Background:

Double-expressor lymphoma (DEL) is characterized by the overexpression of C-MYC and BCL2 proteins without underlying chromosomal rearrangements. Although it is not classified as a distinct entity in the current World Health Organization classification, DEL accounts for 20% to 30% of diffuse large B-cell lymphoma (DLBCL) patients. Currently, the prognosis for DEL patients remains poor despite receiving R-CHOP or R-EPOCH regimens as first-line chemotherapy.

Aims:

This study aimed to assess the clinical efficacy and treatment tolerance of the Pola-R-CHP regimen in DEL patients.

Methods:

In this study, newly diagnosed DEL patients were recruited from our hospital in China between June 2023 and April 2024. The cut-off values for C-MYC and BCL2 protein expression were defined as greater than 40% and 50%, respectively. Clinical information, overall response rates, and adverse events of all patients were collected. The Pola-R-CHP regimen consisted of polatuzumab vedotin (1.8 mg per kilogram of body weight), plus intravenous rituximab (375 mg per square meter), cyclophosphamide (750 mg per square meter), liposomal doxorubicin (30 mg per square meter) on day 1 of each cycle, and oral prednisone (100 mg once daily) on days 1 through 5 of the first six cycles.

Results:

Twenty-three newly diagnosed DEL patients were enrolled, with a median age of 68 years (range 37-79 years). The male-to-female ratio was 11:12. According to the Ann Arbor stage, 78.3% of patients were in stages III/IV, and 52.2% had an International Prognostic Index (IPI) score ≥3. Additionally, 69.6% had at least two extranodal lesions, commonly involving the spleen, gastrointestinal tract, kidneys, adrenal glands, uterus, and ovaries. White blood cell count, hemoglobin, and platelet levels were generally normal. Elevated levels of lactic dehydrogenase and β2 microglobulin were observed in 60.9% and 65.2% of patients, respectively. Based on Hans's algorithm, 82.6% of patients were classified as non-GCB. The median Ki-67 value was 80% (range 60%-95%), and three patients were CD5 positive. P53 protein expression greater than 50% was observed in 69.6% of patients. All patients completed at least three cycles of the Pola-R-CHP regimen. The overall response rate (ORR) was 91.3%, with a complete response rate (CRR) of 47.8% at the end of the third cycle. By the end of treatment, the ORR was 83.3%, and the CRR was 72.2%. The common adverse events of this Pola-R-CHP regimen were hematologic toxicities, and 43.5% of patients exhibited grade 3/4 granulocytopenia after three cycles.

Conclusion:

The Pola-R-CHP regimen demonstrated high response rates and good tolerability in patients with DEL, establishing it as an effective therapeutic option.

Disclosures

No relevant conflicts of interest to declare.

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2024
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