Defining Primary Refractory Large B-cell Lymphoma

Allison M Bock; Raphael Mwangi; Yucai Wang; Arushi Khurana; Matthew J Maurer; Amy Ayers; Brad S Kahl; Peter Martin; Jonathon B Cohen; Carla Casulo; Izidore S Lossos; Umar Farooq; Sabarish Ayyappan; Tanner Wayne Reicks; Thomas M Habermann; Thomas E Witzig; Christopher R Flowers; James R Cerhan; Loretta J Nastoupil; Grzegorz S Nowakowski

doi:10.1182/bloodadvances.2024012760

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$Defining Primary Refractory Large B-cell Lymphoma$

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Defining Primary Refractory Large B-cell Lymphoma

Allison M Bock, Raphael Mwangi, Yucai Wang, Arushi Khurana, Matthew J Maurer, Amy Ayers, Brad S Kahl, Peter Martin, Jonathon B Cohen, Carla Casulo, …

Blood advances, Vol.8(13), pp.3402-3415

04/26/2024

DOI: 10.1182/bloodadvances.2024012760

PMCID: PMC11255370

PMID: 38669353

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Abstract

Patients with large B-cell lymphoma (LBCL) that fail to achieve a complete response (CR) or relapse early after anthracycline-containing immunochemotherapy (IC) have a poor prognosis and are commonly considered "primary refractory disease". However, different definitions of primary refractory disease are used in the literature and clinical practice. In this study, we ex-amined variation in the time to relapse used to define refractory status and association with sur-vival outcomes in patients with primary refractory LBCL in a single-center prospective cohort with a validation in an independent multi-center cohort. Newly diagnosed LBCL patients were enrolled in the Molecular Epidemiological Resource cohort (MER; N=949) or the Lymphoma Epidemiology of Outcomes cohort (LEO; N=2,755) from 9/2002 to 5/2021. Primary refractory LBCL was defined as no response (SD) or progressive disease (PD) during or by the end of frontline (1L) IC (primary PD; PPD), partial response at end of treatment (EOT PR), or relapse within 3-12 months after achieving CR at EOT to 1L IC (early relapse). In the MER cohort, pa-tients with PPD had inferior OS (2-year OS rate 15% MER, 31% LEO) when compared to other subgroups considered in defining primary refractory disease, EOT PR (2-year OS rate 38% MER, 50% LEO) and early relapse (2-year OS rate 44% MER, 58% LEO). Among patients re-ceiving frontline IC with curative intent, we identified that patients with PPD are the key sub-group with poor outcomes. We propose a definition of primary refractory LBCL as SD or PD during or by the end of 1L treatment.

Details

Title: Subtitle: Defining Primary Refractory Large B-cell Lymphoma
Creators: Allison M Bock - Huntsman Cancer Institute
Raphael Mwangi - Mayo Clinic
Yucai Wang - Mayo Clinic
Arushi Khurana - Mayo Clinic
Matthew J Maurer - Mayo Clinic
Amy Ayers - The University of Texas MD Anderson Cancer Center
Brad S Kahl - Washington University in St. Louis
Peter Martin - Weill Cornell Medicine
Jonathon B Cohen - Emory University
Carla Casulo - University of Rochester
Izidore S Lossos - University of Miami
Umar Farooq - University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Sabarish Ayyappan - University of Iowa
Tanner Wayne Reicks - Mayo Clinic
Thomas M Habermann - Mayo Clinic
Thomas E Witzig - Mayo Clinic
Christopher R Flowers - The University of Texas MD Anderson Cancer Center
James R Cerhan - Huntsman Cancer Institute
Loretta J Nastoupil - The University of Texas MD Anderson Cancer Center
Grzegorz S Nowakowski - Mayo Clinic
Resource Type: Journal article
Publication Details: Blood advances, Vol.8(13), pp.3402-3415
DOI: 10.1182/bloodadvances.2024012760
PMID: 38669353
PMCID: PMC11255370
NLM abbreviation: Blood Adv
eISSN: 2473-9537
Language: English
Electronic publication date: 04/26/2024
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Epidemiology; Internal Medicine
Record Identifier: 9984618618402771

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