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Intensive chemotherapy and up-front stem cell transplant for double hit lymphoma

Bone Marrow Transplantation volume 55, pages 1460–1463 (2020)Cite this article

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High-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, so-called ‘double hit lymphoma’ (DHL), represents a subset of B-cell lymphomas with aggressive presentation, chemotherapy resistance and frequent systemic and CNS relapses [1]. Survival after treatment with standard chemotherapy regimens is poor. Retrospective data suggest that outcomes may be improved by intensive chemotherapy, while a benefit of up-front stem cell transplantation is not established [2,3,4,5,6,7]. In 2006, our institution adopted a routine approach of intensive chemotherapy followed by autologous (autoSCT) or allogeneic stem cell transplant (alloSCT) in first remission. We report the long-term outcomes of all patients offered this strategy.

Newly diagnosed DHL cases were retrospectively identified. Fluorescence in situ hybridisation (FISH) was selectively performed on large B-cell lymphoma diagnoses on the basis of aggressive clinical behaviour or suggestive pathological features (Burkitt-like morphology, high Ki67, high MYC or BCL2/6 protein expression, cytogenetic abnormalities). Baseline positron emission tomography (PET) scan and bone marrow biopsy were routinely performed.

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Fig. 1: Overall survival by Kaplan–Meier analysis.

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Authors and Affiliations

  1. Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia

    Jad Othman, Kelly Wong, Christopher Arthur, Keith Fay, William Stevenson, Naomi MacKinlay, Christopher Ward, Victoria Pechey, Luke Coyle, Ian Kerridge & Matthew Greenwood

  2. Haematology Department, Gosford Hospital, Gosford, NSW, Australia

    Tasman Armytage

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  1. Jad Othman
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  2. Tasman Armytage
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Contributions

JO collected and analysed the data, drafted the manuscript and finalised the paper. TA collected data, wrote an earlier version of the manuscript, and reviewed and revised the paper. KW collected data and assisted with statistical analysis. CA, KF, WS, NM, CW, VP, LC, IK and MG contributed to research design, reviewed and revised the paper. All the authors approved the final version.

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Correspondence to Jad Othman.

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Othman, J., Armytage, T., Wong, K. et al. Intensive chemotherapy and up-front stem cell transplant for double hit lymphoma. Bone Marrow Transplant 55, 1460–1463 (2020). https://doi.org/10.1038/s41409-020-0789-5

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