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Rate and Outcome of Late Relapses in Patients With DLBCL Treated With Immunochemotherapy

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Key Points

  • Patients with both DLBCL and indolent lymphoma at diagnosis had higher risk of late relapse.
  • Patients who had DLBCL relapse had a worse prognosis than those who relapsed with indolent lymphoma.

In a study reported in the Journal of Clinical Oncology, Wang et al identified the rates and outcomes of relapses of diffuse large B-cell lymphoma (DLBCL) in patients who had achieved 24-month event-free survival (EFS) after immunochemotherapy.  

Study Details

The study involved 1,324 patients with newly diagnosed DLBCL from 2002 to 2015 who received R-CHOP (rituximab plus cyclophosphamide/doxorubicin/vincristine/prednisone) or R-CHOP–like immunochemotherapy. All patients were from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence. The cumulative rates of late DLBCL and indolent lymphoma relapses were analyzed as competing events.

Late Relapses

Overall, 847 patients achieved 24-month EFS. Among these, the cumulative incidence of late relapse was 6.9% at 3 years, 9.3% at 5 years, and 10.3% at 8 years after 24-month EFS. The 5-year cumulative incidence of DLBCL relapse was similar in patients with DLBCL alone at diagnosis vs patients with concurrent indolent lymphoma at diagnosis (6.3% vs 5.2%, P = .46). The 5-year rate of indolent lymphoma relapse was higher in patients with concurrent indolent lymphoma vs those with DLBCL alone at diagnosis (7.4% vs 2.1%, P < .01).

Among patients with DLBCL alone at diagnosis, the 5-year rate of DLBCL relapse was similar in those with germinal center B-cell–like (GCB) vs non-GCB subtypes (4.1% vs 4.0%, P = .71); the 5-year rate of indolent lymphoma relapse was higher in patients with GCB vs non-GCB subtypes (3.9% vs 0.0%, P = .02).

Patients who relapsed with DLBCL had poorer postrelapse survival than those who relapsed with indolent lymphoma (median = 29.9 months vs unreached, P < .01).

The investigators concluded, “Patients with DLBCL with a concurrent indolent lymphoma and those with the GCB subtype had a higher rate of late relapse, owing to increased relapses with indolent lymphoma. Patients who relapsed with DLBCL had a worse prognosis than those who relapsed with indolent lymphoma.”

Grzegorz S. Nowakowski, MD, of the Division of Hematology, Mayo Clinic, Rochester, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute and the Predolin Foundation. For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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