Info
double-hit in DLBCL
- High-grade B-cell lymphoma w/ MYC & BCL2 &/or BCL6 translocations by FISH (formerly “double-hit in DLBCL”) represent ∼8% of all DLBCL & have poorer prog.
- IHC detected double expressors (MYC >40% BCL2 >70%) may be assoc w/ ↓ prog (JCO 2012;30:3460).
- Clinical Features of Double-HIT and Double-Expressor DLBCL
- 要明確排除 DHL，需要對所有侵襲性淋巴瘤檢體進行 FISH 檢測：但可以先看看是不是 GCB，再看一下 MYC/BCL2 Positive by IHC
: Suggested algorithm for the diagnosis of double-hit lymphoma in resource-poor settings. BCL2 indicates B-cell CLL/lymphoma 2; BCL6, B-cell CLL/lymphoma 6; DLBCL, diffuse large B-cell lymphoma; FISH, fluorescence in situ hybridization; GCB, germinal center B cell; HGBL, high-grade B-cell lymphoma; IHC, immunohistochemistry.- cf. double_expressors
Treatment
- Identify DHL/THL (MYC-R/BCL2-R) (especially GCB)
- Identify DEL
- DHL/THL: intensive chemotherapy: lenalidomide (DA-EPOCH-R / R-CODOX-M/IVAC/ R-HyperCVAD)
- Non-GCB + DEL: smart start protocol, R-CHOP + BTKi
- Non-GCB, age less than 60-65 years: R-CHOP + BTKi
- ABC, age > 60 years, man, IPI of 3-5: Pola-R-CHP
- A subset of patients with ABC type: R-CHOP + Velcade
- IPI of 3-5 and fit: DA-EPOCH-R, frontline ASCT in IPI of 4-5 ?
- Future perspectives: molecular clustering, ctDNA, next generation immunotherapy (CAR T-cell therapy,…)
- ROBUST : A Phase III Study of Lenalidomide Plus R-CHOP Versus Placebo Plus R-CHOP in Previously Untreated Patients With ABC-Type Diffuse Large B-Cell Lymphoma
- Phoenix: Randomized Phase III Trial of Ibrutinib and Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Non-Germinal Center B-Cell Diffuse Large B-Cell Lymphoma: 看起來是 OS 好像沒什麼差😂
- POLARIX: 看起來是 OS 好像沒什麼差😂
- L-MIND: Tafasitamab plus lenalidomide in relapsed or refractory diffuse large B-cell lymphoma (L-MIND): a multicentre, prospective, single-arm, phase 2 study
- single-arm, objective response: 34 (43%; 32–54) had a complete response and 14 (18%; 10–28) had a partial response