According to results from a retrospective study published in Cancer, patients with aggressive B-cell lymphomas and relapsed/refractory disease after frontline treatment with chemoimmunotherapy (CIT) who underwent second-line platinum-based CIT experienced worse clinical outcomes if frontline treatment failure occurred in less than 12 months.
Researchers evaluated 195 patients (61.5% male) with high-grade B-cell lymphoma (88 patients) or diffuse large B-cell lymphoma (107 patients) from 19 academic centers. After receiving frontline treatment, 58% of patients were primary refractory, 15% experienced relapse in less than 6 months, 13% experienced relapse between 6 and 12 months after treatment, 7% experienced relapse between 12 and 24 months after treatment, and 7% experienced relapse more than 24 months after frontline treatment. Progression-free (PFS) and overall survival (OS) were evaluated from time of receipt of second-line treatment.
Across all patients, the overall response rate to second-line CIT was 44%, median PFS was 3 months, and median OS was 8 months.
Patients who were primary refractory or experienced relapse in under 12 months after completing frontline therapy experienced worse median PFS compared with patients who relapsed later (2.8 vs 23 months; P <.001). Similarly, median OS was inferior in the early primary relapse or refractory group compared with patients who relapsed later (6 months vs not reached; P <.001).
Of patients with early treatment failure, 17% achieved a complete response (CR) to second-line CIT, and these patients experienced extended survival. Nonetheless, no clinicopathologic features at the initiation of second-line CIT were predictive of CR in the early relapse or refractory group.
“Only a minority of patients with diffuse large B-cell lymphoma or high-grade B-cell lymphoma and early treatment failure after receipt of intensive frontline CIT benefit from standard second-line CIT,” wrote the authors. “An increased understanding of the genetic heterogeneity of aggressive B-cell lymphoma may help to further classify and risk stratify these patients in both first and later lines of therapy.”
1. Ayers EC, Li S, Medeiros LJ, et al. Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure [published online September 30, 2019]. Cancer. doi:10.1002/cncr.32526