Postrelapse survival in diffuse large B-cell lymphoma after therapy failure following autologous transplantation

Abstract

Outcomes for diffuse large B-cell lymphoma (DLBCL) patients relapsing after autologous hematopoietic cell transplantation (auto-HCT) have been historically poor. We studied outcomes of such patients using data from 4 transplantation centers. Eligibility criteria included adult patients (age ≥18 years) with DLBCL experiencing disease relapse after auto-HCT performed during 2006 to 2015. The time period was stratified into 2 eras (era 1, 2006-2010; era 2, 2011-2015). The primary end point was postrelapse overall survival (PR-OS). Secondary end points were factors prognostic of PR-OS. Of the 700 patients with DLBCL who underwent auto-HCT, 248 (35%) relapsed after auto-HCT. Median PR-OS of all relapsed DLBCL patients after auto-HCT (n = 228) was 9.8 months (95% confidence interval [CI], 7-15). Median PR-OS was significantly better for patients in complete (17.8 months; 95% CI, 7.9-41.6) vs partial remission at auto-HCT (7.1 months; 95% CI, 5.4-11; P = .01), those undergoing auto-HCT >1 year (12.8 months; 95% CI, 7.6-24.9) vs ≤1 year after DLBCL diagnosis (6.3 months; 95% CI, 4.5-9.2; P = .01), and those with late (56.4 months; 95% CI, 23.7-∞) vs early relapse (5.9 months; 95% CI, 4.5-8.8; P < .0001). On multivariate analysis, although late relapse (hazard ratio [HR], 0.21; 95% CI, 0.13-0.34; P < .0001) was associated with significantly lower mortality, the risk of mortality increased with age (HR, 1.25 per decade; 95% CI, 1.06-1.48; P = .009). This is the largest study to date to evaluate outcomes of DLBCL patients relapsing after auto-HCT. Our study provides benchmarking for future trials of chimeric antigen receptor T cells and other promising agents evaluating PR-OS after auto-HCT.

Obesity is associated with an impaired survival in lymphoma patients undergoing autologous stem cell transplantation

“…Baseline patient characteristics displayed no significant differences except for more patients with a progressive disease or stable disease at auto-HSCT in the group of obese patients. This might affect further interpretations of the different groups, especially in light of the fact that remission status at transplantation has been shown to be one of the most relevant indicators of long-term disease control[24, 25]. However, in the multivariate analysis obesity was identified with a clinically relevant hazard ratio (HR 2.618) as an independent risk factor for death, although disease remission status was included into the analysis.…”

Impact and Intricacies of Bone Marrow Microenvironment in B-cell Lymphomas: From Biology to Therapy

“…It is important to note however those patients who relapse following auto-HCT have poor OS following auto-HCT relapse. For instance, although, auto-HCT can salvage patients with relapsed DLBCL,~50% of these patients will eventually relapse again with a poor OS following the relapse, especially in those who relapse within six months [107,108]. Similarly, early relapse following auto-HCT portends worse outcomes in patients with MCL [109].…”

A genetic predictive model for precision treatment of diffuse large B-cell lymphoma with early progression

“…However, the rest eventually succumbed to recurrent or refractory disease [ 1 – 4 ]. Particularly, those with early progression within less than 12 months (POD12) usually experienced a very dismal outcome and did not benefit much from salvage therapy in combination with autologous stem cell transplantation [ 5 , 6 ]. Hence, it is necessary to provide them an alternative treatment beyond standard immunochemotherapy in the setting of frontline therapy.…”