Evaluating risk of late versus early relapse for patients with diffuse large B-cell lymphoma

This study investigated the risk of relapse 5 years or more after treatment for patients with diffuse large B-cell lymphoma (DBLCL). This study concluded that the outcomes of patients with a late relapse were better than those in patients who relapsed early after treatment.

DLBCL is one of the most common types of non-Hodgkin’s lymphoma. Typical first-line treatment involves chemoimmunotherapy. This treatment combines chemotherapy with immunotherapy, such as rituximab (Rituxan). This treatment is very effective for about two-thirds of patients with DLBCL. However, some patients may have cancer come back (relapse) a few years after finishing treatment.

Previous studies suggest that the risk of relapse for patients who have no signs of cancer for two years after initial treatment is about 7%. Patients with very early relapse may develop disease that stops responding to treatment (refractory). However, the outcomes of patients who experience relapse five years or more after treatment are unclear.

This study included 1113 patients with DLBCL. Of these, 699 patients (62.8%) had no signs of cancer after initial treatment. Of these, 196 patients had the cancer come back. Among these patients, 160 (81.6%) had an early relapse, and 36 (18.4%) had a late relapse (5 or more years later). Patients were followed-up for an average of 12.5 years.

On average, patients experienced a relapse at an average of 8.5 years. For almost half (42%) of all patients, this period was 10 years. Overall, 3.2% of all patients (36 patients) experienced a relapse. At relapse, 19 of these patients were diagnosed with DLBCL. 2 patients were diagnosed with follicular lymphoma (FL) and 1 patient was diagnosed with Hodgkin’s lymphoma.

31 patients who relapsed received chemotherapy. Of these, 22 patients also underwent a stem cell transplant. 18 patients also received immunotherapy. Overall, 68% of patients responded to salvage therapy. 58% of these patients had no signs of cancer after treatment. 23% had tumor shrinkage.

At follow-up, patients who had a late relapse had a significantly longer time from relapse to death compared to patients who relapsed early (5.2 years vs. 1.1 years). The probability of surviving for 5 years after a late relapse was significantly higher compared to an early relapse (53% vs. 31%).

On average, patients who had a late relapse survived for significantly longer on average compared to patients who relapsed early (4.5 years vs. 1.0 year). After relapse, 47% of patients who had a late relapse were still alive 5 years later compared to 25% of patients who had an early relapse.

This study concluded that patients with DLBCL who relapse late after initial treatment had better outcomes than patients relapse early after treatment.