Time of relapse after initial therapy significantly adds to the prognostic value of the IPI-R in patients with relapsed DLBCL undergoing autologous stem cell transplantation

We explored the concomitant effect of the International Prognostic Index at the time of relapse (IPI-R) and the time from initial diagnosis to relapse (TTR) on outcome of 80 uniformly treated patients receiving BEAM conditioning followed by SCT for relapsed, chemosensitive diffuse large B-cell lymphoma. Median age at the time of transplantation was 62 years (range 26-77). Median follow-up of survivors was 31.4 months. Median overall survival (OS) from the time of transplant for patients with TTR > 18 months vs ≤18 months was not reached and 50 months, respectively (P = 0.01). Median OS for patients with IPI-R ≥3 was 23.3 months and not reached for patients with IPI-R < 3 (P = 0.01). These factors were independent in multivariate analysis with relative risk for death of 0.91 (0.80-0.99; P = 0.04) for each 6-month increment in TTR and 0.63 (0.42-0.96; P = 0.03) for IPI-R < 3. TTR ≤ 18 months and IPI-R ≥ 3 were combined in a prognostic system where patients with none (n = 32), one (n = 39) or two (n = 9) of these factors had median OS not reached, of 50 and 5 months, respectively (P < 0.01). Patients with early, high IPI-R relapse after first-line therapy have a dismal outcome with SCT and should receive experimental therapies.