Distinct clinical characteristics at diagnosis in patients with late relapses compared with early relapses of diffuse large B-cell lymphoma treated with R-CHOP.

The distinct clinical characteristics of patients at diagnosis of diffuse large B-cell lymphoma (DLBCL), who experience a late relapse compared with those who relapse early, require reappraisal in the era of R-CHOP. Data from the lymphoma registry of the Asan Medical Center between 2002 and 2015 were retrospectively reviewed. Among 846 DLBCL patients treated with first-line R-CHOP and achieved complete response, 169 (20%) relapsed, occurring late (>2 years) in 51 (6%). Compared with early relapses, late relapses were associated with a lower International Prognostic Index score (p=.001), lower incidence of B-symptoms (p=.004), lower lactate dehydrogenase (p=.001), lower stage (I-II; p=.001), and the median overall survival from relapse was significantly longer (2.4 vs. 1.0 years, p=.001). Patients with a late relapse who responded to salvage chemotherapy and received autologous stem-cell transplantation, had higher 5-year survival rate (55.4% vs. 20.2%). Time of relapse and LDH level were independent prognostic factors affecting survival.