{"id":16282,"date":"2022-06-13T20:09:32","date_gmt":"2022-06-13T18:09:32","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16282"},"modified":"2024-12-11T15:21:18","modified_gmt":"2024-12-11T14:21:18","slug":"r-epoch-pour-les-lymphomes-b-diffus-double-expresseurs","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/r-epoch-pour-les-lymphomes-b-diffus-double-expresseurs\/","title":{"rendered":"R-EPOCH pour les lymphomes B diffus \u201cdouble expresseurs\u201d"},"content":{"rendered":"

R\u00e9f. : HematoStat.net ; 3 (2) : R55<\/p>\n

Dodero A, Guidetti A, Marino F, Tucci A, Barretta F, Re A, et al. Dose-adjusted EPOCH and rituximab for the treatment of double expressor and double-hit diffuse large B-cell lymphoma: impact of TP53 mutations on clinical outcome. Haematologica. 2022;107(5):1153<\/span>\u201162.<\/span><\/i><\/div>\n
<\/div>\n

R\u00e9sum\u00e9<\/h3>\n
Environ un tiers des lymphomes B diffus \u00e0 grandes cellules (LBDGC) surexpriment MYC et BCL-2 (DE) associ\u00e9s ou non \u00e0 un r\u00e9arrangement chromosomique ou \u00e0 une mutation de TP53. Dans cette s\u00e9rie r\u00e9trospective, 122 patients \u00e9taient trait\u00e9s avec le sch\u00e9ma R-EPOCH \u00ab doses ajust\u00e9es \u00bb. \u00c0 2 ans, la survie sans progression \u00e9tait de 74 % et la survie globale de 84 %. Pour les patients TP53 mut\u00e9s, la survie \u00e9tait de 62 % contre 88 % pour les patients non mut\u00e9s (p=0,036).<\/div>\n
<\/div>\n

Dans nos pratiques<\/h3>\n
Une grande cohorte r\u00e9trospective avait d\u00e9j\u00e0 montr\u00e9 l\u2019absence de b\u00e9n\u00e9fice en termes de survie (\u00e0 4 ans) du r\u00e9gime R-EPOCH pour les patients avec LBDGC \u00ab <\/span>double-hit<\/i> \u00bb, \u00ab <\/span>triple-hit<\/i> \u00bb ou MYC r\u00e9arrang\u00e9. Ici, ce r\u00e9gime intensif semble tenir la corde pour les patients DE \u00e0 l\u2019exception de ceux pr\u00e9sentant une mutation de TP53 dont le pronostic demeure m\u00e9diocre. On peut toutefois regretter l\u2019absence de bras contr\u00f4le.<\/span><\/div>\n
<\/div>\n
\n

Regard du biostatisticien<\/strong><\/h3>\n

Cette analyse de cohorte tr\u00e8s sp\u00e9cifique focalise ses analyses sur la survie globale et sans rechute. Les r\u00e9sultats semblent int\u00e9ressants mais pour ce qui est de l\u2019impact des translocations DEL et mutations TP53<\/i>, il n’est pas certain que les mod\u00e8les multivari\u00e9s permettent solidement d\u2019approuver les conclusions donn\u00e9es (usage des bons facteurs confondants ?), c’est-\u00e0-dire que ces r\u00e9sultats puissent \u00eatre reproductibles sur une cohorte similaire. Puis comme indiqu\u00e9 par le clinicien, la comparaison avec un autre groupe de traitement aurait \u00e9t\u00e9 la bienvenue.<\/p>\n<\/div>\n

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