Abstract
We performed a national population-based study of all patients diagnosed with diffuse large B-cell lymphoma (DLBCL) in Sweden in 2007–2014 to assess treatment intent and risk of relapsed/refractory disease, including central nervous system (CNS) relapse, in the presence of competing risks. Overall, 84% of patients started treatment with curative intent (anthracycline-based) (n = 3550, median age 69 years), whereas 14% did not (n = 594, median age 84 years) (for 2% the intent was uncertain). Patients treated with curative intent had a 5-year OS of 65.3% (95% CI: 63.7–66.9). The median OS among non-curatively treated patients was 2.9 months. The 5-year cumulative incidence of relapsed/refractory disease in curative patients was 23.1% (95% CI: 21.7–24.6, n = 847). The 2-year cumulative incidence of CNS relapse was 3.0% (95% CI: 2.5–3.6, n = 118) overall, and 8.0% (95% CI: 6.0–10.6, n = 48) among patients with high CNS-IPI (4–6), when considering other relapse locations and death as competing events. The incidence of relapsed/refractory DLBCL overall and in the CNS was lower than in previous reports, still one in seven patients was not considered fit enough to start standard immunochemotherapy at diagnosis. These results are important for quantification of groups of DLBCL patients with poor prognosis requiring completely different types of interventions.
Highlights
Introduction Diffuse largeB-cell lymphoma (DLBCL) is the most common subtype of lymphoma and has an aggressive clinical course[1]
In this large nationwide population-based study, we demonstrate that the proportion of diffuse large B-cell lymphoma (DLBCL) patients overall that experience progression or relapse is only 18.9% at 2 years and 23.1% at 5 years, considerably lower than generally stated[17,18,19,20]
The incidence of central nervous system (CNS) relapse was low; 3.0% in the whole cohort and 8.0% among high-risk patients (CNS International prognostic index (IPI) 4–6). We believe these real-world benchmark figures are important for patients as well as physicians and policy makers to help estimate patient numbers eligible for new treatments in the era of targeted therapies for relapsed/refractory disease
Summary
B-cell lymphoma (DLBCL) is the most common subtype of lymphoma and has an aggressive clinical course[1]. Known clinical risk factors for relapse include advanced stage, high age, elevated serum lactate dehydrogenase (LDH), poor performance status and involvement of more than one extranodal site, as summarized in the widely used International prognostic index (IPI) score[9]. To estimate the risk of central nervous system (CNS) relapse, the CNS-IPI was developed based on IPI with the addition of kidney and/or adrenal gland involvement[10]. 20 years ago, gene-expression profiling techniques were used to identify biological subtypes of DLBCL by cell of origin, the germinal center B-cell (GCB) and activated
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