The conditional survival analysis of relapsed DLBCL after autologous transplant: a subgroup analysis of LY.12 and CORAL

Abstract

The conditional survival of patients after frontline therapy for diffuse large B-cell lymphoma (DLBCL) approaches that of the general population once patients have survived disease free for 2 years. We sought to determine the conditional survival of patients among patients with relapsed de novo DLBCL successfully undergoing an autologous stem-cell transplant (ASCT) after first relapse. A total of 478 patients with de novo DLBCL, relapsed after 1 treatment from the Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) and LY.12, were included. Patients were followed prospectively after ASCT for a median of 5.3 and 8.2 years, respectively. Individual patient data were analyzed for event-free survival (EFS) and overall survival. Standardized mortality ratios (SMRs) were estimated using French and Canadian life tables. The EFS estimates declined with each year of follow-up after ASCT and were 50.1% (95% confidence interval [CI]: 43.7% to 56.3%) and 43.4% (95% CI: 36.7% to 49.9%) at 5 years in CORAL and LY.12, respectively. The rate of death stabilized once patients achieved at least 4 years of EFS. Compared with the age- and sex-matched population, the SMR was significantly higher until 5 years after ASCT, when values were no longer statistically significant. Patients undergoing ASCT for relapsed DLBCL continue to have a higher rate of death at least until they have survived event free for 5 years. These observations can help to determine endpoints for future clinical trials in this population and for patient counseling. This trial was registered at www.clinicaltrials.gov as #NCT00078949.

Conflict of interest statement

Conflict-of-interest disclosure: S.A. reports contributions to advisory boards for Roche Canada, Janssen, Pfizer, and AbbVie. The remaining authors declare no competing financial interests.

© 2020 by The American Society of Hematology.

Figures

Graphical abstract

Figure 1.

One-year, 2-year, and 5-year OS after specified EFS time points with shaded 95% CI area. (A) Data from the CORAL study. (B) Data from the LY.12 study. (C) Combined data from CORAL and LY.12 studies.

Figure 2.

OS vs expected survival in the CORAL study post-ASCT. (A) OS immediately post-ASCT. (B) OS post-EFS24. (C) OS post-EFS60.

Figure 3.

OS vs expected survival in the LY.12 study post-ASCT. (A) OS immediately post-ASCT. (B) OS post-EFS24. (C) OS post-EFS60.

Figure 4.

Forest plots of the multivariate analysis for combined CORAL and LY.12 studies. A hazard ratio of less than 1 indicates a lower risk of relapse or death after autologous transplant. ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; ULN, upper limit of normal.