OUTCOME OF PATIENTS WITH RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) NOT ELIGIBLE FOR AUTOLOGOUS STEM CELL TRANSPLANTATION (ASCT)
Author(s): ,
Robert Pytlik
Affiliations:
1st Department of Medicine,1st Medical Faculty, Charles University,Praha 2,Czech Republic;Department of Cellular Therapy,Institute of Hematology and Blood Transfusion, Prague,Praha 2,Czech Republic
,
Kamila Polgárová
Affiliations:
1st Department of Medicine,1st Medical Faculty, Charles University,Praha 2,Czech Republic
,
Andrea Janíková
Affiliations:
Department of Medicine, Hematology and Oncology,Medical Faculty, Masaryk´s University Brno,Brno,Czech Republic
,
David Belada
Affiliations:
IV. Department of Medicine - Hematology,Medical Faculty Hradec Králové, Charles University,Hradec Králové,Czech Republic
,
Vít Procházka
Affiliations:
Department of Hemato-oncology,Medical Faculty, Palackého University, Olomouc,Olomouc,Czech Republic
,
Heidi Mociková
Affiliations:
Department of Medicine - Hematology,3rd Medical Faculty, Charles University, Prague,Praha 10,Czech Republic
,
David Šálek
Affiliations:
Department of Medicine, Hematology and Oncology,Medical Faculty, Masaryk´s University Brno,Brno,Czech Republic
,
Martin Šimkovič
Affiliations:
IV. Department of Medicine - Hematology,Medical Faculty Hradec Králové, Charles University,Hradec Králové,Czech Republic
,
Tomáš Papajík
Affiliations:
Department of Hemato-oncology,Medical Faculty, Palackého University, Olomouc,Olomouc,Czech Republic
,
Pavel Otáhal
Affiliations:
1st Department of Medicine,1st Medical Faculty, Charles University,Praha 2,Czech Republic;Department of Immunohematology,Institute of Hematology and Blood Transfusion, Prague,Praha 2,Czech Republic
,
Petra Blahovcová
Affiliations:
1st Department of Medicine,1st Medical Faculty, Charles University,Praha 2,Czech Republic
,
Kateřina Benešová
Affiliations:
1st Department of Medicine,1st Medical Faculty, Charles University,Praha 2,Czech Republic
Marek Trněný
Affiliations:
1st Department of Medicine,1st Medical Faculty, Charles University,Praha 2,Czech Republic
(Abstract release date: 05/17/18) EHA Library. Pytlik R. 06/16/18; 215340; PS1017
Dr. Robert Pytlik
Dr. Robert Pytlik
Contributions
Abstract

Abstract: PS1017

Type: Poster Presentation

Presentation during EHA23: On Saturday, June 16, 2018 from 17:30 - 19:00

Location: Poster area

Background
Relapsed/refractory DLBCL has poor prognosis, especially when patients cannot be salvaged by high dose therapy with SCT (age, comorbidities). There is no standard of treatment for these patients, therefore, the optimal combination of drugs, as well as intensity of next-line therapy have to be solved.

Aims
To describe the outcome of patients in Czech Lymphoma Study Group (CLSG) database who were refractory to or relapsed after R-CHOP treatment and found ineligible for SCT.

Methods
This analysis was a part of the NiHiL project (GovTrial No: NCT03199066). Patients with DLBCL progressing on or after treatment with R-CHOP (including reduced intensity R-CHOP or R-miniCHOP) between 2006 and 2016 who did not receive transplantation were identified. Primary progression was defined as progression ≤ 3 months, early relapse as progression 3-12 months, and late relapse > 12 months after completion of R-CHOP. Intensive second-line therapy was defined as a salvage regimen with ≥3 cytotoxic drugs, including high-dose dexamethasone. Palliative second-line treatment was defined as a regimen with ≤ 2 cytotoxic drugs. Categorical data were compared by chi-square tests, numerical data with Mann-Whitney U tests, survival curves were constructed according to Kaplan-Meier method and compared by log-rank test.

Results
Of 355 R/R DLBCL patients, 55 (15%) received autologous SCT and 1 (0.3%) allogeneic SCT. Median age of 299 patients, who were not transplanted, was 71 years (32-91). 48% of them were males, 64% had clinical stage III-IV, 65% had elevated LDH, 41% had ECOG performance status ≥ 2 and 62% had secondary IPI 3-5. There were 37% primary progressions, 30% early and 33% late relapses, with no significant differences in characteristics among these three subgroups. 41% of patients received intensive salvage treatment at relapse, 130 patients (44%) palliative treatment and 47 patients (16%) best supportive care only. 52% of patients received rituximab (Rx).

