626. Aggressive Lymphoma (Diffuse Large B-Cell and Other Aggressive B-Cell Non-Hodgkin Lymphomas)—Results from Prospective Clinical Trials: Optimizing Frontline Chemotherapy
Conclusion cited from the abstract:
S1001 is the largest US study of limited stage DLBCL in the rituximab era, with best NCTN results in this disease subset. Only 5 patients progressed and 2 died from lymphoma. Our study confirms the distinct biology of limited stage DLBCL, with predominance of GCB origin (68%), and head and neck location (66%). Due to small number of lymphoma events, no strong conclusions about prognostic ability of smIPI, COO, DPE, or DHL, could be made.
S1001 demonstrated that 89% of pts maintained excellent outcomes after R-CHOP x 4 with PET-directed therapy. Only 11% of pts were iPET-pos and required radiation, but they also had excellent outcomes. Together with the FLYER trial in younger pts (Poeschel 2018), this NCTN trial establishes R-CHOP x 4 alone as the new standard approach to limited stage disease for majority of the pts.
Kazuyuki Shimada, et al.
Conclusion cited from the abstract: This phase 2 trial met its primary endpoint and showed favorable outcomes with a low cumulative incidence of CNS recurrence and acceptable toxicity profiles. These results indicate that R-CHOP combined with CNS prophylaxis including R-HDMTX and IT could be a reasonable treatment option for untreated IVLBCL without apparent CNS involvement at diagnosis.
Conclusion cited from the abstract:
The combination of BV + R had an acceptable safety profile and appeared effective in achieving early remissions when used as frontline therapy for PTLD and other immunosuppression-related lymphomas. Specifically, over half of pts achieved CR, and 75% have been spared exposure to multi-agent cytotoxic chemotherapy. Furthermore, survival and PFS data were encouraging compared with historical controls. However, nearly half of pts discontinued therapy within 1 year due to toxicity suggesting poor long-term tolerance of the regimen and that earlier cessation of therapy may be warranted. Further studies are needed to confirm these efficacy results and to determine optimal BV+R dosing regimens and durations.
Lucie Oberic, et al.
Conclusion cited from the abstract: SENIOR study is the first prospective phase III trial in ≥80 years old patients with newly diagnosed DLBCL. Addition of lenalidomide to R-miniCHOP does not significantly improve OS irrespective to CD10 status and results in more adverse events. Rituximab delivered subcutaneously was safe and well tolerated. The overall 2y-OS of 66% was similar or higher to those reported in previously published LYSA trials (2y-OS = 59%, Peyrade et al. Lancet Oncol 2011; 2y-OS = 64.7%, Lancet Hematol 2017). Tumour Molecular characterisation are currently ongoing to identify patients that could benefit of R2-miniCHOP.
Conclusion cited from the abstract: MATRIX-RICE followed by ASCT achieved the primary endpoint in this very-poor-prognosis population, without major safety concerns. Survival figures of transplanted pts seem a little better than reported in prior trials, whereas pts with MATRIX-refractory disease had no benefit from crossing to RICE. The best survival figures were recorded in chemo-naïve pts treated at presentation and in pts without CSF/meningeal disease.
Wyndham Wilson, et al.
Conclusion cited from the abstract: In this exploratory analysis, IBR was associated with improved EFS in combination with R-CHOP compared with pbo + R-CHOP in pts with MYC-high + BCL2-high expression in the ITT (non-GCB) population, without a significant improvement in OS. In pts aged < 60 years, both EFS and OS were significantly better with IBR, while there was no significant difference in older pts. These data suggest that IBR + R-CHOP may particularly benefit pts with MYC-high + BCL2-high–expressing lymphomas, a hypothesis warranting further testing in other DLBCL cohorts.