Retreatment with R-CHOP-like therapy in patients with late relapse of diffuse large B-cell lymphoma

Patients with diffuse large B-cell lymphoma (DLBCL) with late relapse (>2 years from diagnosis) may be treated with a second course of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)-like therapy particularly if comorbidities preclude more intensive options. Patients with de novo DLBCL initially treated with an R-CHOP-like regimen who later developed late relapse and were re-treated with curative-intent R-CHOP-like therapy were identified using the BC Cancer databases. Sixty-five patients were identified; at relapse, the median age was 77 years (range, 52-89), 81% had stage III to IV DLBCL, 52% had an Eastern Cooperative Oncology Group performance status of 2 to 4, and 78% had an International Prognostic Index score of 3 to 5. The median time from original diagnosis was 7.4 years (range, 2.5-15.9). Median number of cycles of R-CHOP-like therapy received at relapse was 5 (range, 1-6). Overall response rate was 72%, and 57% complete response. With a median follow-up of 31 months, 2-year time to progression (TTP) was 54%, 2-year progression-free survival was 46%, 2-year disease-specific survival was 64%, and 2-year overall survival was 54%. Patients relapsing >5 years from diagnosis had better TTP, with a 2-year TTP of 66% compared with 9% for patients relapsing between 2 and 5 years (hazard ratio, 0.30; 95% confidence interval, 0.14-0.64; P = .001). Many patients with late-relapsing DLBCL may be effectively treated with further R-CHOP-like therapy, avoiding more intensive and costly secondary therapies.