Page 178 - Haematologica Vol. 109 - July 2024

ARTICLE - ASCT in refractory or early relapsed DLBCL A.M. Tun et al. AB
CD
Figure 3. Post-autologous stem cell transplant outcomes according to line of slavage chemotherapy and response status. (A) Progression-free survival and (B) overall survival by response status. (C) Progression-free survival and (D) overall survival by line of salvage therapy and response status. PFS: progression-free survival; OS: overall survival; ASCT: autologous stem cell transplant; CR: complete response; PR: partial response; ST: salvage chemotherapy.
axicabtagene ciloleucel, was associated with a lower rate of relapse/progression (2-year rate, 40% vs. 53%; P=0.05), a trend for superior PFS (2-year rate, 52% vs. 42%; P=0.1), and a superior OS rate (2-year rate, 69% vs. 47%; P=0.004).28 The caveat regarding this study was that the median line of therapy was higher in patients receiving axicabtagene ciloleucel, and the difference was no longer seen when the analysis was done in patients who received two or fewer lines of therapy (1-year PFS, 59% in the ASCT group vs. 65% in the axicabtagene ciloleucel group; P=0.5).28
There is no consensus among lymphoma clinicians when defining early treatment failure. Most historical studies, such as the CIBMTR, Molecular Epidemiology Resource, and CORAL studies, identified patients with refractory disease
or relapse within 12 months of initial diagnosis as having an unfavorable risk.7,10,12,13 In contrast, the three randomized clinical trials (ZUMA-7, TRANSFORM, and BELINDA) and the NCIC-CTG LY.12 study defined patients with refrac- tory disease or relapse within 12 months of completing frontline therapy as high risk.15–17,29 Consequently, selection of the optimal treatment strategy becomes challenging for patients who relapse between 6 to 12 months after completing frontline therapy.19 It is noteworthy that these patients achieve a remission lasting at least 6 months af- ter completing frontline immunochemotherapy, indicating chemosensitive biology, and are more likely to respond to ST and be able to proceed with HDT and ASCT.7 In our study, patients who relapsed between 6 to 12 months
Haematologica | 109 July 2024
2192