Session: 627. Aggressive Lymphomas: Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Research, clinical trials, adult, epidemiology, Lymphomas, Clinical Research, B Cell lymphoma, Diseases, real-world evidence, aggressive lymphoma, registries, Lymphoid Malignancies, Study Population, Human
Methods: Patients with newly diagnosed lymphoma were enrolled within 6 months of diagnosis in the LEO Cohort at 8 academic medical centers from 2015-2020 and prospectively followed. Inclusion criteria for this analysis was aggressive B-cell lymphoma typically included in frontline trials (e.g. DLBCL, high grade B-cell lymphoma, FL3B), IPI 1-5, frontline therapy with rituximab and anthracycline-based chemotherapy, stage II-IV disease and ages 18-80 years. Event-free survival (EFS) was defined as the time from diagnosis until progression, initiation of 2nd line therapy, or death due to any cause; EFS was evaluated at 24 months (EFS24). Very high LDH was defined as LDH>1.3xULN based on prior modeling (Maurer et al, AJH 2016) and bulky disease was defined as maximum tumor diameter (MTD) of 7cm or greater. IPI 1 and 2 were first evaluated separately and then combined due to similar outcomes in patients with very high LDH and/or bulky disease. High risk IPI1-2 was defined as the presence of either bulky disease and/or very high LDH within an IPI score of 1-2. Confirmation was performed in a similar cohort of patients enrolled in the Iowa/Mayo SPORE Molecular Epidemiology Resource (MER) from 2002-2015; bulky disease was defined using a 10cm cutoff per availability in MER data collection forms.
Results: 1560 patients from LEO were analyzed; median age was 64 years (IQR: 54-71), 42% were female and 83% had stage III/IV disease; subtype was DLBCL, NOS in 1335 (86%). IPI was 1-2 in 766 patients, 3 in 496 patients and 4-5 in 298 patients (table). 391 (51%) with IPI1-2 had either bulky disease and/or very high LDH (high risk IPI1-2) and 375 had low-risk IPI1-2. EFS24 in high risk IPI1-2 (71.6%, 95% CI: 67.2-76.3) was significantly inferior to IPI1-2 without bulky disease or very high LDH (85.2, 95% CI: 81.7-88.9 logrank p=0.0035, figure) and similar to patients with IPI3 (70.7%, 95% CI: 66.8-74.9). Consistent results were observed in 1014 patients analyzed in the MER using a higher cutoff for bulky disease (10cm) due to data availability (table). Patients with high risk IPI1-2 had significantly shorter diagnosis to treatment interval (DTI) in both the LEO (per-week OR=0.83, 95% CI: 0.77-0.88) and MER (per-week OR=0.77, 95% CI: 0.68-0.87) cohorts compared to low risk IPI1-2, both p<0.0001). In sensitivity analysis, LEO results were similar when performed in the subset of patients with DLBCL, NOS.
Conclusion: The presence of either bulky disease and/or very high LDH at presentation identifies a high-risk subset of patients with IPI 1-2 that have similar outcomes to patients with IPI 3 disease. These simple criteria can be easily implemented within existing clinical trial diagnostic work-ups. Future trial designs in frontline aggressive B-cell lymphoma should include patients with IPI 3-5 and patients with IPI 1-2 with either bulky disease and/or very high LDH to better define a high-risk population of patients for clinical trial eligibility.
Disclosures: Maurer: BMS: Consultancy, Research Funding; GenMab: Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche/Genentech: Research Funding; Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees. Farooq: MorphoSys: Consultancy; Kite, a Gilead Company: Honoraria; Caribou: Consultancy, Honoraria; Regeneron: Research Funding. Romancik: KITE: Consultancy; Astra Zeneca: Consultancy; ADC Therapeutics: Consultancy. Lossos: NCI: Research Funding; University of Miami: Current Employment; NCI: Research Funding; Adaptive: Honoraria; LRF: Membership on an entity's Board of Directors or advisory committees; BeiGene: Consultancy. Kahl: BMS: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria, Research Funding; BeiGene: Consultancy, Honoraria, Research Funding; ADCT: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria; Genmab: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Lilly: Consultancy, Honoraria. Martin: AbbVie, AstraZeneca, Beigene, Epizyme, Genentech, Gilead, Janssen, Pepromene, Daiichi Sankyo: Consultancy. Habermann: BMS: Research Funding; Genentech: Research Funding; sorrento: Research Funding. Cerhan: Genmab: Research Funding; Protagonist: Other: Safety Monitoring Committee; NanoString: Research Funding; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding; Genentech: Research Funding. Flowers: Genentech Roche: Consultancy, Research Funding; Foresight Diagnostics: Consultancy, Current holder of stock options in a privately-held company; Celgene: Consultancy, Research Funding; V Foundation: Research Funding; Sanofi: Research Funding; Kite: Research Funding; Cellectis: Research Funding; Guardant: Research Funding; Pharmacyclics: Research Funding; TG Therapeutics: Research Funding; Pfizer: Research Funding; National Cancer Institute: Research Funding; Adaptimmune: Research Funding; N-Power Medicine: Consultancy, Current holder of stock options in a privately-held company; Xencor: Research Funding; SeaGen: Consultancy; Eastern Cooperative Oncology Group: Research Funding; Burroghs Wellcome Fund: Research Funding; Ziopharm: Research Funding; Genmab: Consultancy; Gilead: Consultancy, Research Funding; Karyopharm: Consultancy; Pharmacyclics Jansen: Consultancy; Jannsen Pharmaceuticals: Research Funding; Allogene: Research Funding; Amgen: Research Funding; Abbvie: Consultancy, Research Funding; Novartis: Research Funding; Denovo Biopharma: Consultancy; 4D: Research Funding; Acerta: Research Funding; Iovance: Research Funding; Morphosys: Research Funding; Nektar: Research Funding; Cancer Prevention and Research Institute of Texas: Research Funding; CPRIT Scholar in Cancer Research: Research Funding; Spectrum: Consultancy; Takeda: Research Funding; Beigene: Consultancy; Bayer: Consultancy, Research Funding. Nastoupil: Daiichi Sankyo: Honoraria, Research Funding; AbbVie: Honoraria; Bristol Myers Squibb/Celgene: Honoraria, Research Funding; DeNovo: Honoraria; Caribou Biosciences: Honoraria, Research Funding; ADC Therapeutics: Honoraria; Genentech, Inc., Genmab, Gilead/Kite, Janssen, Merck, Novartis, Takeda: Honoraria, Research Funding; Regeneron: Honoraria; AstraZeneca: Honoraria; Gilead Sciences/Kite Pharma: Honoraria, Research Funding. Nowakowski: Fate Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Ryvu Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bantam Pharmaceutical LLC: Consultancy; ADC Therapeutics: Consultancy; Blueprint Medicines: Consultancy; Celgene Corporation: Consultancy; Debiopharm: Consultancy; F Hoffmann-La Roche Limited: Consultancy; Genentech: Consultancy; Incyte: Consultancy; Karyopharm Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Kite Pharma: Consultancy; Kymera Therapeutics: Consultancy; MEI Pharma: Consultancy; Seagen: Consultancy; Selvita Inc: Consultancy; Zai Lab Limited: Consultancy; Curis: Consultancy; Abbvie: Consultancy; TG Therapeutics: Consultancy; MorphoSys: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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