Late relapses in patients with diffuse large b-cell lymphoma treated with immunochemotherapy

Yucai Wang, Umar Farooq, Brian K. Link, Melissa C. Larson, Rebecca King, Matthew J. Maurer, Cristine Allmer, Mehrdad Hefazi, Carrie A Thompson, Ivana Micallef, Patrick Bruce Johnston, Thomas Matthew Habermann, Thomas Elmer Witzig, Stephen Maxted Ansell, James R Cerhan, Grzegorz S Nowakowski

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Abstract

PURPOSE In patients with diffuse large B-cell lymphoma (DLBCL), most relapses occur within the first 2 years of diagnosis. We sought to define the rate and outcome of late relapses that occurred after achieving event-free survival at 24 months (EFS24). METHODS We prospectively followed 1,324 patients with newly diagnosed DLBCL from 2002 to 2015 and treated with immunochemotherapy. Cumulative incidences of late DLBCL and indolent lymphoma relapses were analyzed as competing events. Postrelapse survival was defined as time from first relapse to death from any cause. RESULTS In 847 patients who achieved EFS24, the cumulative incidence of late relapse was 6.9% at 3 years, 9.3% at 5 years, and 10.3% at 8 years after EFS24. The incidence of DLBCL relapse was similar in patients with DLBCL alone at diagnosis (6.3% at 5 years), compared with patients with concurrent indolent lymphoma at diagnosis (5.2%; P = .46). However, the rate of indolent lymphoma relapse was higher in patients with concurrent indolent lymphoma (7.4% v 2.1% at 5 years; P , .01). In patients with DLBCL alone, the rate of DLBCL relapse was similar in the germinal center B-cell-like (GCB) (4.1% at 5 years) and non-GCB (4.0%; P = .71) subtypes, whereas the rate of indolent lymphoma relapse was higher in patients with the GCB subtype (3.9% v 0.0% at 5 years; P = .02). Postrelapse survival was inferior for patients who relapsed with DLBCL than for those who relapsed with indolent lymphoma (median 29.9 months v unreached; P , .01). CONCLUSION 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.

Original languageEnglish (US)
Pages (from-to)1819-1827
Number of pages9
JournalJournal of Clinical Oncology
Volume37
Issue number21
DOIs
StatePublished - Jul 20 2019

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Lymphoma, Large B-Cell, Diffuse
Lymphoma
Recurrence
Germinal Center
B-Lymphocytes
Disease-Free Survival
Incidence
Survival
Cause of Death

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Late relapses in patients with diffuse large b-cell lymphoma treated with immunochemotherapy. / Wang, Yucai; Farooq, Umar; Link, Brian K.; Larson, Melissa C.; King, Rebecca; Maurer, Matthew J.; Allmer, Cristine; Hefazi, Mehrdad; Thompson, Carrie A; Micallef, Ivana; Johnston, Patrick Bruce; Habermann, Thomas Matthew; Witzig, Thomas Elmer; Ansell, Stephen Maxted; Cerhan, James R; Nowakowski, Grzegorz S.

In: Journal of Clinical Oncology, Vol. 37, No. 21, 20.07.2019, p. 1819-1827.

Research output: Contribution to journalArticle

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abstract = "PURPOSE In patients with diffuse large B-cell lymphoma (DLBCL), most relapses occur within the first 2 years of diagnosis. We sought to define the rate and outcome of late relapses that occurred after achieving event-free survival at 24 months (EFS24). METHODS We prospectively followed 1,324 patients with newly diagnosed DLBCL from 2002 to 2015 and treated with immunochemotherapy. Cumulative incidences of late DLBCL and indolent lymphoma relapses were analyzed as competing events. Postrelapse survival was defined as time from first relapse to death from any cause. RESULTS In 847 patients who achieved EFS24, the cumulative incidence of late relapse was 6.9{\%} at 3 years, 9.3{\%} at 5 years, and 10.3{\%} at 8 years after EFS24. The incidence of DLBCL relapse was similar in patients with DLBCL alone at diagnosis (6.3{\%} at 5 years), compared with patients with concurrent indolent lymphoma at diagnosis (5.2{\%}; P = .46). However, the rate of indolent lymphoma relapse was higher in patients with concurrent indolent lymphoma (7.4{\%} v 2.1{\%} at 5 years; P , .01). In patients with DLBCL alone, the rate of DLBCL relapse was similar in the germinal center B-cell-like (GCB) (4.1{\%} at 5 years) and non-GCB (4.0{\%}; P = .71) subtypes, whereas the rate of indolent lymphoma relapse was higher in patients with the GCB subtype (3.9{\%} v 0.0{\%} at 5 years; P = .02). Postrelapse survival was inferior for patients who relapsed with DLBCL than for those who relapsed with indolent lymphoma (median 29.9 months v unreached; P , .01). CONCLUSION 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.",
author = "Yucai Wang and Umar Farooq and Link, {Brian K.} and Larson, {Melissa C.} and Rebecca King and Maurer, {Matthew J.} and Cristine Allmer and Mehrdad Hefazi and Thompson, {Carrie A} and Ivana Micallef and Johnston, {Patrick Bruce} and Habermann, {Thomas Matthew} and Witzig, {Thomas Elmer} and Ansell, {Stephen Maxted} and Cerhan, {James R} and Nowakowski, {Grzegorz S}",
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T1 - Late relapses in patients with diffuse large b-cell lymphoma treated with immunochemotherapy

