title: Diffuse large B-cell lymphoma with primary treatment failure: Ultra-high risk features and benchmarking for experimental therapies.
abstract: The outcomes of patients with DLBCL and primary treatment failure (PTF) in the rituximab era are unclear. We analyzed 331 patients with PTF, defined as primary progression while on upfront chemoimmunotherapy (PP), residual disease at the end of upfront therapy (RD) or relapse < 6 months from end of therapy (early relapse; ER). Median age was 58 years and response to salvage was 41.7%. Two-year OS was 18.5% in PP, 30.6% in RD and 45.5% in ER. The presence of PP, intermediate-high/high NCCN-IPI at time of PTF or MYC translocation predicted 2-year OS of 13.6% constituting ultra-high risk (UHR) features. Among the 132 patients who underwent autologous hematopoietic cell transplantation, 2-year OS was 74.3%, 59.6% and 10.7% for patients with 0,1 and 2-3 UHR features respectively. Patients with PTF and UHR features should be prioritized for clinical trials with newer agents and innovative cellular therapy.
authors.affiliation: Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Costa
authors.affiliation: Division of Hematology, Ohio state University, Columbus, Ohio, USA.
authors.forename: Kami
authors.initials: K
authors.lastname: Maddocks
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Narendranath
authors.initials: N
authors.lastname: Epperla
authors.affiliation: Division of Hematology and Oncology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Nishitha M
authors.initials: NM
authors.lastname: Reddy
authors.affiliation: Division of Hematology, Oncology and Cell Therapy, Rush University, Chicago, Illinois, USA.
authors.forename: Reem
authors.initials: R
authors.lastname: Karmali
authors.affiliation: Division of Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Elvira
authors.initials: E
authors.lastname: Umyarova
authors.affiliation: Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Veronika
authors.initials: V
authors.lastname: Bachanova
authors.affiliation: Department of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Costa
authors.affiliation: Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Glenn
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research, Tampa, Florida, USA.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Chavez
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia, USA.
authors.forename: Oscar
authors.initials: O
authors.lastname: Calzada
authors.affiliation: Department of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Lansigan
authors.affiliation: Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
authors.forename: Hossain
authors.initials: H
authors.lastname: Nasheed
authors.affiliation: Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Barta
authors.affiliation: Division of Hematology-Oncology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research, Tampa, Florida, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Jaglal
authors.affiliation: Division of Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chhabra
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Hernandez-Ilizaliturri
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Xavier
authors.affiliation: Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Amitkumar
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Deniz
authors.initials: D
authors.lastname: Peker
authors.affiliation: Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Forero-Torres
authors.affiliation: Division of Hematology/Oncology, Tufts University, Boston, Massachusetts, USA.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Al-Mansour
authors.affiliation: Division of Hematology/Oncology, Tufts University, Boston, Massachusetts, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Evens
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia, USA.
authors.forename: Jonathon B
authors.initials: JB
authors.lastname: Cohen
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D019985:Benchmarking; D018450:Disease Progression; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D014182:Transplantation, Autologous; D017211:Treatment Failure