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- Title
Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience.
- Authors
Kuhlman, Justin J.; Moustafa, Muhamad Alhaj; Jiang, Liuyan; Iqbal, Madiha; Seegobin, Karan; Wolcott, Zoe; Ayala, Ernesto; Ansell, Steve; Rosenthal, Allison; Paludo, Jonas; Micallef, Ivana; Johnston, Patrick; Inwards, David; Habermann, Thomas; Kharfan-Dabaja, Mohamed; Witzig, Thomas E.; Nowakowski, Grzegorz S.; Tun, Han W.
- Abstract
High grade B cell lymphoma (HGBL) with leukemic involvement is a rare phenomenon that is not well characterized. We studied the clinicopathologic characteristics and treatment outcomes of 20 HGBL patients with leukemic involvement. Leukemic phase HGBL in both the de novo and relapsed setting carries a poor prognosis and is associated with MYC translocation, double/triple hit status, a history of transformation, and CNS disease risk. Introduction: Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting. Materials and Methods: Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings. Results: Twenty patients met inclusion cr iter i a. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans cr iter i a, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival. Conclusion: L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2022, Vol 22, Issue 8, pe815
- ISSN
2152-2650
- Publication type
Article
- DOI
10.1016/j.clml.2022.04.009