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FISH or Karyotype Analysis Recommended for Patients with Diffuse – Large B-Cell Lymphomas

Diffuse large B-cell lymphoma (DLBCL) is one of the most common types of non-Hodgkin’s lymphoma (NHL). Among DLBLC patients, a small subset (5-10%) holds MYC oncogene rearrangements. Patients with this oncogene rearrangement who undergo treatment with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy are known to have a poor prognosis.

A recent study by Savage et al. published in Blood was the first to evaluate MYC oncogene status among patients undergoing CHOP therapy with the addition of rituximab (also known as rituximab-CHOP or R-CHOP) therapy. Fluorescence in situ hybridization (FISH) identified 12 of 135 DLBCL patients with MYC rearrangement. The study found that MYC rearrangement was predictive of central nervous system (CNS) relapse in patients treated with R-CHOP. Further, among these same patients, inferior progression-free survival and worse overall survival was seen.

The diagnosis of DLBCL patients with MYC rearrangement is likely to be uncommon. Since this subset experiences an increased risk of CNS relapse and are less likely to be cured with CHOP or R-CHOP chemotherapy, all patients with DLBLC should undergo FISH or karyotype analysis to determine their MYC status. Regimens used for the treatment of Burkitt lymphoma might be more appropriate for DLBCL patients with MYC oncogene rearrangement.