Outcomes in Refractory Diffuse Large B-Cell Lymphoma: Results from Two Prospective Korean Cohorts

Abstract

Purpose Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal.Materials and Methods We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation.Results Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529).Conclusion In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.

Recent advances in cellular immunotherapy for lymphoid malignancies

“…However, recent advances in our understanding of the genetic drivers of lymphoid cancers have resulted in a better subclassification of these tumors that differ widely in their phenotype, biology, and clinical behavior [ 1 , 2 ]. For instance, approximately 20–30% of patients with diffuse large B-cell lymphoma (DLBCL), which is the commonest subtype of NHL, are unable to achieve complete remission with the standard chemoimmunotherapy regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) [ 3 ]. Furthermore, patients with high-grade B-cell lymphoma (HGBL) with concurrent MYC plus BCL2 and/or BCL6 rearrangements, the so-called double-hit or triple-hit lymphomas, constitute an additional high-risk group with a complete remission (CR) rate of less than 60% with the conventional R-CHOP therapy [ 4 ].…”