title: Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study.
abstract: Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard second-line treatment for relapsed and refractory diffuse large B-cell lymphoma (DLBCL). However, the strategy is less clear in patients who require third-line treatment. Updated outcomes of 203 patients who could not proceed to scheduled ASCT in the Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) are herein reviewed. In the intent-to-treat analysis, overall response rate to third-line chemotherapy was 39%, with 27% CR or CR unconfirmed, and 12% PR. Among the 203 patients, 64 (31.5%) were eventually transplanted (ASCT 56, allogeneic SCT 8). Median overall survival (OS) of the entire population was 4.4 months. OS was significantly improved in patients with lower tertiary International Prognostic Index (IPI), patients responding to third-line treatment and patients transplanted with a 1-year OS of 41.6% compared with 16.3% for the not transplanted (P<0.0001). In multivariate analysis, IPI at relapse (hazard ratio (HR) 2.409) and transplantation (HR 0.375) independently predicted OS. Third-line salvage chemotherapy can lead to response followed by transplantation and long-term survival in DLBCL patients. However, improvement of salvage efficacy is an urgent need with new drugs.
authors.affiliation: Cliniques Universitaires UCL Saint-Luc, Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Van Den Neste
authors.affiliation: AsklepiosKlinik St Georg, AbteilungHämatologie und Stammzelltransplantation, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Schmitz
authors.affiliation: CHU de l'Archet, Nice, France.
authors.forename: N
authors.initials: N
authors.lastname: Mounier
authors.affiliation: Princess Alexandra Hospital, Woodville, SA, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Gill
authors.affiliation: University College London, Cancer Institute, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Linch
authors.affiliation: Charles Univ. General Hosp., Praha, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Trneny
authors.affiliation: Hématologie Clinique et thérapie cellulaire, Hôpital Haut-Lévêque, Pessac, France.
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.affiliation: University of Manchester, c/o Department of Medical Oncology, Christie Hospital NHS, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Radford
authors.affiliation: Clinique Bois-Cerf, Lausanne, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Ketterer
authors.affiliation: Assuta Medical Center, Tel-Aviv, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Shpilberg
authors.affiliation: Universitätsklinikum Essen, KlinikfürHämatologie, Essen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Dührsen
authors.affiliation: St Vincent's Hospital Sydney, Darlinghurst, NW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Ma
authors.affiliation: Hemato-Oncologie Hôpital Hôpital Saint-Louis, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Brière
authors.affiliation: Hemato-Oncologie Hôpital Hôpital Saint-Louis, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Thieblemont
authors.affiliation: Hospices Civils de Lyon, Service d'Hématologie, Université de Lyon, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Salles
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Moskowitz
authors.affiliation: AsklepiosKlinik St Georg, AbteilungHämatologie und Stammzelltransplantation, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Glass
authors.affiliation: Hemato-Oncologie Hôpital Hôpital Saint-Louis, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Gisselbrecht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D033581:Stem Cell Transplantation; D015996:Survival Rate