Do MYC rearrangements Matter in HIV-Associated Large B Cell Lymphomas? "EUROMYC" Study (a European retrospective study).

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 R-CHOP, in 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 HIV+ patients with (MYC+) and without MYC rearrangement (MYC-). A total of 155 HIV+ patients who had received FISH analysis for MYC were enrolled in 11 European centres: 43 MYC+ and 112 MYC-. Within MYC+ patients 10 had double/triple hit lymphomas, and 33 had isolated MYC rearranegment (single hit lymphoma). MYC+ patients 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 two groups. However, MYC+ patients received more frequently intensive chemotherapy (44%) compared to (R)CHOP alone (35%) or infusional treatment (DA-EPOCH-R, R-CDE) (19%). Among MYC+ patients, those who received intensive chemotherapy achieved a better outcome compared to patients who received non intensive treatment (complete remission 84% vs 52%, p 0,028; 5-year PFS 66% vs 36%, p 0,021). Our retrospective results suggest that HIV-associated LBCL with MYC rearrangement could be considered for an intensive therapeutic approach whenever possible, while (R)CHOP seems to give inferior results in this subset of patients in terms of complete remission and PFS.