627. Aggressive Lymphoma (Diffuse Large B-Cell and Other Aggressive B-Cell Non-Hodgkin Lymphomas)—Results from Retrospective/Observational Studies: Population-Based Outcomes

Conclusion cited from the abstract: 

Outcomes for adult BL in this contemporary, large, multicenter RW analysis appear inferior to smaller published series. Interestingly, despite increased adverse prognostic factors, survival rates appeared similar in HIV+ pts. In addition, use of rituximab, achievement of initial CR, and Tx at an academic CC were associated with improved survival. Finally, a novel BL-specific survival model identified pts with markedly divergent outcomes.

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398

Conclusion cited from the abstract: Using data from this large prospective observational study on elderly DLBCL patients we were able to build a new prognostic index that allows to identify 3 risk groups with significant differences in terms of 3 years OS. The EPI is the first index that integrates geriatric assessment with clinical features and contributes to improving management and clinical research in elderly patients with DLBCL.

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Conclusion cited from the abstract: 

The 5-year cumulative incidence of relapsed/refractory disease in patients with DLBCL treated with curative intent is 23% in this population-based study, which is lower than in previously published reports. Overall, 16% of patients were not able to start primary curative intent treatment, representing an older group of patients with a dismal OS. An additional 5% of patients were not able to tolerate more than 1-2 cycles, defining another group of patients with unmet medical needs. The 2-year cumulative incidence of CNS relapse is <10% even in high-risk patients when estimating absolute risk in the real world where patients also face risks of non-CNS relapse and death.

Figure 1 A): Overall survival (OS) and progression-free survival (PFS) among 4205 patients with diffuse large B-cell lymphoma (DLBCL) diagnosed in Sweden 2007-2014 treated with curative (n=3528 ) or palliative intent (n=677). B): Cumulative incidence of CNS relapse in the presence of competing risks of death and non-CNS relapse. C): Net probability of CNS relapse by CNS IPI (N=3499). D): Cumulative incidence of CNS relapse restricted to 414 patients with high CNS IPI (4-6).

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400

Conclusion cited from the abstract: TTP to following IC is strongly associated with post-progression survival in DLBCL. We developed a model from the largest frontline clinical trial dataset in DLBCL and validated a simple to apply clinical prognostic tool in the r/r setting. The model allows better understanding of expected outcomes in r/r DLBCL and can aid design and interpretation of trial results in this setting. The model underestimated the actual survival probability when applied to non-trial validation cohorts. Recalibration of the model for transplant eligible patients and development of smartphone based point-of-care application of the model is ongoing.

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401

Conclusion cited from the abstract: Using a PET-guided approach to treatment, the majority of patients with limited-stage DLBCL have negative PET scans after 3 cycles of R-CHOP. Patients with negative PET scans have an excellent outcome when treated with 4 cycles of R-CHOP alone, without exposure to radiation. Patients with a positive PET scan who complete treatment with radiation therapy have a slightly less favorable outcome, and may be appropriate for alternative approaches. A detailed analysis of patterns of relapse, as well as efforts to identify clinical factors, PET parameters and biomarkers associated with poor outcome and delayed relapse are ongoing.

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Conclusion cited from the abstract: In adult BL, baseline CNSinv and poor PS predicted subsequent CNS recurrence, an outcome that is associated with a dismal prognosis. Furthermore, treatment with DA-EPOCH was associated with a significantly increased risk of CNS recurrence in this real-world analysis. For BL pts with baseline CNSinv treated in routine clinical practice, regimens with highly BBB-penetrant drugs (e.g. CODOX-M/IVAC, hyperCVAD/MA) may be preferred. Studies should delineate ways to mitigate the risk of CNS recurrence with lower-intensity programs.

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