Relapse timing does not factor into survival for DLBCL treated with autologous transplant
Though CAR T-cell therapy quickly became the standard of care in diffuse large B-cell lymphoma, a presenter at ASCO2020 Virtual Scientific Program suggested studies need to continue to look at autologous transplant.
“While CAR T-cell therapy is now the standard of care for chemorefractory diffuse large B-cell lymphoma, we need results from the ongoing randomized studies that are comparing CAR T-cell therapy to autologous transplant, specifically in those early chemotherapy failure patients, before the widespread replacement of autologous transplant for chemosensitive diffuse large B-cell lymphoma patients,” Nirav N. Shah, MD, MS, of the Medical College of Wisconsin, said during his recorded presentation.
Shah explained their goal of evaluating the OS, PFS, rates of relapse progression and non-relapse mortality in the CIBMTR cohort of patients with PET-positive disease who underwent autologous transplant from 2003 to 2018. After limiting to those who received front-line rituximab-based chemotherapy and PET-CT prior to transplant showing partial response, the cohort came to 249 patients. They also stratified patients by early, within 12 months (n = 182), and late (n = 67) chemotherapy failure.
Patients who experienced early failures had a median age of 57 years compared with 63 years in the late failure group. The early failure cohort also had more patients diagnosed with stage 3 or 4 disease (74%) vs. the late failure group (54%). Eighty percent of the early failure group also had primary refractory disease after front-line chemotherapy. The treatments, both chemotherapy and BEAM conditioning, were similar in both groups.
“In terms of non-relapsed mortality at 5 years, there was no difference in the non-relapsed mortality in the late chemotherapy failure and early chemotherapy failure groups, with 8% non-relapsed mortality in the late chemotherapy failure group and 10% in the early chemotherapy failure group,” Shah said. “Similarly, there was no difference at 5 years in the rates of progression and relapse, with 57% of patients relapsing in the late chemotherapy failure group vs. 48% in the early chemotherapy failure group.”
At 1 year, PFS favored the late failure group with 66% being alive and in remission vs. 51% in the early failure group (P = .03). This trend did not continue through to the 5-year PFS with both groups having 41% PFS at 5 years. Similar results persisted in the OS data.
“Looking at these two cohorts, there was no difference in progression, relapse, non-relapsed mortality or in progression-free survival,” Shah said. “However, there was a statistically significant higher risk of death in the early chemotherapy failure group with a relative risk of 1.61 (P = .03).”
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