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Lymphoma

Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study

Bone Marrow Transplantation volume 51, pages 51–57 (2016)Cite this article

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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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Authors and Affiliations

  1. Cliniques Universitaires UCL Saint-Luc, Brussels, Belgium

    E Van Den Neste

  2. AbteilungHämatologie und Stammzelltransplantation, AsklepiosKlinik St Georg, Hamburg, Germany

    N Schmitz & B Glass

  3. CHU de l'Archet, Nice, France

    N Mounier

  4. Princess Alexandra Hospital, Woodville, SA, Australia

    D Gill

  5. University College London, Cancer Institute, London, UK

    D Linch

  6. Charles Univ. General Hosp., Praha, Czech Republic

    M Trneny

  7. Hématologie Clinique et thérapie cellulaire, Hôpital Haut-Lévêque, Pessac, France

    N Milpied

  8. c/o Department of Medical Oncology, University of Manchester, Christie Hospital NHS, Manchester, UK

    J Radford

  9. Clinique Bois-Cerf, Lausanne, Switzerland

    N Ketterer

  10. Assuta Medical Center, Tel-Aviv, Israel

    O Shpilberg

  11. Universitätsklinikum Essen, KlinikfürHämatologie, Essen, Germany

    U Dührsen

  12. St Vincent’s Hospital Sydney, Darlinghurst, NW, Australia

    D Ma

  13. Hemato-Oncologie Hôpital Hôpital Saint-Louis, Paris, France

    J Brière, C Thieblemont & C Gisselbrecht

  14. Hospices Civils de Lyon, Service d’Hématologie, Université de Lyon, Lyon, France

    G Salles

  15. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    C H Moskowitz

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  1. E Van Den Neste
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Correspondence to C Gisselbrecht.

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Competing interests

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.

Additional information

Preliminary results were presented at the 55th ASH 2013 annual meeting (Blood 2013; 122: 764).

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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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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