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.”
- 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
This article originally appeared on Hematology Advisor