Retreatment with R-CHOP-like Therapy Is Active with Durable Responses in Patients with Late Relapse of Diffuse Large B-Cell Lymphoma

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.4454-4454
• Main Authors: Edelman Saul, Eduardo, Valcarcel, Bryan, Ayers, Amy A., Noorani, Mansoor, Chihara, Dai, Furqan, Fateeha, Ahmed, Sairah, Iyer, Swaminathan P, Neelapu, Sattva S., Fayad, Luis E., Hagemeister, F. B., Nze, Chijioke, Jain, Preetesh, Wang, Michael, Strati, Paolo, Chauhan, Ayushi, Vega, Francisco, Flowers, Christopher R., Westin, Jason R.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-211247

Background Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma, relapses after >2 years in 10% of patients (pts) defined as late-relapse (LR DLBCL) and is often treated with high dose immunochemotherapy (HD ICP) followed by stem cell transplant (SCT). LR DLBCL may be genetically distinct from the initial DLBCL, and thus potentially chemotherapy naïve (PMID: 37319384). Retreatment with first-line (1L) regimen with curative intent may be feasible while avoiding HD ICP toxicity. We aimed to retrospectively analyze outcomes of LR DLBCL retreatment in a single-institution cohort. Methods We evaluated 199 pts diagnosed with LR DLBCL between 01/2010 and 12/2023 at MD Anderson Cancer Center and included 21 pts that received second- or third- line (2L, 3L) rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-like therapy. Parameters included age, gender, stage, IPI score, cell of origin (COO), BCL-2, BCL-6, and MYC by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), therapies, and response. Primary endpoints were complete remission (CR) rate, 2-year progression-free survival (PFS) and 2-year overall survival (OS) after 2L R-CHOP-like therapy, using Kaplan-Meier method and the univariable Cox regression analysis (UVA). Missing data were handled with complete case analysis. Results Among 21 pts, median age was 62 (54-80), 9 (43%) were female and 13 (62%) non-Hispanic white. At initial presentation 12 pts (63%) had stage III-IV, 19 (95%) PS ECOG 0-1, 12 (67%) extranodal involvement (ENI), 7 (58%) high LDH, 4 (33%) high IPI (3-5), 7 (54%) germinal center B-cell (GCB) subtype, 5 (26%) transformed, 1 (5%) high-grade B-cell lymphoma (HGBCL). By IHC, 9 (82%), 9 (75%), and 2 (67%) were BCL2, BCL6, MYC positive, respectively. By FISH, 3 (75%), 2 (50%) and 1 (11%) were BCL2, BCL6, MYC positive, respectively. For 1L therapy, 12 (57%) pts received R-CHOP, 5 (24%) R-EPOCH, and 1 each (5%) R-CHOP+Bortezomib, R-CEOP, R-CVP and R-Cytoxan/Gemzar/Vincristine, with the median number of cycles of 6 (3-8). All pts achieved 1L CR, which included consolidative radiation (5 pts, 24%) and autologous SCT (1 pt, 5%). The median time from initial DLBCL to LR DLBCL was 87.5 months (25.1-148.9). The median age at LR DLBCL diagnosis was 70 (58-88), 16 pts (76%) had stage III-IV, 20 (100%) PS ECOG 0-1, 11 (54%) ENI, 14 (67%) high LDH, 11 (55%) high IPI, 11 (65%) GCB subtype, 7 (35%) transformed, 2 (12%) HGBCL. By