Researchers identified prognostic factors in adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who underwent autologous stem cell transplants before relapsing again — taking on, in this work, rarely studied third-line treatments.
The study, “Outcomes of diffuse large B-cell lymphoma patients relapsing after autologous stem cell transplantation: an analysis of patients included in the CORAL study,” published in the journal Bone Marrow Transplantation, suggested that the prognostic factors could help clinicians in choosing a treatment strategy for difficult-to-treat patients.
The findings also underscored the importance of achieving a response to treatment before attempting stem cell transplants.
Although that characteristics of DLBCL patients who relapse after a first treatment round are relatively well-studied, little is known about factors that influence treatment among patients receiving a third-line therapy.
In the Phase 3 CORAL study (NCT00137995), DLBCL patients who did not respond or who had relapsed after first-line treatment were treated with one of two Rituxan (rituximab)-including combination therapies, followed by an autologous stem cell transplant.
Among the 255 patients given stem cell transplants, 75 relapsed again. The median time between transplant and relapse was 7.1 months, and the majority of patients who relapsed after transplant were men.
Post-transplant, patients were again randomized to receive either maintenance treatment with Rituxan or to observation. A small number of patients, making up 5.3 percent, relapsed before randomization. Another 49.3 percent of relapsed patients were found in the Rituxan group, and 45.3 percent in the observation group, showing that the maintenance treatment did not prevent relapse.
Relapsed patients were treated with various forms of third-line treatment, all combinations of chemotherapy with or without Rituxan. Of the initial 75 relapse patients, 16 (21.6 percent) could eventually undergo another transplant. Three received autologous stem cell transplants and 13 stem cells donated from another person.
An analysis of patient characteristics after third-line treatment revealed that the disease-free interval after a transplant, as well as the International Prognostic Index after the second transplant, could be used as prognostic factors. (The index is a tool used by oncologists to aid in predictions of lymphoma development. Patients with a score of 0-2 lived for a median time of 12.6 months, while those with scores higher than 2 had a median survival time of 5.3 months.)
Patients who relapsed less than six months after the transplant had an overall survival of 5.7 months, while those relapsing after six months post-transplant lived for a median of 11.3 months.
Survival did not differ depending on the type of third-line treatment a patient went through, the researchers reported.