title: Patterns and Timing of Failure for Diffuse Large B-Cell Lymphoma After Initial Therapy in a Cohort Who Underwent Autologous Bone Marrow Transplantation for Relapse.
abstract: To evaluate the location and timing of initial recurrence in patients with diffuse large B-cell lymphoma (DLBCL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplant (HDC/ASCT), to direct approaches for disease surveillance, elucidate the patterns of failure of contemporary treatment strategies, and guide adjuvant treatment decisions.
  
  
  
  We analyzed consecutive patients with DLBCL who underwent HDC/ASCT between May 1992 and March 2014 at our institution. Of the 187 evaluable patients, 8 had incomplete data, and 79 underwent HDC/ASCT as a component of initial treatment for de novo or refractory DLBCL and were excluded from further analysis.
  
  
  
  The median age was 50.8 years; the median time to relapse was 1.3 years. Patients were segregated according to the initial stage at diagnosis, with early stage (ES) defined as stage I/II and advanced stage (AS) defined as stage III/IV. In total, 40.4% of the ES and 75.5% of the AS patients relapsed in sites of initial disease; 68.4% of those with ES disease and 75.0% of those with AS disease relapsed in sites of initial disease only. Extranodal relapses were common (44.7% in ES and 35.9% in AS) and occurred in a variety of organs, although gastrointestinal tract/liver (n=12) was most frequent.
  
  
  
  Most patients with DLBCL who relapse and subsequently undergo HDC/ASCT initially recur in the previously involved disease site(s). Time to recurrence is brief, suggesting that frequency of screening is most justifiably greatest in the early posttherapy years. © 2016 Elsevier Inc.
authors.affiliation: Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
authors.forename: Sughosh
authors.initials: S
authors.lastname: Dhakal
authors.affiliation: Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
authors.forename: James E
authors.initials: JE
authors.lastname: Bates
authors.affiliation: Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
authors.forename: Carla
authors.initials: C
authors.lastname: Casulo
authors.affiliation: Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.affiliation: Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Becker
authors.affiliation: Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.affiliation: Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York. Electronic address: louis_constine@urmc.rochester.edu.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016026:Bone Marrow Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D059248:Chemoradiotherapy / Q000401:mortality* / Q000706:statistics & numerical data; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy*; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014182:Transplantation, Autologous / Q000401:mortality / Q000706:statistics & numerical data; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents