title: 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.
authors.affiliation: Hematology Department, Hospital Clínic, IDIBAPS, C/. Villarroel, 170, 08036, Barcelona, Spain, jorovira@clinic.ub.es.
authors.forename: Jordina
authors.initials: J
authors.lastname: Rovira
authors.forename: Alexandra
authors.initials: A
authors.lastname: Valera
authors.forename: Lluis
authors.initials: L
authors.lastname: Colomo
authors.forename: Xavier
authors.initials: X
authors.lastname: Setoain
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez
authors.forename: Alejandra
authors.initials: A
authors.lastname: Martínez-Trillos
authors.forename: Eva
authors.initials: E
authors.lastname: Giné
authors.forename: Ivan
authors.initials: I
authors.lastname: Dlouhy
authors.forename: Laura
authors.initials: L
authors.lastname: Magnano
authors.forename: Anna
authors.initials: A
authors.lastname: Gaya
authors.forename: Daniel
authors.initials: D
authors.lastname: Martínez
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez
authors.forename: Elías
authors.initials: E
authors.lastname: Campo
authors.forename: Armando
authors.initials: A
authors.lastname: López-Guillermo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab