Prognosis of patients with diffuse large B cell lymphoma not reaching complete response or relapsing after frontline chemotherapy or immunochemotherapy

Abstract

A retrospective study was performed to assess the outcome of patients with diffuse large B cell lymphoma (DLBCL) who did not achieve complete response or who relapsed before and after the use of rituximab. Clinical features and outcome of 816 (425 M/391 F; median age 63 years) patients diagnosed from 1991 to 2001 (pre-rituximab era, N = 348) and from 2002 to 2012 (rituximab era, N = 468) in a single institution were evaluated. Five hundred fifty-three patients achieved complete remission (CR), 57 partial response (PR), and 206 were refractory with a median overall survival of 15, 1.5, and 0.4 years, respectively. Patients receiving rituximab had lower risk of refractoriness or relapse. In primarily refractory and PR patients, there was not a difference in survival depending on whether patients received or not rituximab-containing frontline treatment. Early death rate was 11%, including 3.6% due to infectious complications. Rituximab did not modify these figures. In the relapse setting, 5-year survival from relapse was 25% for patients who never received rituximab, 54% for those who received rituximab only at relapse, and 48% for those treated with immunochemotherapy both as frontline and at relapse. In conclusion, relapsed/refractory patients with DLBCL show poor prognosis despite the use of frontline immunochemotherapy. New therapeutic approaches are needed in this group of patients.

Fig. 1

Outcome of the whole series of patients with diffuse large B cell lymphoma (a) and of those treated with curative intention (b). Overall survival (OS) and progression-free survival (PFS) of the subgroups (a1, b1). PFS according to the year of diagnosis (before and after December 2001) (a2, b2). OS according to the year of diagnosis (before and after December 2001) (a3, b3)

Fig. 2

Survival from salvage treatment of frontline chemorefractory patients diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment

Fig. 3

Survival from salvage treatment of patients in partial remission after frontline therapy diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment

Fig. 4

Survival from relapse diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment

Fig. 5

Survival from relapse according to rituximab treatment at diagnosis or relapse. CT → R-CT chemotherapy at diagnosis and immunochemotherapy at relapse; R-CT → R-CT immunochemotherapy both at diagnosis and at relapse; CT → CT chemotherapy both at diagnosis and at relapse; a all cohort; b only patients treated with curative intention at relapse