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Relapse in stage I(E) diffuse large B-cell lymphoma.

Marcel Nijland1, Karin Boslooper1, Gustaaf van Imhoff1

  • 1Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

Hematological Oncology
|October 31, 2017
PubMed
Summary

Relapses in limited stage diffuse large B-cell lymphoma (DLBCL) are common, with poor outcomes post-recurrence. Early identification of factors like MYC translocations and central nervous system involvement is crucial for improving survival.

Keywords:
CNSMYCdiffuse large B-cell lymphomalimited stagerelapsesurvival

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Area of Science:

  • Hematology
  • Oncology
  • Clinical Research

Background:

  • Limited stage diffuse large B-cell lymphoma (DLBCL) generally has a favorable prognosis.
  • However, 10-20% of patients experience relapses, and prognostic models incompletely identify those at risk.
  • The outcomes following relapse in limited stage DLBCL compared to advanced stages are not well-defined.

Purpose of the Study:

  • To investigate the relapse patterns and outcomes in patients with stage I(E) DLBCL.
  • To compare outcomes based on initial treatment modalities (abbreviated R-CHOP plus radiotherapy vs. full R-CHOP).
  • To identify potential biological factors associated with relapse and poor outcomes.

Main Methods:

  • Retrospective analysis of 126 newly diagnosed stage I(E) DLBCL patients from January 2004 to December 2012.
  • Data collected from two clinical databases, including initial treatment, clinical characteristics, relapse patterns, and survival.
  • Analysis of relapse localization, time to tumor progression, disease-specific survival, and factors like MYC translocation and central nervous system (CNS) involvement.

Main Results:

  • The 5-year time to tumor progression was 85% and disease-specific survival was 92%.
  • No significant difference in outcomes was observed between abbreviated R-CHOP with radiotherapy and 6-8 cycles of R-CHOP.
  • Late relapses (>5 years) occurred in 26% of relapsed patients, and 32% had CNS relapses. MYC translocations were observed in 28% of analyzed relapsed cases.
  • The median survival after relapse was poor at 8 months, with only one patient undergoing successful autologous stem-cell transplantation.

Conclusions:

  • Relapse in limited stage DLBCL carries a poor prognosis, necessitating serious consideration for salvage treatment.
  • Early identification of prognostic factors, including MYC translocations and CNS dissemination risk, is vital for improving patient outcomes.
  • Salvage treatment strategies for relapsed limited stage DLBCL should mirror those used for advanced stage disease.