Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study

Michael Crump, Sattva S. Neelapu, Umar Farooq, Eric Van Den Neste, John Kuruvilla, Jason Westin, Brian K. Link, Annette Hay, James R. Cerhan, Liting Zhu, Sami Boussetta, Lei Feng, Matthew J. Maurer, Lynn Navale, Jeff Wiezorek, William Y. Go and Christian Gisselbrecht
This article has an Erratum 131(5):587

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  • Defining primary refractory diffuse large B-cell lymphoma: aligning clinical trials with ground reality

    I commend the authors of the SCHOLAR-1 study (1) for their herculean data compilation, meticulous analysis and relevant subgroup analysis. This study indeed establishes a helpful baseline for future comparisons of new therapies in the relapsed/refractory setting for diffuse large B-cell lymphoma (DLBCL), however I do think that the definition of ‘primary refractory DLBCL’ used is the study is quite restrictive. There exists significant heterogeneity in the definition of primary refractory DLBCL in clinical trials(2)- it has been defined as failure to achieve a complete remission (CR) and have documented persistent disease at the completion of FLT (3); achieving less than a partial response (PR) to FLT (4); and achieving less than a PR to FLT or progressing within 3 months of completion of therapy (5). While Crump et al have defined primary refractory disease as ‘stable disease (SD) as best response to ≥4 cycles of first-line therapy (FLT)’, I would argue that anything less than a complete remission (CR) to FLT is suboptimal in DLBCL and should be considered primary refractory. I would like to remind the readers that any amount of residual disease at the end of FLT warrants a repeat biopsy; and if found positive for lymphoma, treated with appropriate salvage therapy. The inherent biologic difference between Crump et al’s ‘primary refractory DLBCL’ and the broadened definition of ‘primary refractory DLBCL’ used in clinical practice is chemo sensitivity- the primary refractor...

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    Conflict of Interest:
    None declared.