Abstract
Despite a general favourable outcome in limited stage diffuse large B‐cell lymphoma (DLBCL), relapses occur in about 10 to 20% of patients. Prognostic models only partially identify patients at risk for relapse. Moreover, it is not known whether the outcome after such a relapse is similar to the outcome after relapse in advanced stages. From January 2004 through December 2012, all newly diagnosed patients with stage I(E) DLBCL were retrospectively analysed from 2 clinical databases to investigate the relapse pattern and outcome in relation to initial treatment and clinical characteristics. In 126 patients (median age 64 years), histologically confirmed stage I(E) DLBCL was diagnosed. With a median follow‐up of 53 months (range 5‐132 months), 1 progressive disease and 18 relapses occurred. The 5‐year time to tumour progression and disease‐specific survival were 85% (95% CI 79‐91%) and 92% (95% CI 87%‐97%), respectively. We observed no significant difference in relapse localization, time to tumour progression, and disease‐specific survival between patients treated with abbreviated R‐CHOP plus involved field radiotherapy or with 6 to 8 cycles of R‐CHOP. Analysis of relapses showed relapse >5 years after initial treatment (late relapse) in 5 of 19 patients (26%). Six of 19 patients (32%) had central nervous system relapse. Three of 11 relapsed cases available for analysis (28%) showed an MYC translocation, suggesting an overrepresentation in the relapse group. Outcome of patients with a relapse was poor with a median survival after relapse of 8 months. Only 1 patient (5%) underwent successful autologous stem cell transplantation. To improve outcome in these patients, early identification of new biological factors such as a MYC translocation or a high risk for CNS dissemination might be helpful. Moreover, treatment of any relapse after stage I disease should be taken seriously. Salvage treatment should be similar to relapses after advanced DLBCL.
Highlights
Diffuse large B‐cell lymphoma (DLBCL) accounts for 25 to 30% of adult non‐Hodgkin lymphomas.1 Twenty‐five to 40% of patients present with limited stage disease, defined as stages I and II according to the Ann Arbor classification.Until the beginning of this century, optimal treatment for limited stage DLBCL used to consist of 3 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy plus involved field radiotherapy (IFRT)
A relapse more than 5 years after diagnosis: 3 of 14 patients treated with abbreviated R‐CHOP plus IFRT and 2 of 4 patients treated with R‐CHOP (p 0.52) (Figure 1)
The number of analysed patients is low, we found no MYC positive DLBCL in late relapses
Summary
Diffuse large B‐cell lymphoma (DLBCL) accounts for 25 to 30% of adult non‐Hodgkin lymphomas. Twenty‐five to 40% of patients present with limited stage disease, defined as stages I and II according to the Ann Arbor classification. We decided to analyse in an observational cohort study the relapses of patients with stage I(E) DLBCL focusing on [1] initial therapy (only R‐CHOP vs combined modality treatment), [2] clinical characteristics and risk profile of the patient, [3] patterns of relapse, [4] if available the presence of MYC breaks, and [5] the final outcome after treatment. To this end, we used 2 large databases in the northern part of the Netherlands, thereby avoiding trial‐based selection and better approaching real life observations
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