Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure

Emily C. Ayers; Shaoying Li; L. Jeffrey Medeiros; David A. Bond; Kami J. Maddocks; Pallawi Torka; Angel Mier Hicks; Madeira Curry; Nina D. Wagner-Johnston; Reem Karmali; Amir Behdad; Bita Fakhri; Brad S. Kahl; Michael C. Churnetski; Jonathon B. Cohen; Nishitha M. Reddy; Dipenkumar Modi; Radhakrishnan Ramchandren; Christina Howlett; Lori A. Leslie; Samuel Cytryn; Catherine S. Diefenbach; Rawan Faramand; Julio C. Chavez; Adam J. Olszewski; Yang Liu; Stefan K. Barta; Dhruvika Mukhija; Brian T. Hill; Helen Ma; Jennifer E. Amengual; Sunita Nathan; Sarit E. Assouline; Victor M. Orellana-Noia; Craig A. Portell; Ashwin Chandar; Kevin A. David; Anshu Giri; Brian T. Hess; Daniel J. Landsburg

doi:10.1002/cncr.32526

Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure

Emily C. Ayers
, Shaoying Li
, L. Jeffrey Medeiros
, David A. Bond
, Kami J. Maddocks
, Pallawi Torka
, Angel Mier Hicks
, Madeira Curry
, Nina D. Wagner-Johnston
, Reem Karmali
, Amir Behdad
, Bita Fakhri
, Brad S. Kahl
, Michael C. Churnetski
, Jonathon B. Cohen
, Nishitha M. Reddy
, Dipenkumar Modi
, Radhakrishnan Ramchandren
, Christina Howlett
, Lori A. Leslie

Samuel Cytryn, Catherine S. Diefenbach, Rawan Faramand, Julio C. Chavez, Adam J. Olszewski, Yang Liu, Stefan K. Barta, Dhruvika Mukhija, Brian T. Hill, Helen Ma, Jennifer E. Amengual, Sunita Nathan, Sarit E. Assouline, Victor M. Orellana-Noia, Craig A. Portell, Ashwin Chandar, Kevin A. David, Anshu Giri, Brian T. Hess, Daniel J. Landsburg

School of Medicine

Hackensack Meridian School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. Methods: Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. Results: In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P <.001) and OS (6 months vs not reached; P <.001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. Conclusions: Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.

Original language	English
Pages (from-to)	293-303
Number of pages	11
Journal	Cancer
Volume	126
Issue number	2
DOIs	https://doi.org/10.1002/cncr.32526
State	Published - Jan 15 2020

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Oncology
Cancer Research

Keywords

chemotherapy
diffuse large B-cell lymphoma
high-grade B-cell lymphoma
relapsed/refractory
salvage therapy

Access to Document

10.1002/cncr.32526

Cite this

Ayers, E. C., Li, S., Medeiros, L. J., Bond, D. A., Maddocks, K. J., Torka, P., Mier Hicks, A., Curry, M., Wagner-Johnston, N. D., Karmali, R., Behdad, A., Fakhri, B., Kahl, B. S., Churnetski, M. C., Cohen, J. B., Reddy, N. M., Modi, D., Ramchandren, R., Howlett, C., ... Landsburg, D. J. (2020). Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure. Cancer, 126(2), 293-303. https://doi.org/10.1002/cncr.32526

@article{a0ed63d721d04f7fac1bc5b2a0cccbc2,

title = "Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure",

abstract = "Background: Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. Methods: Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. Results: In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44\%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P <.001) and OS (6 months vs not reached; P <.001) compared with patients with late treatment failure. Although the 17\% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. Conclusions: Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.",

keywords = "chemotherapy, diffuse large B-cell lymphoma, high-grade B-cell lymphoma, relapsed/refractory, salvage therapy",

