Clinical features and therapy of double-hit and double-expressor lymphomas

  • Authors: Baryakh EA1,2, Misyurina AE3, Kovrigina AM3, Obukhova TN3, Kravchenko SK3, Magomedova AU3, Zingerman BV3, Misyurina EN1, Poteshkina NG1,2, Lysenko MA1, Vorobev AI3
  • Affiliations:
    1. City Clinical Hospital №52 of the Department of Health of Moscow
    2. N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation
    3. Hematology Research Center of the Ministry of Health of the Russian Federation
  • Issue: Vol 18, No 5 (2016)
  • Pages: 22-30
  • Section: Articles
  • URL: https://modernonco.orscience.ru/1815-1434/article/view/27106
  • Cite item

Abstract


Purpose. The identifying of the clinical, morphological, immunophenotypic and cytogenetic features of double-hit and double-expressor lymphomas as well as the development of optimal tactics of treatment and evaluation of efficiency of the ASCT were the main purposes of the study. Material and methods. The study included 85 patients: 45 males and 40 females, the median was 46,6 years (15-73). 62 patients with DLBCL and 23 with BCLu were given BL-M-04/ m-NHL-BFM-90 regimes in Hematological Scientific Center and Municipal Clinical Hospital №52, 2001-2015. Results. Stage I was diagnosed in 5 (6%) patients, II - in 13 (15%) patients, III - in 7 (8%) patients, IV - in 60 (71%) patients. Double-hit lymphoma was diagnosed in 6 (7%) patients (5 MYC+/BCL2+, 1 MYC+/BCL6+), single-hit lymphoma was diagnosed in 6 patients. The translocation was detected in 5 of 12 cases t(8;14)(q24;q32), in 1 case of 12 - t(2;8)(p21;q24), in 2 cases of 12 - t(8;22)(q24;q11) (restructuring c-MYC and IGL gene loci have been identified), in 3 cases of 12 - restructuring of c-MYC with non-IG partner [translocation was absent t(8;14)(q24;q32) and restructuring IGK and IGL gene loci], the partner was not identified in one case of translocation with c-MYC gene [restructuring c-MYC gene loci was identified and translocation was absent t(8;14(q24;q32)]. 8 factors had prognostic significance in relation to OS: nosology - BCLu vs DLBCL (p=0.007; RR=4.5), bone marrow lesion (p=0.0004; RR=7.9), B-symptoms (p=0.0002; RR=8.4), BCL2 expression (I=0.01; RR=4.4), MYC/BCL2 coexpression (p=0.017; RR=0.08), double-hit or double-expressor lymphomas (p=0.009; RR=15.1), the absence of rituximab in therapy (p=0.03; RR=0.3), unfulfillment of ASCT (p=0.003; RR=0.06). Two factors were significant in relation to probability of development of recurrence/progression: double-hit or double-expressor lymphomas (p=0.0005; RR=4.0) and IPI (p=0.03; RR=4.9). Conclusions. Thus, complex diagnostic includes the antibody to the BCL2 (clone 124, Dako) and MYC (clone Y69, Epitomics), and the conduct of standard cytogenetic analysis (SCA) and FISH to detect rearrangements of MYC, BCL2, and BCL6 genes in addition to standard immunohistochemical panel for aggressive B-cell lymphomas. It allows not only to establish the correct diagnosis (DLBCL, BCLu or LB), but also to detect the double-hit and double-expressor lymphomas, which require intensive induction with rituximab and high-consolidation ASCT in first remission.

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About the authors

E A Baryakh

City Clinical Hospital №52 of the Department of Health of Moscow; N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: ebaryakh@gmail.com
123182, Russian Federation, Moscow, ul. Pekhotnaia, d. 3; 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

A E Misyurina

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

A M Kovrigina

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

T N Obukhova

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

S K Kravchenko

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

A U Magomedova

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

B V Zingerman

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

E N Misyurina

City Clinical Hospital №52 of the Department of Health of Moscow

123182, Russian Federation, Moscow, ul. Pekhotnaia, d. 3

N G Poteshkina

City Clinical Hospital №52 of the Department of Health of Moscow; N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

123182, Russian Federation, Moscow, ul. Pekhotnaia, d. 3; 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

M A Lysenko

City Clinical Hospital №52 of the Department of Health of Moscow

123182, Russian Federation, Moscow, ul. Pekhotnaia, d. 3

A I Vorobev

Hematology Research Center of the Ministry of Health of the Russian Federation

125167, Russian Federation, Moscow, Novyi Zykovskii pr., d. 4

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