BCL2 rearrangement

No Consensus RCHOP everyone says clearly inferior @graham74GC from what i have heard Prefer DA R- EPOCH Others like good old RCODX M RIVAC Disease Misbehaves Even More Correct Answer is 🤓 High-grade B-cell lymphomas (HGBLs) with MYC and BCL2 and/or BCL6 rearrangements (@MorphologyAmigo)

How would you treat DLBCL edition! A 50 yo patient presents with a left parotid mass. Biopsy is consistent with DLBCL, germinal center subtype. PET/CT is unrevealing other than left parotid mass. ECOG = 0 LDH = normal FISH panel = MYC and BCL2 rearrangements! (@AaronGoodman33)

- Diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements (DLBCL/HGBL-MYC/BCL2) - DA EPOCH-R (@ghous_ghulam)

DLBCL- high grade B-cell lymphoma with MYC and BCL2 rearrangements .. R-EPOCH? 👀 (@Itsinmyblood92)

I ask because we recently had a case of t-NHL with MYC (break-apart) and IGH-BCL2 rearrangements by FISH. Reported h/o MZL…which seemed odd to me. Maybe prior MZL dx wrong…perhaps CD10- FL, with IGH-BCL2 we didn’t know about, called MZL on a limited specimen? (@dgermain21)

Double Hit (DH) vs Expressor DLBCL (DE) DE = IHC MYC+(>40%), BCL2+(>50%) ABC>GCB Bad Rx = RCHOP DH = FISH MYC+BCL2 and/or BCL6 rearrangement GCB>ABC Very bad (esp MYC+IG partner) Rx = DA-EPOCH-R? DH gene sig = RNA 50% negative for MYC+BCL2 rearrangement Very bad Rx = ??? (@AaronGoodman33)

Lymphoma Question! EGD performed for 50 yo with stomach pain and found 5 cm mass. Biopsy with DLBCL. FISH with MYC-IgH and BCL2-IgH rearrangements (double hit). PET with no other sites of disease. IPI = 0. You recommend? (@AaronGoodman33)

Lymphoma Question! 55 yo with abdominal pain. PET/CT gastric mass and nothing else. EGD with 6 cm gastric mass Biopsy DLBCL, NOS, germinal center FISH with MYC-IgH + BCL2-IGH rearrangements Stage IE IPI = 0 Your treatment rec? @ASkarbnik @dgermain21 Or comment answer! (@AaronGoodman33)

Double Hit (DH) vs Expressor DLBCL (DE) DE = IHC MYC+(>40%), BCL2+(>50%) ABC>GCB Bad Rx = RCHOP DH = FISH MYC+BCL2 and/or BCL6 rearrangement GCB>ABC Very bad (esp MYC+IG) Rx = RCHOP or DA-EPOCH-R? DH gene sig = RNA 50% negative for MYC+BCL2 rearrangement Very bad Rx = ??? (@AaronGoodman33)

Our poster is online! #ASH2020 What could be the specificities of CLL harboring a BCL2 rearrangement ? Let's find out 😎 @DrMDavids @DanaFarber (@Charles_Herbaux)