Outcomes in refractory diffuse large B-cell lymphoma: results from a multicenter real-world study in China

Cancer Communications

article

Shuo Wang¹  Chung-Chou H. Chang³  Pengpeng Xu¹  Xiaoyun Zheng⁵  Juying Wei⁶  Yao Liu⁷  Guohui Cui⁸  Yong Tang⁹  Yan Ma^1,10  Haiwen Huang^1,11  Hongmei Yi^1,12  Li Wang¹  Weili Zhao¹  Jianda Hu⁵  Wenbin Qian⁶  Xi Zhang⁷  Yu Hu⁸  Qi Zhu⁹  Bobin Chen^1,10  Depei Wu^1,11 

[1] Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine;These authors contributed equally to this work.;Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 15213 United States of America;Chinese-French Research Center in Living Science and Genomics, Laboratory of Molecular Pathology;Fujian Institute of Hematology, Fujian Medical University Union Hospital;The First Affiliated Hospital of Medical School of Zhejiang University;Department of Hematology, Xinqiao Hospital, Army Medical University;Union Hospital, Tongji Medical College, Huazhong University of Science and Technology;Shanghai Ninth People's Hospital;Huashan Hospital Affiliated with Fudan University;Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, the First Affiliated Hospital of Soochow University;Department of Pathology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

关键词: diffuse large B-cell lymphoma;    multicenter cohort study;    refractory;    relapse;    rituximab;    immunochemotherapy;    treatment response;    prognosis;   

DOI  :  10.1002/cac2.12126

学科分类：社会科学、人文和艺术（综合）

来源: Springer

【 摘 要 】

Background Diffuse large B-cell lymphoma (DLBCL) patients refractory to rituximab-based immunochemotherapy have a dismal prognosis. However, the definition of refractory DLBCL remains inconsistent and no large cohort study data is available from Asian countries. To validate the definition and outcomes of refractory DLBCL in China, we conducted a multicenter, retrospective cohort study. Methods The REtrospective AnaLysis of Treatment REspoNse of refractory DLBCL (REAL-TREND) study was performed using real-world data from 8 centers in China. DLBCL patients with curative intent were included in the REAL-TREND dataset. Overall survival (OS) was estimated using the Kaplan-Meier method and compared by the log-rank test. Due to heterogeneity in response rates among different centers, the response rates of refractory patients were pooled using random-effect models. Multivariate survival analysis was performed using the Cox regression model. Results A total of 2778 DLBCL patients diagnosed between January, 2010 and December, 2015 were enrolled to this study. After validating previous definitions, the SCHOLAR-1 study was most suitable to define refractory DLBCL. The estimated 5-year cumulative incidence of refractory patients was 20% (95% confidence Interval [CI] = 18%-22%). After the determination of refractory disease, overall response rate and complete remission rate were 30% (95% CI = 22%-38%) and 9% (95% CI = 4%-15%), respectively. Patients with either no response to immunochemotherapy or relapse within 12 months after stem-cell transplantation had inferior survival with a median OS of 5.9 months (95% CI = 5.5-7.1 months) and 2-year OS rate of 16% (95% CI = 12%-20%). International prognostic index score 4-5 (hazard ratio [HR] = 2.22; 95% CI = 1.47-3.35), central nervous system relapse (HR = 1.43; 95% CI = 1.04-1.97), and best response status (HR = 2.68; 95% CI = 1.42-5.03 for partial remission. HR = 5.97, 95% CI = 3.21-11.11 for stable disease/progressive disease) were independent unfavorable prognostic factors. Conclusions This is the first large-scale Asian cohort study focusing on outcomes of refractory DLBCL. The definition of the SCHOLAR-1 study identifies patients with homogenously inferior survival, thus is appropriate to select refractory DLBCL. Due to poor clinical outcomes in the rituximab era, patients with refractory DLBCL may be potential candidates for novel treatment modalities.

【 授权许可】

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