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Clinical Trial
. 2019 Jun 11;3(11):1661-1669.
doi: 10.1182/bloodadvances.2019000102.

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

Narendranath Epperla  1 , Talha Badar  2 , Aniko Szabo  2 , John Vaughn  1 , Steve Borson  3 , Neeraj Y Saini  4 , Romil D Patel  4 , Nirav N Shah  2 , Mehdi Hamadani  2 , Sairah Ahmed  4 , Amanda F Cashen  3 , Timothy S Fenske  2
Affiliations
Clinical Trial

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

Narendranath Epperla et al. Blood Adv. .

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.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
CONSORT diagram.
Figure 2.
Figure 2.
PR-OS of the entire population.
Figure 3.
Figure 3.
PR-OS based on remission status at auto-HCT.
Figure 4.
Figure 4.
PR-OS based on timing of relapse after auto-HCT. (A) Within 1 year vs >1 year after auto-HCT. (B) Detailed breakdown of PR-OS within 1 year vs >1 year after auto-HCT.
Figure 5.
Figure 5.
PR-OS based on timing of auto-HCT: era 1 vs era 2.
See this image and copyright information in PMC

References

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