Refractory diffuse large B‐cell lymphoma after first‐line immuno‐CT: Treatment options and outcomes |
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| Authors: | Lauriane Filliatre‐clement Delphine Maucort‐Boulch Estelle Bourbon Lionel Karlin Violaine Safar Emmanuel Bachy Pierre Sesques Emmanuelle Ferrant Fadela Bouafia Anne Lazareth Dana Ghergus Bertrand Coiffier Alexandra Traverse Glehen Gilles Salles Hervé Ghesquieres Clémentine Sarkozy |
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| Affiliation: | 1. Hospices Civils de Lyon, Centre Hospitalier Lyon‐Sud, Service d'Hématologie, Pierre Bénite Cedex, France;2. Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nancy, Vandoeuvre‐lès‐Nancy, France;3. Service de Biostatistique‐Bioinformatique, Hospices Civils de Lyon, Lyon, France;4. Université Lyon 1, Villeurbanne, France;5. CNRS UMR 5558, Laboratoire de Biométrie et Biologie évolutive, équipe Biostatistique‐Santé, Villeurbanne, France;6. INSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon‐Sud Charles Mérieux Lyon‐1, Pierre Bénite Cedex, France |
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| Abstract: | 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. |
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| Keywords: | diffuse large B‐cell lymphoma refractory rituximab |
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