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Highly favorable outcomes with salvage radiation therapy and autologous hematopoietic cell transplantation in relapsed and refractory DLBCL patients with minimal to no response to salvage chemotherapy

Bone Marrow Transplantation volume 57, pages 1038–1041 (2022)Cite this article

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For patients with rel/ref diffuse large B-cell lymphoma (DLBCL) following initial R-CHOP-like chemotherapy, high-dose chemotherapy and AHCT after platinum-based SC can cure an additional 10–15% of patients [1,2,3,4,5]. These results depend on a chemosensitivity to SC by modern PET criteria [6,7,8,9,10,11].

Outcomes after AHCT are poor for patients whose disease fails to achieve at least a partial remission (PR) [1]. For patients with residual, PET-avid disease after SC who are ineligible for AHCT, we have adopted a unique combined-modality salvage regimen with radiation therapy (RT) to residual sites of active disease as determined by functional imaging shortly followed by AHCT. Despite their poor-risk disease, a subset of these patients has been successfully salvaged with this combined-modality consolidation with durable progression-free survival (PFS) and overall survival (OS).

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Fig. 1: Progression-free survival and overall survival for patients with relapsed/refractory DLBCL treated with salvage RT followed by AHCT.

References

  1. Sehn LH, Gascoyne RD. Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity. Blood. 2015;125:22–32. https://doi.org/10.1182/blood-2014-05-577189.

    Article  CAS  PubMed  Google Scholar 

  2. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med. 1995;333:1540–5. https://doi.org/10.1056/NEJM199512073332305.

    Article  CAS  PubMed  Google Scholar 

  3. Gisselbrecht C, Glass B, Mounier N, Singh Gill D, Linch DC, Treneny M, et al. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28:4184–90. https://doi.org/10.1200/JCO.2010.28.1618.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Oliansky DM, Czuczman M, Fisher RI, Irwin FD, Lazarus HM, Omel J, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of diffuse large B cell lymphoma: update of the 2001 evidence-based review. Biol Blood Marrow Transpl. 2011;17:18–19. https://doi.org/10.1016/j.bbmt.2010.07.008.

    Article  Google Scholar 

  5. Crump M, Neelapu SS, Farooq U, Van Den Neste E, Kuruvilla J, Westin J, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017;130:1800–8.

    Article  CAS  Google Scholar 

  6. Majhail NS, Farnia SH, Carpenter PA, Camplin RE, Crawford S, Marks DI, et al. Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transpl. 2015;21:1–7. https://doi.org/10.1016/j.bbmt.2015.07.032.

    Article  Google Scholar 

  7. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059–68.

    Article  Google Scholar 

  8. Hamlin PA, Zelenetz AD, Kewlaramani T, Qin J, Satagopan JM, Verbel D, et al. Age-adjusted International prognostic index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. Blood. 2003;102:1989–96.

    Article  CAS  Google Scholar 

  9. Illidge T, Specht L, Yahalom J, Aleman B, Berthelsen AKK, Constine L, et al. Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2014;89:49–58.

    Article  Google Scholar 

  10. Tseng YD, Chen YH, Catalano PJ, Ng A. Rates and durability of response to salvage radiation therapy among patients with refractory or relapsed aggressive non-Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2015;19:223–31.

    Article  Google Scholar 

  11. Wong J, Pickles T, Connors J, Aquino-Parsons C, Sehn L, Freeman C, et al. Efficacy of palliative radiation therapy (RT) for chemotherapy relapsed or refractory diffuse large B-cell lymphoma: a population-based retrospective review. Pr Radiat Oncol. 2021;11:e203–9. https://doi.org/10.1016/j.prro.2020.11.003.

    Article  Google Scholar 

  12. Moskowitz CH, Nimer SD, Glassman JR, Portlock CS, Yahalom J, Straus DJ, et al. The International Prognostic Index predicts of outcome following autologous stem cell transplantation in patients with relapsed and primary refractory intermediate-grade lymphoma. Bone Marrow Transpl. 1999;23:561–7. https://doi.org/10.1038/sj.bmt.1701624.

    Article  CAS  Google Scholar 

  13. Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med. 2017;377:2531–44. https://doi.org/10.1056/NEJMoa1707447.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Schuster SJ, Bishop MR, Tam CS, Waller EK, Borchmann P, McGuirk JP, et al. Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma. N Engl J Med. 2019;380:45–56.

    Article  CAS  Google Scholar 

  15. Abramson JS, Plaomba ML, Gordon LI, Lunning MA, Wang M, Arnason J, et al. Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicenter seamless design study. Lancet. 2020;396:839–62.

    Article  Google Scholar 

  16. Locke FL, Ghobadi A, Jacobson CA, Miklos DB, Lekakis LJ, Oluwole OO, et al. Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicenter, phase 1-2 trial. Lancet Oncol. 2019;20:31–42.

    Article  CAS  Google Scholar 

  17. Pinnix CC, Gunther JR, Dabaja BS, Strati P, Fang P, Hawkins MC, et al. Bridging therapy prior to axicabtagene ciloleucel for relapsed/refractory large B-cell lymphoma. Blood Adv. 2020;4:2871–83.

    Article  CAS  Google Scholar 

  18. Figura NB, Robinson TJ, Sim AJ, Wang X, Cao B, Chavez JC, et al. Patterns and predictors of failure in recurrent or refractory large B-cell lymphomas following chimeric antigen receptor (CAR) T-cell therapy. Int J Radiat Oncol Biol Phys. 2021. https://doi.org/10.1016/j.ijrobp.2021.06.038.

  19. Hernandez I, Prasad V, Gellad WF. Total costs of chimeric antigen receptor T-cell immunotherapy. JAMA Oncol. 2018;4:994–6.

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the patients and their families, as well as the Lymphoma and Bone Marrow Transplant Disease Management Teams. This research was supported in part by the National Institutes of Health (Grant P01 CA23766) and the National Cancer Institute (Cancer Center Support Grant P30 CA008748). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joanna C. Yang

  2. Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA

    Joanna C. Yang

  3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Michael Scordo & Craig S. Sauter

  4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Karen W. Chau & Joachim Yahalom

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  5. Joachim Yahalom
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Contributions

JCY, CSS, and JY were responsible for conceiving and designing the study. JCY, KWC, and MS were responsible for collecting the data for analysis. JCY was responsible for drafting the manuscript and all authors revised the manuscript. All authors interpreted the results and approved the final version of the manuscript.

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Correspondence to Joanna C. Yang.

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Competing interests

JCY, KWC, and JY: none. MS has served as a paid consultant for McKinsey & Company, Angiocrine Bioscience, Inc, and Omeros Corporation. He has received research funds from Angiocrine Bioscience, Inc. CSS has served as a paid consultant on advisory boards for: Juno Therapeutics, Sanofi-Genzyme, Spectrum Pharmaceuticals, Novartis, Genmab, Precision Biosciences, Kite, a Gilead Company, Celgene and GSK. He has received research funds for investigator-initiated trials from: Juno Therapeutics and Sanofi-Genzyme.

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Yang, J.C., Scordo, M., Chau, K.W. et al. Highly favorable outcomes with salvage radiation therapy and autologous hematopoietic cell transplantation in relapsed and refractory DLBCL patients with minimal to no response to salvage chemotherapy. Bone Marrow Transplant 57, 1038–1041 (2022). https://doi.org/10.1038/s41409-022-01623-8

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