Response to second-line therapy defines the potential for cure in patients with recurrent diffuse large B-cell lymphoma: implications for the development of novel therapeutic strategies.
BACKGROUND
Patients with diffuse large B-cell lymphoma (DLBCL) who are not cured by initial therapy sometimes experience disease-free survival after autologous stem cell transplantation. Chemotherapy responsiveness before transplantation is a major predictor of outcome. Patients not responding to second-line regimens may receive third-line therapy in the hopes of achieving response, but outcome data are limited.


METHODS
We identified patients with relapsed or refractory DLBCL at Weill Cornell Medical Center for whom data on responses to second-line chemotherapy were available.


RESULTS
A total of 74 patients with relapsed or refractory DLBCL who underwent second-line chemotherapy between 1996 and 2007 were identified. Of these patients, 27 (36%) did not respond. The median overall survival of nonresponding patients was 4 months, and only 1 patient (4%) survived for 1 year. The choice of third-line aggressive chemotherapy instead of less intensive approaches did not confer a survival benefit.


CONCLUSIONS
Our data demonstrate that patients with recurrent DLBCL not responding to second-line chemotherapy demonstrate dismal outcomes. Trials of novel regimens should be prioritized as management strategies for these patients. Our data provide an important benchmark in the evaluation of the potential clinical value of such approaches.
Center for Lymphoma and Myeloma, Weill Cornell Medical Center, New York, NY 10021, USA. ree2001@med.cornell.edu
Rebecca L
RL
Elstrom
Peter
P
Martin
Katya
K
Ostrow
Jacqueline
J
Barrientos
Amy
A
Chadburn
Richard
R
Furman
Jia
J
Ruan
Tsiporah
T
Shore
Michael
M
Schuster
Leandro
L
Cerchietti
Ari
A
Melnick
Morton
M
Coleman
John P
JP
Leonard
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016879:Salvage Therapy / Q000379:methods*; D033581:Stem Cell Transplantation; D016896:Treatment Outcome; D055815:Young Adult