Management of Patients with MYC-Altered Lymphomas

Patients diagnosed with non-Burkitt high-grade B cell non-Hodgkin lymphomas demonstrating rearrangement in MYC, an oncogene promoting cellular proliferation, frequently do not achieve long-term disease-free survival due to a suboptimal response to standard front-line and salvage therapies. Double-hit lymphomas, harboring rearrangements in MYC as well as BCL2 and/or BCL6, appear to carry a particularly poor prognosis, although patients with this disease appear to achieve better survival outcomes when treated with intensified chemotherapy. Increased expression of MYC protein by immunohistochemistry as well as increased copy number or amplification of MYC may also be adverse pathologic features of non-Burkitt high-grade B cell non-Hodgkin lymphomas, although the benefit of treating these patients with intensified as opposed to standard dose chemotherapy remains unclear. Recognition and proper management of patients with MYC-altered lymphomas is crucial to improving patient outcomes.