author = "Ayers, \{Emily C.\} and Shaoying Li and Medeiros, \{L. Jeffrey\} and Bond, \{David A.\} and Maddocks, \{Kami J.\} and Pallawi Torka and \{Mier Hicks\}, Angel and Madeira Curry and Wagner-Johnston, \{Nina D.\} and Reem Karmali and Amir Behdad and Bita Fakhri and Kahl, \{Brad S.\} and Churnetski, \{Michael C.\} and Cohen, \{Jonathon B.\} and Reddy, \{Nishitha M.\} and Dipenkumar Modi and Radhakrishnan Ramchandren and Christina Howlett and Leslie, \{Lori A.\} and Samuel Cytryn and Diefenbach, \{Catherine S.\} and Rawan Faramand and Chavez, \{Julio C.\} and Olszewski, \{Adam J.\} and Yang Liu and Barta, \{Stefan K.\} and Dhruvika Mukhija and Hill, \{Brian T.\} and Helen Ma and Amengual, \{Jennifer E.\} and Sunita Nathan and Assouline, \{Sarit E.\} and Orellana-Noia, \{Victor M.\} and Portell, \{Craig A.\} and Ashwin Chandar and David, \{Kevin A.\} and Anshu Giri and Hess, \{Brian T.\} and Landsburg, \{Daniel J.\}",

note = "Publisher Copyright: {\textcopyright} 2019 American Cancer Society",

year = "2020",

month = jan,

day = "15",

doi = "10.1002/cncr.32526",

language = "English",

volume = "126",

pages = "293--303",

journal = "Cancer",

issn = "0008-543X",

publisher = "John Wiley and Sons Inc.",

number = "2",

}

Ayers, EC, Li, S, Medeiros, LJ, Bond, DA, Maddocks, KJ, Torka, P, Mier Hicks, A, Curry, M, Wagner-Johnston, ND, Karmali, R, Behdad, A, Fakhri, B, Kahl, BS, Churnetski, MC, Cohen, JB, Reddy, NM, Modi, D, Ramchandren, R, Howlett, C, Leslie, LA, Cytryn, S, Diefenbach, CS, Faramand, R, Chavez, JC, Olszewski, AJ, Liu, Y, Barta, SK, Mukhija, D, Hill, BT, Ma, H, Amengual, JE, Nathan, S, Assouline, SE, Orellana-Noia, VM, Portell, CA, Chandar, A, David, KA, Giri, A, Hess, BT & Landsburg, DJ 2020, 'Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure', Cancer, vol. 126, no. 2, pp. 293-303. https://doi.org/10.1002/cncr.32526

TY - JOUR

T1 - Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure

AU - Ayers, Emily C.

AU - Li, Shaoying

AU - Medeiros, L. Jeffrey

AU - Bond, David A.

AU - Maddocks, Kami J.

AU - Torka, Pallawi

AU - Mier Hicks, Angel

AU - Curry, Madeira

AU - Wagner-Johnston, Nina D.

AU - Karmali, Reem

AU - Behdad, Amir

AU - Fakhri, Bita

AU - Kahl, Brad S.

AU - Churnetski, Michael C.

AU - Cohen, Jonathon B.

AU - Reddy, Nishitha M.

AU - Modi, Dipenkumar

AU - Ramchandren, Radhakrishnan

AU - Howlett, Christina

AU - Leslie, Lori A.

AU - Cytryn, Samuel

AU - Diefenbach, Catherine S.

AU - Faramand, Rawan

AU - Chavez, Julio C.

AU - Olszewski, Adam J.

AU - Liu, Yang

AU - Barta, Stefan K.

AU - Mukhija, Dhruvika

AU - Hill, Brian T.

AU - Ma, Helen

AU - Amengual, Jennifer E.

AU - Nathan, Sunita

AU - Assouline, Sarit E.

AU - Orellana-Noia, Victor M.

AU - Portell, Craig A.

AU - Chandar, Ashwin

AU - David, Kevin A.

AU - Giri, Anshu

AU - Hess, Brian T.

AU - Landsburg, Daniel J.

PY - 2020/1/15

Y1 - 2020/1/15

N2 - Background: Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. Methods: Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. Results: In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P <.001) and OS (6 months vs not reached; P <.001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. Conclusions: Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.

AB - Background: Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. Methods: Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. Results: In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P <.001) and OS (6 months vs not reached; P <.001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. Conclusions: Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.

KW - chemotherapy

KW - diffuse large B-cell lymphoma

KW - high-grade B-cell lymphoma

KW - relapsed/refractory

KW - salvage therapy

UR - https://www.scopus.com/pages/publications/85073980898

U2 - 10.1002/cncr.32526

DO - 10.1002/cncr.32526

M3 - Article

C2 - 31568564

SN - 0008-543X

VL - 126

SP - 293

EP - 303

JO - Cancer

JF - Cancer

IS - 2

ER -

Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure

Abstract

UN SDGs

ASJC Scopus subject areas

Keywords

Access to Document

Other files and links

Fingerprint

Cite this