Population-wide introduction of dose-adjusted EPOCH-R in high-grade B-cell lymphoma with MYC / BCL2 rearrangements, DLBCL morphology

作者：Waleed Alduaij, Laurie H. Sehn, Jean‐Nicolas Champagne, Brett Collinge, Susana Ben‐Neriah, Aixiang Jiang, Laura K. Hilton, Merrill Boyle, Barbara Meissner, Graham W. Slack, Pedro Farinha, Jeffrey W. Craig, Kerry J. Savage, Diego Villa, Alina S. Gerrie, Ciara L. Freeman, Andrew J. Mungall, Christian Steidl, David W. Scott · 发表于：Blood Advances · 年份：2025 · DOI：10.1182/bloodadvances.2025017282 · 被引用次数：4 · 研究领域：Lymphoma Diagnosis and Treatment、Acute Lymphoblastic Leukemia research、CAR-T cell therapy research

ABSTRACT: High-grade B-cell lymphoma with "double-hit" MYC and BCL2 rearrangements (HGBCL-DH-BCL2) is associated with poor outcomes following standard chemoimmunotherapy, prompting dose-intensive regimen use. However, the benefit of intensification is unclear due to rarity precluding randomized trials, and selection bias in retrospective comparisons. In 2015, BC Cancer introduced a provincial guideline recommending dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) for fit patients aged ≤75 years with HGBCL-DH-BCL2 identified by routine cytogenetic testing. To assess this guideline's impact, we compared the outcomes of patients with de novo HGBCL-DH-BCL2 tumors of diffuse large B-cell lymphoma (DLBCL) morphology across 2 eras. The DA-EPOCH-R era (2015-2020) included patients diagnosed after guideline implementation. The historic era (2005-2010) included patients identified from a historic province-wide cohort of patients with DLBCL morphology tumors that underwent universal cytogenetic testing in a research setting, predominantly treated with standard chemoimmunotherapy. Two-year overall survival (OS) was significantly improved in the DA-EPOCH-R vs historic era (75% vs 47%, P = .008) in HGBCL-DH-BCL2, whereas OS remained unchanged in DLBCL, not otherwise specified (78% vs 76%, P = .17). Within HGBCL-DH-BCL2, tumors harboring immunoglobulin MYC partner loci (43%) and those expressing the dark-zone signature (77%) were as...