Ibrutinib Monotherapy in Relapsed or Refractory, Transformed Diffuse Large B-cell Lymphoma.
Solomon A Graf, Ryan D Cassaday, Karolyn Morris, Jenna M Voutsinas, Qian Vicky Wu, Sanaz Behnia, Ryan C Lynch, Elizabeth Krakow, Heather Rasmussen, Thomas R Chauncey, Sandra Kanan, Lorinda Soma, Stephen D Smith, Ajay K Gopal
Author Information
Solomon A Graf: Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA; Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
Ryan D Cassaday: Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA; Division of Hematology.
Karolyn Morris: Division of Medical Oncology, University of Washington Medicine, Seattle, WA.
Jenna M Voutsinas: Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA.
Qian Vicky Wu: Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA.
Sanaz Behnia: Division of Nuclear Medicine, Department of Radiology.
Ryan C Lynch: Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA.
Elizabeth Krakow: Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA.
Heather Rasmussen: Division of Medical Oncology, University of Washington Medicine, Seattle, WA.
Thomas R Chauncey: Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA; Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
Sandra Kanan: Division of Medical Oncology, University of Washington Medicine, Seattle, WA.
Lorinda Soma: Department of Pathology, University of Washington Medicine, Seattle, WA.
Stephen D Smith: Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA.
Ajay K Gopal: Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA. Electronic address: agopal@uw.edu.
BACKGROUND: Histologic transformation to diffuse large B-cell lymphoma (tDLBCL) occurs in a significant proportion of indolent lymphomas. However, few studies of novel agents inform its management, particularly when relapsed after or refractory (R/R) to prior treatment. patients AND METHODS: We prospectively evaluated ibrutinib monotherapy in pathologically documented patients with R/R tDLBCL in a single-arm study. The primary endpoint was overall response rate. RESULTS: Twenty patients who had received a median of 4 (range, 2-9) prior lines of therapy overall (median, 2.5; range, 1-9 for tDLBCL) were treated. The overall response rate was 35%, including complete responses in 15%. The median progression-free survival and overall survival were 4.1 months (95% confidence interval, 2.4-6.2 months) and 22.4 months (95% confidence interval, 7.5 months to not reached), respectively. Disease control > 2 months was seen in 75% and > 1 year in 15%. Response was associated with either low tumor bulk or low metabolic tumor volume (P = .05) but not with antecedent lymphoma histology (P = 1.0). Treatment-related adverse events were consistent with prior studies of ibrutinib. CONCLUSIONS: ibrutinib showed low toxicity and meaningful efficacy in R/R tDLBCL, including short-term disease control in most cases. Results demonstrate the potential utility of ibrutinib in this challenging clinical setting, including as a potential bridge to more definitive treatments.
