Journal: Blood advances
This retrospective BC Cancer series evaluated outcomes of re-treatment with curative‑intent R‑CHOP–like therapy in patients with de novo DLBCL who experienced a late relapse (>2 years after initial diagnosis) following prior R‑CHOP–like treatment.
Key points:
- Population: 65 patients with late-relapsing DLBCL; at relapse, median age 77 (52–89), 81% stage III–IV, 52% ECOG 2–4, and 78% IPI 3–5, reflecting an older, high‑risk, comorbid cohort.
- Disease-free interval: Median time from original diagnosis to relapse was 7.4 years (2.5–15.9).
- Treatment: At relapse, patients received a median of 5 cycles (1–6) of R‑CHOP–like therapy.
- Efficacy:
- Overall response rate: 72%
- Complete response rate: 57%
- Outcomes (median follow‑up 31 months):
- 2‑year time to progression (TTP): 54%
- 2‑year progression‑free survival: 46%
- 2‑year disease‑specific survival: 64%
- 2‑year overall survival: 54%
- Prognostic impact of relapse timing:
- Relapse >5 years from diagnosis: 2‑year TTP 66%
- Relapse 2–5 years from diagnosis: 2‑year TTP 9%
- Hazard ratio for TTP for >5‑year vs 2–5‑year relapse: 0.30 (95% CI, 0.14–0.64; P = .001).
Clinical implication: In older, often frail patients with late‑relapsing DLBCL, especially when relapse occurs >5 years from initial diagnosis, re‑treatment with R‑CHOP–like therapy can achieve meaningful response rates and durable disease control, providing a less intensive and less costly alternative to more aggressive second‑line strategies.