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Ayers EC , Li S , Medeiros LJ , Bond DA , Maddocks KJ , Torka P , Mier Hicks A , Curry M , Wagner-Johnston ND , Karmali R , Behdad A , Fakhri B , Kahl BS , Churnetski MC , Cohen JB , Reddy NM , Modi D , Ramchandren R , Howlett C , Leslie LA , Cytryn S , Diefenbach CS , Faramand R , Chavez JC , Olszewski AJ , Liu Y , Barta SK , Mukhija D , Hill BT , Ma H , Amengual JE , Nathan S , Assouline SE , Orellana-Noia VM , Portell CA , Chandar A , David KA , Giri A , Hess BT , Landsburg DJ
Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure
Cancer. 2020 jan 15;126(2) :293-303
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BACKGROUND: Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. METHODS: Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. RESULTS: In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P < .001) and OS (6 months vs not reached; P < .001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. CONCLUSIONS: Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.
1097-0142 Ayers, Emily C ORCID: https://orcid.org/0000-0003-3748-4507 Li, Shaoying Medeiros, L Jeffrey Bond, David A Maddocks, Kami J Torka, Pallawi Mier Hicks, Angel Curry, Madeira Wagner-Johnston, Nina D Karmali, Reem Behdad, Amir Fakhri, Bita ORCID: https://orcid.org/0000-0002-2124-7243 Kahl, Brad S Churnetski, Michael C ORCID: https://orcid.org/0000-0001-7442-9633 Cohen, Jonathon B ORCID: https://orcid.org/0000-0002-2723-6481 Reddy, Nishitha M Modi, Dipenkumar ORCID: https://orcid.org/0000-0001-6525-8844 Ramchandren, Radhakrishnan Howlett, Christina Leslie, Lori A Cytryn, Samuel Diefenbach, Catherine S Faramand, Rawan Chavez, Julio C Olszewski, Adam J ORCID: https://orcid.org/0000-0002-6472-6658 Liu, Yang Barta, Stefan K Mukhija, Dhruvika Hill, Brian T Ma, Helen Amengual, Jennifer E Nathan, Sunita Assouline, Sarit E Orellana-Noia, Victor M Portell, Craig A ORCID: https://orcid.org/0000-0002-9487-8345 Chandar, Ashwin David, Kevin A Giri, Anshu Hess, Brian T Landsburg, Daniel J Journal Article United States Cancer. 2019 Sep 30. doi: 10.1002/cncr.32526.