The following article features coverage from the American Society of Clinical Oncology 2020 meeting. Click here to read more of Hematology Advisor’s conference coverage.

 

A retrospective examination of outcomes from autologous transplantation in 249 evaluable patients with relapsed chemosensitive diffuse large B-cell lymphoma (DLBCL) who received frontline rituximab revealed that those patients experiencing early, compared with late, chemoimmunotherapy failure had similar 5-year progression-free survival rates.

The data were presented by Nirav N. Shah, MD, of Medical College of Wisconsin, as part of the ASCO20 Virtual Scientific Program.


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“Auto transplant is the standard of care for aggressive non-Hodgkin lymphoma based on randomized clinical trials,” Dr Shah said. 

However, from 2017 to 2018, there was a 45% decrease in autologous transplant volume, suggesting that some patients who had chemosensitive disease and had only a partial response were proceeding with other treatments — presumably chimeric antigen receptor T-cell (CAR-T) therapy.

This study was designed to test the hypothesis that autologous transplant provides durable disease control for patients with DLBCL who have chemosensitive but positron emission tomography/computed tomography (PET/CT)-positive disease at the time of transplant.

The study used the CIBMTR registry to identify 182 patients for whom early chemotherapy failed (relapse within 1 year) and 67 for whom late chemoimmunotherapy failed. Patients who experienced early treatment failure were significantly younger (57 years vs 63 years; P <.01). Additionally, the early chemotherapy failure group also had significantly more patients with stage III-IV disease and more with primary refractory disease after first-line therapy.

At 5 years, there was no difference in nonrelapse mortality between the 2 groups (8% for late vs 10% for early failure). The cumulative incidence of relapse at 5 years was 48% among patients with early failure and 57% among patients with late failure.

Although 1-year outcomes for progression-free survival and overall survival favored patients who experienced late failure, there were no significant differences in 5-year probabilities for progression-free or overall survival between the 2 groups.

Overall survival did favor patients who experienced late treatment failure, however (5-year probability was 51% for early failure vs 63% for late failure; P =.09).

Multivariate analyses indicated patients who saw early chemotherapy failure had an increased risk for death (hazard ratio [HR], 1.61; 95% CI, 1.05-2.46; P =.03), but no increased risk for progression-free survival or relapse.

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“These data from the CIBMTR registry demonstrate that those patients who have chemosensitive relapsed DLBCL despite having PET/CT-positive partial response at time of autologous transplant still have 5 year progression-free survival of 41% regardless of timing of relapse,” Dr Shah noted. “These data support ongoing use of autologous transplant as a consolidative procedure in patients with chemosensitive relapsed DLBCL, even for those in partial response at the time of transplant.”

Results from ongoing randomized studies comparing CAR-T therapy to auto-HCT are needed before widespread replacement of transplant for these patients should occur.

Disclosure: Some of the authors disclosed financial relationships with pharmaceutical and/or medical device companies. For a full list of disclosures, please refer to the original abstract.

Reference                                                                         

Shah NN, Ahn KW, Litovich C, et al. Is autologous transplantation (autoHCT) in relapsed diffuse large B-cell lymphomaa (DLBCL) patients achieving only a PET/CT positive partial remisison (PR) appropriate in the CAR-T cell era? Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 8000.  

This article originally appeared on Cancer Therapy Advisor