Patients with aggressive B-cell lymphoma and MYC rearrangement at FISH exhibit poor outcome after R-CHOP. In the last decade, 68 patients with Burkitt lymphoma (BL; n=46) or high-grade B-cell lymphoma (single, double or triple hit; HGBCL; n=22) were treated with a dose-dense, short-term therapy termed "CARMEN regimen", at five Italian Centers. Forty-six (68%) patients were HIV-positive. CARMEN included a 36-day induction with sequsingle weekly doses of cyclophosphamide, vincristine, rituximab, methotrexate, etoposide, and doxorubicin plus intrathecal chemotherapy, followed by high-dose-cytarabine-based consolidation. Patients who did not achieve complete remission (CR) after induction received BEAM-conditioned ASCT after consolidation. Sixty-one (90%) patients completed induction and 59 (87%) completed consolidation. Seventeen patients received ASCT. Grade-4 hematological toxicity was common but did not cause treatment discontinuation; grade-4 non-hematological toxicity was recorded in 11 (16%) patients, with grade-4 infections in 6 (9%). Six (9%) patients died of toxicity (sepsis in four, COVID-19, ARDS). CR rate after the whole treatment was 73% (95%CI=55-91%) for HGBCL patients and 78% (95%CI=66-90%) for BL patients. At a median follow-up of 65 (IQR 40-109) months, 48 patients remain event-free, with a 5-year PFS of 63% (95%CI=58-68%) for HGBCL and 72% (95%CI=71-73%) for BL, with a 5-year OS of 63% (95%CI=58-68%) and 76% (95%CI=75-77%), respectively. HIV seropositivity had not a detrimental effect on outcome. This retrospective study shows that CARMEN is a safe and active regimen both in HIV-negative and -positive patients with MYC-rearranged lymphomas. Encouraging survival figures, attained with a single dose of doxorubicin and cyclophosphamide, deserve further investigation in HGBCL and other aggressive lymphomas.
Safety and efficacy of a dose-dense short-term therapy in patients with MYC-translocated aggressive lymphoma
Cattaneo, Chiara;Facchetti, Fabio;
2022-01-01
Abstract
Patients with aggressive B-cell lymphoma and MYC rearrangement at FISH exhibit poor outcome after R-CHOP. In the last decade, 68 patients with Burkitt lymphoma (BL; n=46) or high-grade B-cell lymphoma (single, double or triple hit; HGBCL; n=22) were treated with a dose-dense, short-term therapy termed "CARMEN regimen", at five Italian Centers. Forty-six (68%) patients were HIV-positive. CARMEN included a 36-day induction with sequsingle weekly doses of cyclophosphamide, vincristine, rituximab, methotrexate, etoposide, and doxorubicin plus intrathecal chemotherapy, followed by high-dose-cytarabine-based consolidation. Patients who did not achieve complete remission (CR) after induction received BEAM-conditioned ASCT after consolidation. Sixty-one (90%) patients completed induction and 59 (87%) completed consolidation. Seventeen patients received ASCT. Grade-4 hematological toxicity was common but did not cause treatment discontinuation; grade-4 non-hematological toxicity was recorded in 11 (16%) patients, with grade-4 infections in 6 (9%). Six (9%) patients died of toxicity (sepsis in four, COVID-19, ARDS). CR rate after the whole treatment was 73% (95%CI=55-91%) for HGBCL patients and 78% (95%CI=66-90%) for BL patients. At a median follow-up of 65 (IQR 40-109) months, 48 patients remain event-free, with a 5-year PFS of 63% (95%CI=58-68%) for HGBCL and 72% (95%CI=71-73%) for BL, with a 5-year OS of 63% (95%CI=58-68%) and 76% (95%CI=75-77%), respectively. HIV seropositivity had not a detrimental effect on outcome. This retrospective study shows that CARMEN is a safe and active regimen both in HIV-negative and -positive patients with MYC-rearranged lymphomas. Encouraging survival figures, attained with a single dose of doxorubicin and cyclophosphamide, deserve further investigation in HGBCL and other aggressive lymphomas.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
