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. 2021 Jan 7;11(1):9.
doi: 10.1038/s41408-020-00403-1.

Incidence of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) including CNS relapse in a population-based cohort of 4243 patients in Sweden

Sara Harrysson  1   2 , Sandra Eloranta  3 , Sara Ekberg  3 , Gunilla Enblad  4 , Mats Jerkeman  5 , Bjorn E Wahlin  6   7 , Per-Ola Andersson  8 , Karin E Smedby  3   6
Affiliations

Incidence of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) including CNS relapse in a population-based cohort of 4243 patients in Sweden

Sara Harrysson et al. Blood Cancer J. .

Abstract

We performed a national population-based study of all patients diagnosed with diffuse large B-cell lymphoma (DLBCL) in Sweden in 2007-2014 to assess treatment intent and risk of relapsed/refractory disease, including central nervous system (CNS) relapse, in the presence of competing risks. Overall, 84% of patients started treatment with curative intent (anthracycline-based) (n = 3550, median age 69 years), whereas 14% did not (n = 594, median age 84 years) (for 2% the intent was uncertain). Patients treated with curative intent had a 5-year OS of 65.3% (95% CI: 63.7-66.9). The median OS among non-curatively treated patients was 2.9 months. The 5-year cumulative incidence of relapsed/refractory disease in curative patients was 23.1% (95% CI: 21.7-24.6, n = 847). The 2-year cumulative incidence of CNS relapse was 3.0% (95% CI: 2.5-3.6, n = 118) overall, and 8.0% (95% CI: 6.0-10.6, n = 48) among patients with high CNS-IPI (4-6), when considering other relapse locations and death as competing events. The incidence of relapsed/refractory DLBCL overall and in the CNS was lower than in previous reports, still one in seven patients was not considered fit enough to start standard immunochemotherapy at diagnosis. These results are important for quantification of groups of DLBCL patients with poor prognosis requiring completely different types of interventions.

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Conflict of interest statement

This study was financed partly through the Swedish Cancer Society and partly through a public–private real-world evidence collaboration between Karolinska Institutet and Janssen Pharmaceutical NV. The funding bodies supported the data collection but did not have a role in the study design, data analyses or manuscript writing/decision to publish. Drs. Harrysson, Eloranta, Ekberg, Enblad, Jerkeman, Wahlin, Andersson, Smedby have nothing further to disclose.

Figures

Fig. 1
Fig. 1. Overall survival and progression-free survival.
Overall survival (OS) among curatively (n = 3550) and non-curatively (n = 594) treated diffuse large B-cell lymphoma (DLBCL) patients diagnosed 2007–2014 in Sweden, and progression-free survival (PFS) among curatively treated patients.
Fig. 2
Fig. 2. Incidence of relapsed/refractory disease.
Cumulative incidence of relapsed/refractory disease at any site among curatively treated diffuse large B-cell lymphoma (DLBCL) patients overall (n = 3550, 847 events), and by age at diagnosis (>/≤ 70 years) (incidence assessed in the presence of the competing risk of death*). Asterisk indicates Not depicted.
Fig. 3
Fig. 3. Incidence of relapsed/refractory disease by IPI.
Cumulative incidence of relapsed/refractory disease at any site among curatively treated diffuse large B-cell lymphoma (DLBCL) patients by IPI (0–1, 2, 3, 4–5) (incidence assessed in the presence of the competing risk of death*). Asterisk indicates not depicted.
Fig. 4
Fig. 4. Incidence of CNS relapse.
Cumulative incidence of CNS relapse among curatively treated diffuse large B-cell lymphoma (DLBCL) patients overall (for whom detailed medical records were available, n = 3478, 118 events), and by age at diagnosis and CNS-IPI risk group, respectively (incidence assessed in the presence of the competing risks of relapse without CNS involvement and death*). Asterisk indicates not depicted.
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