Impact of initial chemotherapy regimen on outcomes for patients with double- expressor lymphoma: A multi- center analysis

Abstract

Diffuse large B- cell lymphoma featuring overexpression of MYC and B- Cell Lymphoma 2 (double expressor lymphoma, DEL) is associated with poor outcomes. Existing evidence suggesting improved outcomes for DEL with the use of more intensive regimens than R- CHOP is restricted to younger patients and based on limited evidence from low patient numbers. We retrospectively evaluated the impact of intensive frontline regimens versus R- CHOP in a multicenter analysis across 7 academic medical centers in the United States. We collected 90 cases of DEL, 46 out of 90 patients (51%) received R- CHOP and 44/90 (49%) received an intensive regimen, which was predominantly DA- EPOCH- R. Treatment cohorts were evenly balanced for demographics and disease characteristics, though the intensive group had a higher lactate dehydrogenase (LDH, 326 vs. 230 U/L p = 0.06) and presence of B- symptoms (50% vs. 22%, p = 0.01) compared to the R- CHOP cohort. There was no difference in PFS (median 53 vs. 38 months, p = 0.49) or overall survival (67 vs. not reached months, p = 0.14) between the R- CHOP and intensive therapy cohorts, respectively. On multivariate analysis, intensive therapy was associated with a hazard ratio of 2.35 (95% CI 0.74- 7.41), though this was not statistically significant. Additionally, a subgroup analysis of intermediate high- risk lymphoma defined by IPI - ¥3 did not identify a difference in survival outcomes between regimens. We conclude that in our multi- center cohort there is no evidence supporting the use of intensive regimens over R- CHOP, suggesting that R- CHOP remains the standard of care for treating DEL.