Abstract
Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard second-line treatment for relapsed and refractory diffuse large B-cell lymphoma (DLBCL). However, the strategy is less clear in patients who require third-line treatment. Updated outcomes of 203 patients who could not proceed to scheduled ASCT in the Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) are herein reviewed. In the intent-to-treat analysis, overall response rate to third-line chemotherapy was 39%, with 27% CR or CR unconfirmed, and 12% PR. Among the 203 patients, 64 (31.5%) were eventually transplanted (ASCT 56, allogeneic SCT 8). Median overall survival (OS) of the entire population was 4.4 months. OS was significantly improved in patients with lower tertiary International Prognostic Index (IPI), patients responding to third-line treatment and patients transplanted with a 1-year OS of 41.6% compared with 16.3% for the not transplanted (P<0.0001). In multivariate analysis, IPI at relapse (hazard ratio (HR) 2.409) and transplantation (HR 0.375) independently predicted OS. Third-line salvage chemotherapy can lead to response followed by transplantation and long-term survival in DLBCL patients. However, improvement of salvage efficacy is an urgent need with new drugs.
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Acknowledgements
We thank the LYSARC for coordinating the study; Fabienne Morand, Sami Boussetta, Marion Fournier, Laurence Girard, Clemence Capron and the project leaders from the different countries; the patients and their families; AJE for reviewing the English; Catherine Druon for preparing the manuscript; and all investigators (see Supplementary Materials) and pathologists. This work was supported by research grants from F-Hoffmann La Roche Ltd, LYSARC. Written on behalf of the CORAL (Collaborative trial in Relapsed Aggressive Lymphoma).
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CG: Roche—Research Funding. MT: Roche—Honoraria, Research Funding. JR: Roche—Consultancy. OS: Roche—Consultancy, Honoraria, Research Funding. UD: Roche Pharma—Honoraria, Research Funding. CHM: Genentech—Consultancy, Research Funding. BG: Roche—Honoraria, Research Funding. GS: Roche—Honoraria, research funding. The authors declare no conflict of interest.
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Preliminary results were presented at the 55th ASH 2013 annual meeting (Blood 2013; 122: 764).
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Van Den Neste, E., Schmitz, N., Mounier, N. et al. Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study. Bone Marrow Transplant 51, 51–57 (2016). https://doi.org/10.1038/bmt.2015.213
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DOI: https://doi.org/10.1038/bmt.2015.213
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