughly 8%–10% of patients with diffuse large B-cell lymphoma have a double hit type of lymphoma (DHL). DHL is due to genetic changes in two genes (MYC and BCL2 or BCL6). DHL has been associated with poor response to standard treatments compared to DLBCL alone. Recent trials have examined dose-intense chemotherapy in DHL. These studies, however, have included small numbers of patients.

This study combined the results of 11 previous studies, including 394 patients. 97% of these patients had abnormalities in the MYC or BCL2 genes. 180 patients were treated with the standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. 91 patients were treated with an intermediate dose combination, R-EPOCH (rituximab, etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisone). 123 were treated with a dose-intense (DI) combination. These included higher doses of similar chemotherapies, and added agents such as methotrexate (Trexall).

Average time to disease progression was 12.1 months for R-CHOP, 22.2 months for R-EPOCH, and 18.9 months for DI groups. R-EPOCH used as a first treatment option significantly reduced the risk of progression by 34% compared to R-CHOP. DI treatment was associated with a 26% decreased risk of progression compared to R-CHOP, but this was not statistically significant. There were no significant differences in overall survival (time from treatment until death from any cause) based on treatment type.

This study concluded that first-line treatment with R-EPOCH significantly improved time to progression compared to the standard R-CHOP, but there were no overall survival benefits.