Among patients with MYC-rearranged aggressive lymphoma, the short-term CARMEN regimen appears to be effective, including among patients who are human immunodeficiency virus (HIV)-positive, according to the results of a retrospective study published in Blood Advances.

MYC translocations are a hallmark of Burkitt lymphoma (BL) and high-grade B-cell lymphoma (HGBCL), which was recently classified by the World Health Organization as being between BL and diffuse large B-cell lymphoma. MYC translocations are, furthermore, linked with inferior outcomes.

Previous research has indicated that patients with BL or HGBCL are less likely to respond to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), a mainstay chemoimmunotherapy regimen used for other hematologic cancers. Intensified combinations have, however, been suggested as options among these patients, including those who are HIV-positive.


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For this retrospective study, researchers evaluated whether the CARMEN regimen — a 36-day induction with weekly doses of cyclophosphamide, vincristine, rituximab, methotrexate, etoposide, and doxorubicin plus intrathecal chemotherapy, with high-dose cytarabine–based consolidation — is safe and effective among patients with MYC-translocated aggressive lymphoma.

Overall, data from 68 patients were included, among whom 22 and 46 had HGBCL and BL, respectively. In the HGBCL and BL groups, the median ages were 55 and 45 years, respectively, 68% and 80% of patients were male sex, and 41% and 80% of patients were HIV-positive. All patients who did not reach a complete response after the CARMEN induction combination received carmustine, etoposide, cytarabine, and melphalan-conditioned autologous stem cell transplantation after consolidation.

The median follow-up was 65 months. At this point, analysis showed that 90% of patients completed the induction regimen, while 87% completed consolidation and 17 patients underwent autologous stem cell transplantation. After the full CARMEN treatment, the complete response rate was 73% (95% CI, 55-91) in the HGBCL group and 78% (95% CI, 66-90) in the BL group.

At time of follow-up, 48 patients were event-free; the 5-year progression-free survival rate was 63% (95% CI, 58-68) among those with HGBCL and 72% (95% CI, 71-73) among those with BL. The 5-year overall survival rates in the HBCL and BL groups were 63% and 76%, respectively.

Grade 4 nonhematologic toxicities occurred in 16% of patients; grade 3 or worse neutropenia and thrombocytopenia occurred in at least 49% of patients during the induction and consolidation phases. A total of 9% of patients died because of toxicity. Patient HIV status, however, did not appear to predict for outcome.

“Promising results in HGBCL and MYC translocation and double-hit lymphoma prompt us to further explore this combination in aggressive B-cell lymphomas,” the authors wrote in their report.

Reference

Ferreri AJM, Angelillo P, Erbella F, et al. Safety and efficacy of a dose-dense short-term therapy in patients with MYC-translocated aggressive lymphoma. Blood Adv. 2022;6(22):5811-20. doi:10.1182/bloodadvances.2022007475