Impact of initial chemotherapy regimen on outcomes for patients with double-expressor lymphoma: A multi-center analysis

Christopher R. D’Angelo, Walter Hanel, Yi Chen, Menggang Yu, David Yang, Ling Guo, Reem Karmali, Madelyn Burkart, Colleen Ciccosanti, Kevin David, Zachary Risch, Carlos Murga-Zamalloa, Sumana Devata, Ryan Wilcox, Malvi Savani, Elizabeth L. Courville, Veronika Bachanova, Emma Rabinovich, David Peace, Fauzia OsmanNarendranath Epperla, Vaishalee P. Kenkre

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Diffuse large B-cell lymphoma featuring overexpression of MYC and B-Cell Lymphoma 2 (double expressor lymphoma, DEL) is associated with poor outcomes. Existing evidence suggesting improved outcomes for DEL with the use of more intensive regimens than R-CHOP is restricted to younger patients and based on limited evidence from low patient numbers. We retrospectively evaluated the impact of intensive frontline regimens versus R-CHOP in a multicenter analysis across 7 academic medical centers in the United States. We collected 90 cases of DEL, 46 out of 90 patients (51%) received R-CHOP and 44/90 (49%) received an intensive regimen, which was predominantly DA-EPOCH-R. Treatment cohorts were evenly balanced for demographics and disease characteristics, though the intensive group had a higher lactate dehydrogenase (LDH, 326 vs. 230 U/L p = 0.06) and presence of B-symptoms (50% vs. 22%, p = 0.01) compared to the R-CHOP cohort. There was no difference in PFS (median 53 vs. 38 months, p = 0.49) or overall survival (67 vs. not reached months, p = 0.14) between the R-CHOP and intensive therapy cohorts, respectively. On multivariate analysis, intensive therapy was associated with a hazard ratio of 2.35 (95% CI 0.74–7.41), though this was not statistically significant. Additionally, a subgroup analysis of intermediate high-risk lymphoma defined by IPI ≥3 did not identify a difference in survival outcomes between regimens. We conclude that in our multi-center cohort there is no evidence supporting the use of intensive regimens over R-CHOP, suggesting that R-CHOP remains the standard of care for treating DEL.

Original languageEnglish (US)
Pages (from-to)473-482
Number of pages10
JournalHematological Oncology
Issue number4
Early online dateAug 4 2021
StatePublished - Oct 2021

Bibliographical note

Funding Information:
This work was supported by an NIH NHLBI T32 training grant (5T32HL007899‐20) to Christopher R. D’Angelo.

Publisher Copyright:
© 2021 John Wiley & Sons Ltd.


  • double expressor lymphoma
  • initial therapy
  • retrospective clinical analysis


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