An international team of haematologists have developed a prognostic model that can identify diffuse large B-cell lymphoma patients who are most likely to benefit from an allogeneic transplant following a failed prior autologous haematopoietic cell transplant.
Writing in the study published in the British Journal of Haematology the research team including Professor Mark Hertzberg from Prince of Wales Hospital in Sydney said the prognosis for people with diffuse large B-cell lymphoma (DLBCL) with recurrent disease was poor yet there was currently no consensus on the optimal treatment for these patients.
Contemporary data, accumulated after rituximab was introduced routinely into DLBCL treatment protocols, suggested that 3-year progression-free survival was only 40-50% after autoHCT.
“The decision of whether to pursue an alloHCT for a DLBCL patient who has progressed after an autoHCT is, unfortunately, a common clinical dilemma,” they wrote.
The research team therefore identified 503 patients from the Center for International Blood and Marrow Transplant Research database (CIBMTR) who underwent alloHCT after disease progression/relapse following a prior autoHCT.
A Karnofsky performance score <80, an autologous haematopoietic cell transplantation (autoHCT) to allogeneic transplant (alloHCT) interval <1 year, and chemoresistant disease at alloHCT identified patients in whom the strategy would most likely be beneficial.
The total risk score using these three prognostic factors ranged from 0 to 11, with a score of 11 indicating a very high risk of failure.
Poor performance status attracted 4 points, a short interval between the procedures attracted 2 points, and chemoresistant disease scored 5 points.
Three-year PFS was 40% for those who scored 0 points on the prognostic scale down to just 6% in those who accumulated the maximum 11 points. Three-year OS ranged from 43% down to 11% as the score increased.
Overall non-relapse mortality – that is death not attributable to relapse or progression of the lymphoma – remained high after alloHCT, being 23% at 1 year and 30% at 3 years. About 46% of patients had a score of 0.
The analysis also showed that graft versus host disease increased the risk of non-relapse mortality and overall mortality without reducing the risk of relapse or progression.
In addition, myeloablative conditioning provided no benefit in these patients, including those with chemoresistant disease.
“The CIBMTR prognostic score reported in this study is not only easy to use, but utilizes information readily available prior to alloHCT (response to last therapy before alloHCT, KPS at HCT and TIBAA)” the researchers concluded.
They cautioned that the model should be used to counsel patients on transplantation outcomes immediately prior to alloHCT and not at the time of their initial relapse.