Retreatment with R-CHOP-like Therapy in Patients with Late Relapse of Diffuse Large B-Cell Lymphoma Open Access

• Late relapse DLBCL is characterized by chemotherapy-sensitive disease for which chemotherapy retreatment may be a reasonable option.

• A second course of R-CHOP-like therapy may result in durable remission in this population, avoiding the need for more intensive therapies.

Patients with diffuse large B-cell lymphoma (DLBCL) with late relapse (>2 years from diagnosis) may be treated with a second course of R-CHOP-like therapy particularly if comorbidities preclude more intensive options. Patients with de novo DLBCL initially treated with an R-CHOP-like regimen who developed late relapse and were retreated with curative-intent R-CHOP-like therapy were identified through BC Cancer databases. Sixty-five patients were identified; at relapse: median age 77 years (range, 52-89), 81% stage III-IV, 52% ECOG performance status 2-4, 78% IPI score 3-5. Median time from original diagnosis was 7.4 years (range, 2.5-15.9). Median number of cycles of R-CHOP-like therapy received at relapse was 5 (range 1-6). Overall response rate was 72%; 57% complete response. With a median follow-up of 31 months, 2-year time-to-progression (TTP) was 54%, 2-year progression-free survival was 46%, 2-year disease-specific survival was 64% and 2-year overall survival was 54%. Patients relapsing >5 years from diagnosis had better TTP, with a 2-year TTP of 66% compared to 9% for patients relapsing between 2-5 years (HR 0.30 [95%CI 0.14-0.64]; p=0.001). Many patients with late-relapsing DLBCL may be effectively treated with further R-CHOP-like therapy, avoiding more intensive and costly secondary therapies.