Leukemia/Lymphoma/Hematologic

SS 35 - Hematologic 3 -?Translating Better Technology to Improved Outcome in Primary and Relapsed Disease

255 - Impact of Double/Triple Hit Lymphoma on Radiation Therapy Efficacy Among Patients With Relapsed/Refractory Diffuse Large B Cell Lymphoma

Wednesday, October 24
8:25 AM - 8:35 AM
Location: Room 007 A/B

Impact of Double/Triple Hit Lymphoma on Radiation Therapy Efficacy Among Patients With Relapsed/Refractory Diffuse Large B Cell Lymphoma
A. Kim1, P. Stevenson2, R. Cassaday3, L. Soma1, J. Fromm3, A. K. Gopal3, S. C. Smith3, B. G. Till3, R. Lynch3, K. J. Russell4, and Y. D. Tseng5; 1University of Washington, Seattle, WA, 2Fred Hutchinson Cancer Research Center, Seattle, WA, 3University of Washington, seattle, WA, 4Seattle Cancer Care Alliance, seattle, WA, 5Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA

Purpose/Objective(s): Double/triple-hit lymphomas (DHL/THL), recently recognized in the WHO 2017 as high grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangement, are associated with chemoresistance, relapsed/refractory (R/R) disease, and worse survival. While radiation therapy (RT) is an effective treatment for R/R diffuse large B-cell lymphoma (DLBCL), its efficacy for DHL/THL is unknown. As RT efficacy may be associated with chemosensitivity, we hypothesized that R/R DLBCL patients with DHL/THL may have lower rates of response to RT compared to non-DHL/THL patients.

Materials/Methods: We retrospectively reviewed patients with R/R DLBCL irradiated at a single institution between 1/2008 and 6/2017. Patients without confirmed c-MYC translocation status (our institution’s standard for DHL/THL screening) were excluded. Among patients irradiated to gross disease, radiographic assessment of RT response within the RT portal was categorized as complete/partial response (CR/PR), stable disease (SD), and progressive disease (PD). Local control (LC), distant failure (DF), progression-free (PFS) and overall survival (OS) were calculated with Kaplan Meier methods.

Results: Among 244 irradiated patients with DLBCL, 80 patients had confirmed c-MYC status. Forty-nine had R/R disease (15 DHL/THL, 34 non-DHL/THL) and formed our cohort (Table). Compared with non-DHL/THL patients, DHL/THL patients were more likely male, have germinal center B-cell like (GCB) cell of origin, and less likely to receive curative-intent RT, despite receiving a similar dose of RT. Most (90%) were irradiated to gross disease. With a median follow up of 184 days, over half (59.5%) achieved a CR/PR to RT, which was higher among non-DHL/THL versus DHL/THL patients: 70.8% vs 33.3%. Notably, 60% of DHL/THL patients had SD after RT. One patient with non-DHL/THL progressed within the RT field. DHL/THL patients had worse DF (79% vs 45%; p=0.001), PFS (20% vs 44%; p=0.021), and OS (20% vs 65%; p=0.081) at 6 months. Acute toxicity was grade 3 (dermatitis, hematologic, nausea, dysphagia) in 10.2% and grade 4 (tumor lysis syndrome) in 2%.

Conclusion: RT appears to be a well-tolerated and effective treatment for R/R DLBCL patients. While DHL/THL patients had lower response rates to RT, none had PD within the RT field. These findings may be driven, in part, by the short survival of DHL/THL patients after RT and require confirmation in other cohorts. Table. Summary of clinical and treatment characteristics
All (N=49) Non DHL/THL (N=34) DHL/THL (N=15)
Median age at diagnosis, years Male sex Primary chemo-refractory GCB subtype Median # chemo before RT (range) % stem cell transplant 59.1 67.3% 44.9% 51.3% 2 (1-6) 42.9% 58.9 61.8% 47.1% 41.2% 2 (1-6) 41.2% 59.7 80% 40.0% 86.7% 2 (1-4) 46.7%
Curative (vs palliative) RT intent RT to gross (vs microscopic) disease Median RT dose (range) 46.9% 90% 35 Gy (4-57) 52.9% 88.2% 34.6 Gy (4-57) 33% 93.3% 36 Gy (20-45)

Author Disclosure: A. Kim: None. P. Stevenson: None. R. Cassaday: Research Grant; Merck, Pfizer, Incyte, Seattle Genetics, Gilead. Consultant; Amgen, Adaptive Biotechnologies, Jazz. L. Soma: None. J. Fromm: None. A.K. Gopal: Research Grant; Biogen Idec, BioMarin, Cephalon/Teva, Abbott, Gilead, Janssen, Merek, Piramal, Spectrum. Honoraria; Takeda. Consultant; Pfizer, Sanofi-Aventis, Seattle Genetics, Aptevo. S.C. Smith: None. B.G. Till: None. K.J. Russell: Aid in clinical trial design and review clinical collaborations; Varian / Calypso Medical Division. Consultant; Varian / Calypso Medical Division. Y.D. Tseng: Employee; Allen Brain Science Institute.

Aileen Kim, MD

Disclosure:
Employment
University of Washington: Resident Physician: Employee

Presentation(s):

Send Email for Aileen Kim


Assets

255 - Impact of Double/Triple Hit Lymphoma on Radiation Therapy Efficacy Among Patients With Relapsed/Refractory Diffuse Large B Cell Lymphoma



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Impact of Double/Triple Hit Lymphoma on Radiation Therapy Efficacy Among Patients With Relapsed/Refractory Diffuse Large B Cell Lymphoma