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Clin Lymphoma Myeloma Leuk. 2017 Mar;17(3):145-151. doi: 10.1016/j.clml.2016.11.001. Epub 2016 Nov 23.

Late Relapses After High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Diffuse Large B-cell Lymphoma in the Rituximab Era.

Author information

1
Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA.
2
Division of Epidemiology, Department of Public Health Sciences, University of Rochester, Rochester, NY.
3
Department of Medicine, Yale New Haven Medical Center, New Haven, CT.
4
Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY.
5
Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
6
Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY; Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
7
Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
8
Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY. Electronic address: Carla_Casulo@URMC.Rochester.edu.

Abstract

BACKGROUND:

The standard of care for diffuse large B-cell lymphoma (DLBCL) relapsing after front-line therapy is high-dose chemotherapy and autologous stem cell transplantation (ASCT). Evidence has suggested that early relapses (ie, within 1 year) after this approach portends exceptionally poor outcomes. However, data examining relapses > 1 year after ASCT for patients with refractory or relapsed DLBCL are limited, in particular, in the rituximab era. We sought to examine the effect of early (≤ 1 year) and late (> 1 year) relapse after ASCT in a single-institution cohort of patients with relapsed and refractory DLBCL treated with chemoimmunotherapy.

MATERIALS AND METHODS:

A retrospective analysis was performed on the data from 85 consecutive patients who had undergone ASCT for biopsy-confirmed relapsed or refractory DLBCL from 2001 to 2010 at the University of Rochester Medical Center. All patients had received rituximab as a part of treatment. Of the 85 patients, 35 developed relapse after ASCT. These 35 patients were divided into 2 groups according to the timing of the relapse (≤ 1 year and > 1 year after ASCT).

RESULTS:

The median follow-up period was 6.4 years. For all patients, the overall survival (OS) from post-ASCT relapse was 5.2 years. For the 27 patients developing relapse at ≤ 1 year after ASCT, the median OS was 0.6 year and progression-free survival was 0.4 year. For the 8 patients developing relapse at > 1 year after ASCT, the median OS was 5.9 years and progression-free survival was 2.9 years.

CONCLUSION:

Patients with relapsed or refractory DLBCL experiencing relapse > 1 year after ASCT had good outcomes. Despite the relative rarity in incidence, a significant risk of relapse of DLBCL after ASCT remains, suggesting the need for continued monitoring because of the possibility of later progression.

KEYWORDS:

Autologous stem cell transplant; DLBCL; Early relapse; Refractory; Relapse

PMID:
27998707
DOI:
10.1016/j.clml.2016.11.001
[Indexed for MEDLINE]
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