|The following article features coverage from the American Society of Clinical Oncology 2020 meeting. Click here to read more of Cancer Therapy 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.
“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.
“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.
Read more of Cancer Therapy Advisor‘s coverage of the ASCO 2021 meeting by visiting the conference page.
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.