High-dose chemotherapy followed by autologous transplantation may overcome the poor prognosis of diffuse large B-cell lymphoma patients with MYC/BCL2 co-expression

摘要

The concurrent expression of MYC and BCL2 on immunohistochemistry (IHC) ('double expressor') is recently emerging as one of the strongest and most unfavorable prognostic factor for diffuse large B-cell lymphoma (DLBCL). 1 , 2 , 3 , 4 , 5 Nevertheless, the higher prevalence of older patients, together with the association between double expressor DLBCL and advanced age, may have represented a potential confounding factor affecting the conclusions of all these studies. In fact, older DLBCL patients generally have inferior outcome due to the higher risk of adverse events and difficulties to perform high-dose salvage therapies. 6 This potential age bias was strongly suggested by a recent German study that included only young DLBCL patients at diagnosis, and did not confirm the negative prognostic effect of the double expressor phenotype after either eight cycles R-CHOEP-14 or sequential high-dose therapy followed by autologous stem cell transplant (ASCT). 7 This discordant result may be explained by either the lower prognostic relevance of MYC/BCL2 among young DLBCL patients, and by the ability of intense chemotherapy regimens to overcome the negative prognostic value of MYC/BCL2 co-expression.