Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure.

Abstract

BACKGROUND:

Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown.

METHODS:

Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy.

RESULTS:

In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P < .001) and OS (6 months vs not reached; P < .001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy.

CONCLUSIONS:

Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.

• Authors: Emily C Ayers, Shaoying Li, L Jeffrey Medeiros, David A Bond, Kami J Maddocks, Pallawi Torka, Angel Mier Hicks, Madeira Curry, Nina D Wagner-Johnston, Reem Karmali, Amir Behdad, Bita Fakhri, Brad S Kahl, Michael C Churnetski, Jonathon B Cohen, Nishitha M Reddy, Dipenkumar Modi, Radhakrishnan Ramchandren, Christina Howlett, Lori A Leslie, Samuel Cytryn, Catherine S Diefenbach, Rawan Faramand, Julio C Chavez, Adam J Olszewski, Yang Liu, Stefan K Barta, Dhruvika Mukhija, Brian T Hill, Helen Ma, Jennifer E Amengual, Sunita Nathan, Sarit E Assouline, Victor M Orellana-Noia, Craig A Portell, Ashwin Chandar, Kevin A David, Anshu Giri, Brian T Hess, Daniel J Landsburg
• Journal: Cancer (Cancer) Vol. 126 Issue 2 Pg. 293-303 (01 15 2020) ISSN: 1097-0142 [Electronic] United States
• PMID: 31568564 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2019 American Cancer Society.

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (pharmacology, therapeutic use)
• Drug Resistance, Neoplasm
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation
• Humans
• Kaplan-Meier Estimate
• Lymphoma, Large B-Cell, Diffuse (mortality, pathology, therapy)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (mortality, pathology, therapy)
• Progression-Free Survival
• Retrospective Studies
• Salvage Therapy (methods, standards)
• Standard of Care
• Transplantation, Autologous (standards)
• Treatment Failure
• Young Adult