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Late relapse in patients with diffuse large-cell lymphoma treated with MACOP-B
A Y Lee1, J M Connors, P Klimo
1Department of Medicine, British Columbia Cancer Agency, Vancouver Clinic, Canada.
Summary
Late relapses in diffuse large-cell lymphoma (DLCL) occur after 24 months of continuous complete remission. Late relapses in DLCL are similar to de novo DLCL, with outcomes depending on the specific histologic subtype at relapse.
Area of Science:
- Hematology
- Oncology
- Clinical Medicine
Background:
- Diffuse large-cell lymphoma (DLCL) is an aggressive non-Hodgkin lymphoma.
- Initial curative chemotherapy aims for long-term remission.
- Late relapse, defined as recurrence after >24 months of continuous complete remission, is a distinct clinical event.
Purpose of the Study:
- To investigate the clinical course and outcomes of patients experiencing late relapse of advanced-stage DLCL.
- To identify factors influencing the behavior and prognosis of late relapses.
Main Methods:
- A cohort of 127 patients with advanced-stage DLCL received a 12-week MACOP-B chemotherapy regimen.
- Patients achieving complete remission (CR) were monitored for relapse.
- Late relapse was defined as relapse occurring after >24 months of continuous CR (cCR).
Main Results:
- The 10-year actuarial risk of late relapse was projected at 22%, averaging 2.2% per year after 24 months.
- All 17 late relapses occurred in patients with B-cell lymphoma, with a median time to relapse of 69 months.
- Patients relapsing with aggressive subtypes treated with curative intent had a 6-year survival rate of 42%; those with follicular histology had a 6-year survival rate of 40% with palliative treatment.
Conclusions:
- Late relapse in DLCL warrants specific consideration, as its behavior mirrors de novo disease.
- Curative therapy should be pursued for late relapses with aggressive histology.
- Palliative treatment may benefit patients with late relapses exhibiting follicular histology.