DLBCL/HGBL: early 1L failure predicts inferior outcomes with platinum-based 2L immunochemotherapy

  • Ayers EC & al.
  • Cancer
  • 30 Sep 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with diffuse large B-cell lymphoma (DLBCL) or high-grade B-cell lymphoma (HGBL), early treatment failure with intensive first-line (1L) therapy independently predicted inferior outcomes with platinum-based (2L) immunochemotherapy.

Why this matters

  • This may be the largest study reporting outcomes in this setting after failure with intensive 1L therapy.

Study design

  • Study to investigate outcomes in 195 patients with relapsed/refractory DLBCL or HGBL treated with salvage platinum-based immunochemotherapy after failure of intensive 1L therapy.
  • Frontline regimens:
    • 82% received dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R);
    • 16% received rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine (R-HyperCVAD); and
    • 2% received rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine (R-CODOX-M/IVAC).
  • Funding: None disclosed.

Key results

  • 43% overall response to 2L therapy.
  • 3 (95% CI, 2.4-4) months median PFS.
  • 8 (95% CI, 6-10.1) months median OS.
  • In multivariate analysis, patients with early treatment failure (primary refractory/relapse
  • Disease progression: HR=2.43; 95% CI, 1.11-5.31; P=.024.
  • Death: HR=5.90; 95% CI, 2.02-17.21; P=.001.

Limitations

  • Retrospective data.