Premium
Refractory diffuse large B‐cell lymphoma after first‐line immuno‐CT: Treatment options and outcomes
Author(s) -
Filliatreclement Lauriane,
MaucortBoulch Delphine,
Bourbon Estelle,
Karlin Lionel,
Safar Violaine,
Bachy Emmanuel,
Sesques Pierre,
Ferrant Emmanuelle,
Bouafia Fadela,
Lazareth Anne,
Ghergus Dana,
Coiffier Bertrand,
Traverse Glehen Alexandra,
Salles Gilles,
Ghesquieres Hervé,
Sarkozy Clémentine
Publication year - 2018
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2512
Subject(s) - medicine , rituximab , refractory (planetary science) , salvage therapy , diffuse large b cell lymphoma , univariate analysis , progressive disease , gastroenterology , lymphoma , international prognostic index , retrospective cohort study , anthracycline , aggressive lymphoma , surgery , oncology , multivariate analysis , disease , chemotherapy , cancer , physics , astrobiology , breast cancer
In the rituximab era, one‐third of diffuse large B‐cell lymphoma patients experience relapse/refractory disease after first‐line anthracycline‐based immunochemotherapy. Optimal management remains an unmet medical need. The aim of this study was to report the outcomes of a cohort of refractory patients according to their patterns of refractoriness and the type of salvage option. We performed a retrospective analysis, which included 104 diffuse large B‐cell lymphoma patients treated at Lyon Sud University Hospital (2002‐2017) who presented with refractory disease. Refractoriness was defined as progressive/stable disease during first‐line treatment (primary refractory, N = 47), a partial response after the end of first‐line treatment that required subsequent treatment (residual disease, N = 19), or relapse within 1 year of diagnosis after an initial complete response (CR) (early relapse, N = 38). The 2‐year overall survival (OS) rates for primary refractory, early relapse, and residual disease patients were 27%, 25%, and 52%, respectively, while the event‐free survival rates for those groups were 13%, 13%, and 42%, respectively. In a univariate analysis, lactate dehydrogenase level, Ann Arbor stage, poor performance status, high age‐adjusted International Prognostic Index score, and age > 65 years were associated with shorter OS. The use of rituximab and platinum‐based chemo during the first salvage treatment was associated with prolonged OS. In a multivariate analysis, age (HR:2.06) and rituximab use (HR:0.54) were associated with OS. Among patients <65 years who achieved a CR, autologous stem‐cell transplant was associated with higher 2‐year OS (90% vs 74%, P = 0.10). Patients who were treated with a targeted therapy in the context of a clinical trial after second‐line treatment had a higher 2‐year OS (34% vs 19%, P = 0.06). In conclusion, patients with primary refractory disease or early relapse have very poor outcomes but may benefit from rituximab retreatment during the first salvage treatment.