AU - Wang, Yucai

AU - Farooq, Umar

AU - Link, Brian K.

AU - Larson, Melissa C.

AU - King, Rebecca

AU - Maurer, Matthew J.

AU - Allmer, Cristine

AU - Hefazi, Mehrdad

AU - Thompson, Carrie A

AU - Micallef, Ivana

AU - Johnston, Patrick Bruce

AU - Habermann, Thomas Matthew

AU - Witzig, Thomas Elmer

AU - Ansell, Stephen Maxted

AU - Cerhan, James R

AU - Nowakowski, Grzegorz S

PY - 2019/7/20

Y1 - 2019/7/20

N2 - PURPOSE In patients with diffuse large B-cell lymphoma (DLBCL), most relapses occur within the first 2 years of diagnosis. We sought to define the rate and outcome of late relapses that occurred after achieving event-free survival at 24 months (EFS24). METHODS We prospectively followed 1,324 patients with newly diagnosed DLBCL from 2002 to 2015 and treated with immunochemotherapy. Cumulative incidences of late DLBCL and indolent lymphoma relapses were analyzed as competing events. Postrelapse survival was defined as time from first relapse to death from any cause. RESULTS In 847 patients who achieved EFS24, the cumulative incidence of late relapse was 6.9% at 3 years, 9.3% at 5 years, and 10.3% at 8 years after EFS24. The incidence of DLBCL relapse was similar in patients with DLBCL alone at diagnosis (6.3% at 5 years), compared with patients with concurrent indolent lymphoma at diagnosis (5.2%; P = .46). However, the rate of indolent lymphoma relapse was higher in patients with concurrent indolent lymphoma (7.4% v 2.1% at 5 years; P , .01). In patients with DLBCL alone, the rate of DLBCL relapse was similar in the germinal center B-cell-like (GCB) (4.1% at 5 years) and non-GCB (4.0%; P = .71) subtypes, whereas the rate of indolent lymphoma relapse was higher in patients with the GCB subtype (3.9% v 0.0% at 5 years; P = .02). Postrelapse survival was inferior for patients who relapsed with DLBCL than for those who relapsed with indolent lymphoma (median 29.9 months v unreached; P , .01). CONCLUSION 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.

AB - PURPOSE In patients with diffuse large B-cell lymphoma (DLBCL), most relapses occur within the first 2 years of diagnosis. We sought to define the rate and outcome of late relapses that occurred after achieving event-free survival at 24 months (EFS24). METHODS We prospectively followed 1,324 patients with newly diagnosed DLBCL from 2002 to 2015 and treated with immunochemotherapy. Cumulative incidences of late DLBCL and indolent lymphoma relapses were analyzed as competing events. Postrelapse survival was defined as time from first relapse to death from any cause. RESULTS In 847 patients who achieved EFS24, the cumulative incidence of late relapse was 6.9% at 3 years, 9.3% at 5 years, and 10.3% at 8 years after EFS24. The incidence of DLBCL relapse was similar in patients with DLBCL alone at diagnosis (6.3% at 5 years), compared with patients with concurrent indolent lymphoma at diagnosis (5.2%; P = .46). However, the rate of indolent lymphoma relapse was higher in patients with concurrent indolent lymphoma (7.4% v 2.1% at 5 years; P , .01). In patients with DLBCL alone, the rate of DLBCL relapse was similar in the germinal center B-cell-like (GCB) (4.1% at 5 years) and non-GCB (4.0%; P = .71) subtypes, whereas the rate of indolent lymphoma relapse was higher in patients with the GCB subtype (3.9% v 0.0% at 5 years; P = .02). Postrelapse survival was inferior for patients who relapsed with DLBCL than for those who relapsed with indolent lymphoma (median 29.9 months v unreached; P , .01). CONCLUSION 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.

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