Ofatumumab, Etoposide, and Cytarabine Intensive Mobilization Regimen in Patients with High-risk Relapsed/Refractory Diffuse Large B-Cell Lymphoma Undergoing Autologous Stem Cell Transplantation

医学 内科学 依托泊苷 弥漫性大B细胞淋巴瘤 肿瘤科 阿糖胞苷 发热性中性粒细胞减少症 移植 养生 中性粒细胞减少症 造血干细胞移植 化疗 外科 挽救疗法
作者
Swetha Kambhampati,Bradley Hunter,Andrei Varnavski,Bita Fakhri,Lawrence D. Kaplan,Weiyun Z. Ai,Miguel Hernandez Pampaloni,Chiung‐Yu Huang,Thomas Martin,Lloyd E. Damon,Charalambos Andreadis
出处
期刊:Clinical Lymphoma, Myeloma & Leukemia [Elsevier]
卷期号:21 (4): 246-256.e2 被引量:3
标识
DOI:10.1016/j.clml.2020.11.005
摘要

Background More than one-half of high-risk patients with relapsed/refractory (rr) diffuse large B-cell lymphoma (DLBCL) relapse after autologous hematopoietic cell transplantation (auto-HCT). In this phase II study, we investigate the long-term outcomes of high-risk patients with rrDLBCL receiving intensive consolidation therapy (ICT) with OVA (ofatumumab, etoposide, and high-dose cytarabine) prior to auto-HCT. Patients and Methods The primary endpoints were the ability of OVA to mobilize peripheral stem cells and the 2-year progression-free survival (PFS) rate following OVA. Secondary endpoints included safety, 2-year overall survival (OS), impact of cell of origin (COO), and the prognostic utility of next-generation sequencing minimal residual disease (MRD) testing. We simultaneously retrospectively assessed the outcomes of DLBCL patients who underwent ICT with a similar regimen at our institution. Results Twenty-seven patients received salvage chemotherapy, with a response rate of 25% in patients with germinal center B-cell (GCB)-DLBCL versus 92% in patients with non-GCB-DLBCL (P = .003). Nineteen responding patients underwent ICT with OVA (100% successful stem cell mobilization). The 2-year PFS and OS rate was 47% and 59%, respectively, with no difference based on COO. Similar findings were observed when the study and retrospective cohorts were combined. Neutropenia was the most common toxicity (47%). MRD-negative patients at the completion of salvage had a median OS of not reached versus 3.5 months in MRD-positive patients (P = .02). Conclusions OVA followed by auto-HCT is effective and safe for high-risk rrDLBCL. Patients with GCB-DLBCL had a lower response to salvage chemotherapy, but no difference in outcomes based on COO was seen after auto-HCT. MRD testing in the relapsed setting was predictive of long-term survival.
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