Patterns and Timing of Failure for Diffuse Large B-Cell Lymphoma After Initial Therapy in a Cohort Who Underwent Autologous Bone Marrow Transplantation for Relapse

Publication date: Available online 27 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sughosh Dhakal, James E. Bates, Carla Casulo, Jonathan W. Friedberg, Michael W. Becker, Jane L. Liesveld, Louis S. Constine
PurposeDespite the remarkable advances resulting from R-CHOP-based chemotherapy, a significant proportion of patients with diffuse large B-cell lymphoma (DLBCL) will relapse or have refractory disease. For newly diagnosed patients, the role of adjuvant radiotherapy (RT) following R-CHOP remains ill-defined. We evaluated the location and timing of initial recurrence in patients with DLBCL who subsequently underwent high-dose chemotherapy with autologous stem cell transplant (HDC/ASCT) in order to direct approaches for disease surveillance, inform us about the patterns of failure of contemporary treatment strategies, and guide adjuvant treatment decisions.Materials/MethodsWe analyzed consecutive patients with DLBCL who underwent HDC/ASCT between May 1992 and March 2014 at our institution. Of the 187 evaluable patients, 8 had incomplete data, and 79 underwent HDC/ASCT as a component of initial treatment for de novo or refractory DLBCL and were excluded from further analysis.ResultsThe median age was 50.8 years; the median time to relapse was 1.3 years. Patients were segregated according to the initial stage at diagnosis with early-stage (ES) defined as stage I/II and advanced-stage (AS) defined as stage III/IV. In total, 40.4% of the ES and 75.5% of the AS patients relapsed in sites of initial disease; 68.4% of those with ES disease and 75.0% of those with AS disease relapsed in sites of initial disease only. Extranodal relapses were common (44.7% in ES and 35.9% in AS), and occurred in a variety of organs, though GI tract/liver (n = 12) was most frequent.ConclusionsMost patients with DLBCL who relapse and subsequently undergo HDC/ASCT initially recur in the previously involved disease site(s). Time to recurrence is brief suggesting that frequency of screening is most justifiably greatest in the early post-therapy years.

Teaser

A significant proportion of patients with diffuse large B-cell lymphoma (DLBCL) will relapse or have refractory disease to initial chemotherapy. We analyze the patterns of initial disease and patterns of relapse among patients with DLBCL who subsequently underwent high-dose chemotherapy with autologous stem cell transplant (HDC/ASCT) at our institution and showed a substantial majority of patients relapse in sites of initial disease.


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