Median PFS for the whole group was 4.7 and median OS 8 months, with significant survival differences among primary progressions, early and late relapses (OS 4.3 v. 8.3 v. 14.5 months, p = 0.0007, PFS 3.2 v. 5.0 v. 9.2 months, p = 0.0001). Survival differences were not statistically significant among age subgroups ≤60, 61-70 and >70 years (OS 14.1 v. 6.7 v. 8.6 months, p = 0.13, PFS 4.1 v. 4.1 v. 6.2 months, p = 0.50).  When patients receiving best supportive care only were excluded, there were no significant differences between intensive and palliative second-line treatment subgroups (OS 9 v. 8.4 months, p = 0.7927, PFS 5 v. 5 months, p = 0.6245). When patients receiving only best supportive care were excluded, Rx improved only PFS (5.5 v. 3.2 months, p = 0.04) but not OS (10.9 v. 4.9 months, p = 0.07) compared to treatment without Rx.

Conclusion
In our registry-based population of R/R DLBCL patients, 85% did not receive SCT, and their prognosis was dismal. Intensive second-line treatment did not bring survival benefit in transplant ineligible patients. Addition of rituximab to second-line therapy significantly improved their progression-free but not overall survival.

This study was supported by grants AZV ČR 16-31092A and AZV ČR 15-34498A

Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): chemotherapy, Diffuse large B cell lymphoma, Relapsed lymphoma

Abstract: PS1017

Type: Poster Presentation

Presentation during EHA23: On Saturday, June 16, 2018 from 17:30 - 19:00

Location: Poster area

Background
Relapsed/refractory DLBCL has poor prognosis, especially when patients cannot be salvaged by high dose therapy with SCT (age, comorbidities). There is no standard of treatment for these patients, therefore, the optimal combination of drugs, as well as intensity of next-line therapy have to be solved.

Aims
To describe the outcome of patients in Czech Lymphoma Study Group (CLSG) database who were refractory to or relapsed after R-CHOP treatment and found ineligible for SCT.

Methods
This analysis was a part of the NiHiL project (GovTrial No: NCT03199066). Patients with DLBCL progressing on or after treatment with R-CHOP (including reduced intensity R-CHOP or R-miniCHOP) between 2006 and 2016 who did not receive transplantation were identified. Primary progression was defined as progression ≤ 3 months, early relapse as progression 3-12 months, and late relapse > 12 months after completion of R-CHOP. Intensive second-line therapy was defined as a salvage regimen with ≥3 cytotoxic drugs, including high-dose dexamethasone. Palliative second-line treatment was defined as a regimen with ≤ 2 cytotoxic drugs. Categorical data were compared by chi-square tests, numerical data with Mann-Whitney U tests, survival curves were constructed according to Kaplan-Meier method and compared by log-rank test.

Results
Of 355 R/R DLBCL patients, 55 (15%) received autologous SCT and 1 (0.3%) allogeneic SCT. Median age of 299 patients, who were not transplanted, was 71 years (32-91). 48% of them were males, 64% had clinical stage III-IV, 65% had elevated LDH, 41% had ECOG performance status ≥ 2 and 62% had secondary IPI 3-5. There were 37% primary progressions, 30% early and 33% late relapses, with no significant differences in characteristics among these three subgroups. 41% of patients received intensive salvage treatment at relapse, 130 patients (44%) palliative treatment and 47 patients (16%) best supportive care only. 52% of patients received rituximab (Rx).

Median PFS for the whole group was 4.7 and median OS 8 months, with significant survival differences among primary progressions, early and late relapses (OS 4.3 v. 8.3 v. 14.5 months, p = 0.0007, PFS 3.2 v. 5.0 v. 9.2 months, p = 0.0001). Survival differences were not statistically significant among age subgroups ≤60, 61-70 and >70 years (OS 14.1 v. 6.7 v. 8.6 months, p = 0.13, PFS 4.1 v. 4.1 v. 6.2 months, p = 0.50).  When patients receiving best supportive care only were excluded, there were no significant differences between intensive and palliative second-line treatment subgroups (OS 9 v. 8.4 months, p = 0.7927, PFS 5 v. 5 months, p = 0.6245). When patients receiving only best supportive care were excluded, Rx improved only PFS (5.5 v. 3.2 months, p = 0.04) but not OS (10.9 v. 4.9 months, p = 0.07) compared to treatment without Rx.

Conclusion
In our registry-based population of R/R DLBCL patients, 85% did not receive SCT, and their prognosis was dismal. Intensive second-line treatment did not bring survival benefit in transplant ineligible patients. Addition of rituximab to second-line therapy significantly improved their progression-free but not overall survival.

This study was supported by grants AZV ČR 16-31092A and AZV ČR 15-34498A

Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): chemotherapy, Diffuse large B cell lymphoma, Relapsed lymphoma

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