Late relapse in patients with diffuse large B-cell lymphoma

The outcomes for 162 patients with diffuse large B-cell lymphoma treated with a CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone)-like regimen who obtained a complete remission and who subsequently relapsed after ≥5 years of remission (late relapse, N = 30), or <5 years of remission (early relapse, N = 132), were compared. The late relapsing patients had better prognostic characteristics at diagnosis, such as stage I/II disease (73% vs. 49%, P = 0.04), a normal lactic dehydrogenase (77% vs. 48%, P = 0.01), and a Karnofsky performance score of ≥80 (100% vs. 86%, P = 0.01). The 3-year survival after relapse was better in late relapsing patients (48% vs. 25%, P = 0.03), but the survival at 5 years (32% vs. 20%) and 10 years (13% vs. 14%) after relapse was not different. A multivariate analysis of factors predicting survival after relapse found age (P < 0.0001) and presence of B-symptoms (P = 0.03) to predict survival, but not early versus late relapse. A small percentage of the late relapsing patients can have a prolonged second remission. However, the overall survival from the time of relapse was not different between early and late relapsing patients with most succumbing to lymphoma.