A prospective study on early PET/CT scans during the first cycle of salvage chemotherapy for relapsed or refractory diffuse large B-cell lymphoma

Abstract

Many patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) will not respond to platinum-containing salvage chemotherapy. Predicting treatment failure earlier could help clinicians minimize chemotherapy toxicities for non-responders in favor of other treatments. We conducted a pilot study where 2 early PET/CTs were obtained on days 4 (D4) and 21 (D21) of cycle 1 (C1) of salvage therapy for DLBCL. Twenty-five patients were enrolled and have evaluable data. Ten (40%) had an unplanned therapy change after C1 and before end-of-treatment (EOT) evaluation due to treatment failure on early PET/CT as interpreted by the treating physician. Early PET/CT response at D4 or D21 was not associated with EOT response in evaluable patients. Disease specific survival was longer for patients with a persistent response on both D4 and D21 (p = 0.042). Early PET/CT may predict salvage chemotherapy failure and could inform future clinical trials investigating early therapy change to non-chemotherapy treatments.

Keywords:

• Diffuse large B-cell lymphoma
• positron emission tomography/computed tomography
• end of treatment
• real-time response assessment
• salvage chemotherapy

Disclosure statement

HHC is a consultant for Sage Evidence-Based Medicine & Practice Institute. RS has received research support from Rafael Pharmaceuticals and Seattle Genetics. PS is a consultant for Roche-Genentech and has received research support from AstraZeneca/Acerta. LJN has received honorarium from ADC Therapeutics, BMS, Bayer, Epizyme, Genentech, Gilead/Kite, Janssen, Morphosys, Novartis, Pfizer, TG Therapeutics; research support from BMS, Caribou Bioscience, Epizyme, Genentech, Gilead/Kite, IGM Biosciences, Janssen, Novartis, Pfizer, TG Therapeutics. SSN has received honorarium from Kite, a Gilead Company, Merck, Bristol Myers Squibb, Novartis, Celgene, Pfizer, Allogene Therapeutics, Cell Medica/Kuur, Incyte, Precision Biosciences, Legend Biotech, Adicet Bio, Calibr, and Unum Therapeutics; research support from Kite, a Gilead Company, Bristol Myers Squibb, Merck, Poseida, Cellectis, Celgene, Karus Therapeutics, Unum Therapeutics, Allogene Therapeutics, Precision Biosciences, and Acerta; and royalties from Takeda Pharmaceuticals. CRF is a consultant for Abbvie, Bayer, BeiGene, Celgene, Denovo Biopharma, Genetech/Roche, Genmab, Gilead, Karyopharm, Pharmacyclics/Janssen, SeaGen, and Spectrum and has received research support from 4 D, Abbvie, Acerta, Adaptimmune, Allogene, Amgen, Bayer, Celgene, Cellectis, EMD, Gilead, Genentech/Roche, Guardant, Iovance, Jannssen Pharmaceutical, Kite, Morphosys, Pfizer, Pharmacyclics, Sanofi, Takeda, TG Therapeutics, Xencor, Ziopharm, Burroughs Welcome Fund, Eastern Cooperative Oncology Group, NCI, V Foundation, Cancer Prevention and Research Institute of Texas: CPRIT Scholar in Cancer Research. JW is a consultant for Gilead/Kite, BMS, Novartis, Morphosys, ADC Therapeutics, Genentech, Iksuda, IMV, Umoja, Abbvie, Amgen, and has received research support from Gilead/Kite, BMS, Novartis, Morphosys, Genentech, Abbvie, Janssen, Curis, AstraZeneca, and Janssen. Authors not listed had no disclosures to report.

Author contributions

HJC collected and analyzed data and wrote the manuscript. HHC designed the study, performed radiographic analysis, and wrote the manuscript. RS, LF, PS, RN, FH, LJN, HJL, SSN, CRF, FS, and MR cared for patients and critically reviewed the manuscript. HAM performed radiographic analysis and provided infrastructure support. LF analyzed data. JW designed the study and wrote the manuscript.

Clinical trial information

This trial was registered on Clinicaltrials.gov (NCT02405078).

Additional information

Funding

This research is supported in part by the MD Anderson NIH/NCI Cancer Center Support Grant under award number P30 CA016672.