MYC rearrangements in HIV-associated large B-cell lymphomas: EUROMYC, a European retrospective study

• Published in: Blood advances Vol. 8; no. 4; pp. 968 - 977
• Main Authors: Pagani, Chiara, Rusconi, Chiara, Dalla Pria, Alessia, Ravano, Emanuele, Schommers, Philipp, Bastos-Oreiro, Mariana, Verga, Luisa, Gini, Guido, Spina, Michele, Arcaini, Luca, Steffanoni, Sara, Dalu, Davide, Crucitti, Lara, Lorenzi, Luisa, Balzarini, Piera, Cattaneo, Chiara, Bongiovanni, Lucia, Rosenwald, Andreas, Facchetti, Fabio, Bower, Mark, Ferreri, Andrés J. M., Rossi, Giuseppe, Tucci, Alessandra, Re, Alessandro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 27.02.2024; The American Society of Hematology
• Subjects: Cyclophosphamide - therapeutic use; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; In Situ Hybridization, Fluorescence; Lymphoid Neoplasia; Lymphoma, Large B-Cell, Diffuse - drug therapy; Proto-Oncogene Proteins c-myc - genetics; Retrospective Studies; Rituximab - therapeutic use; Vincristine - therapeutic use
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2023010704

•HIV-associated lymphomas with MYC rearrangement could be considered for an intensive therapeutic approach.•Standard (R)CHOP seems to give inferior complete remission rate and PFS in this subset of patients. [Display omitted] Large B-cell lymphoma (LBCL) carrying MYC rearrangement, alone or together with BCL2 and/or BCL6 translocations, have shown a poor prognosis when treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the HIV population. Scanty data are available on the prevalence and prognostic impact of MYC rearrangements in HIV-associated LBCL. We conducted a retrospective study to evaluate the clinical effect of MYC rearrangement in HIV-associated LBCL. We evaluated clinical characteristics, treatment received, and outcome of LBCL in patients with HIV with MYC rearrangement (MYC+) and without MYC rearrangement (MYC–). A total of 155 patients with HIV who had received fluorescence in situ hybridization analysis for MYC were enrolled in 11 European centers: 43 with MYC+ and 112 MYC–. Among patients with MYC, 10 had double-/triple-hit lymphomas, and 33 had isolated MYC rearrangement (single-hit lymphoma). Patients with MYC+ had more frequently advanced stage, >2 extranodal site at presentation, and higher proliferative index. There were no significant differences in overall survival and progression-free survival (PFS) between the 2 groups. However, patients with MYC+ received more frequently intensive chemotherapy (iCT) (44%) than (R)CHOP alone (35%) or infusional treatment (DA-EPOCH-R and R-CDE) (19%). Among patients with MYC+, those who received iCT achieved a better outcome than patients who received nonintensive treatment (complete remission, 84% vs 52%; P = .028; 5-year PFS, 66% vs 36%; P = .021). Our retrospective results suggest that HIV-associated LBCL with MYC+ could be considered for an intensive therapeutic approach whenever possible, whereas (R)CHOP seems to give inferior results in this subset of patients in terms of complete remission and PFS.