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. 2020 May 12;4(9):2011-2017.
doi: 10.1182/bloodadvances.2020001646.

The conditional survival analysis of relapsed DLBCL after autologous transplant: a subgroup analysis of LY.12 and CORAL

Sarit Assouline  1 , Shen Li  1 , Christian Gisselbrecht  2 , Patrick Fogarty  3 , Annette Hay  4 , Eric van den Neste  5 , Lois E Shepherd  4 , Norbert Schmitz  6 , Tara Baetz  7 , Armand Keating  8 , Sue Robinson  9 , Matthew Seftel  10 , Caterina Stelitano  11 , Marina S Djurfeldt  5 , Ralph Meyer  12 , Bingshu E Chen  5 , Michael Crump  8
Affiliations

The conditional survival analysis of relapsed DLBCL after autologous transplant: a subgroup analysis of LY.12 and CORAL

Sarit Assouline et al. Blood Adv. .

Abstract

The conditional survival of patients after frontline therapy for diffuse large B-cell lymphoma (DLBCL) approaches that of the general population once patients have survived disease free for 2 years. We sought to determine the conditional survival of patients among patients with relapsed de novo DLBCL successfully undergoing an autologous stem-cell transplant (ASCT) after first relapse. A total of 478 patients with de novo DLBCL, relapsed after 1 treatment from the Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) and LY.12, were included. Patients were followed prospectively after ASCT for a median of 5.3 and 8.2 years, respectively. Individual patient data were analyzed for event-free survival (EFS) and overall survival. Standardized mortality ratios (SMRs) were estimated using French and Canadian life tables. The EFS estimates declined with each year of follow-up after ASCT and were 50.1% (95% confidence interval [CI]: 43.7% to 56.3%) and 43.4% (95% CI: 36.7% to 49.9%) at 5 years in CORAL and LY.12, respectively. The rate of death stabilized once patients achieved at least 4 years of EFS. Compared with the age- and sex-matched population, the SMR was significantly higher until 5 years after ASCT, when values were no longer statistically significant. Patients undergoing ASCT for relapsed DLBCL continue to have a higher rate of death at least until they have survived event free for 5 years. These observations can help to determine endpoints for future clinical trials in this population and for patient counseling. This trial was registered at www.clinicaltrials.gov as #NCT00078949.

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Conflict of interest statement

Conflict-of-interest disclosure: S.A. reports contributions to advisory boards for Roche Canada, Janssen, Pfizer, and AbbVie. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
One-year, 2-year, and 5-year OS after specified EFS time points with shaded 95% CI area. (A) Data from the CORAL study. (B) Data from the LY.12 study. (C) Combined data from CORAL and LY.12 studies.
Figure 2.
Figure 2.
OS vs expected survival in the CORAL study post-ASCT. (A) OS immediately post-ASCT. (B) OS post-EFS24. (C) OS post-EFS60.
Figure 3.
Figure 3.
OS vs expected survival in the LY.12 study post-ASCT. (A) OS immediately post-ASCT. (B) OS post-EFS24. (C) OS post-EFS60.
Figure 4.
Figure 4.
Forest plots of the multivariate analysis for combined CORAL and LY.12 studies. A hazard ratio of less than 1 indicates a lower risk of relapse or death after autologous transplant. ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; ULN, upper limit of normal.
See this image and copyright information in PMC

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