title: Late Relapses After High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Diffuse Large B-cell Lymphoma in the Rituximab Era.
abstract: The standard of care for diffuse large B-cell lymphoma (DLBCL) relapsing after front-line therapy is high-dose chemotherapy and autologous stem cell transplantation (ASCT). Evidence has suggested that early relapses (ie, within 1 year) after this approach portends exceptionally poor outcomes. However, data examining relapses > 1 year after ASCT for patients with refractory or relapsed DLBCL are limited, in particular, in the rituximab era. We sought to examine the effect of early (≤ 1 year) and late (> 1 year) relapse after ASCT in a single-institution cohort of patients with relapsed and refractory DLBCL treated with chemoimmunotherapy.
  
  
  
  A retrospective analysis was performed on the data from 85 consecutive patients who had undergone ASCT for biopsy-confirmed relapsed or refractory DLBCL from 2001 to 2010 at the University of Rochester Medical Center. All patients had received rituximab as a part of treatment. Of the 85 patients, 35 developed relapse after ASCT. These 35 patients were divided into 2 groups according to the timing of the relapse (≤ 1 year and > 1 year after ASCT).
  
  
  
  The median follow-up period was 6.4 years. For all patients, the overall survival (OS) from post-ASCT relapse was 5.2 years. For the 27 patients developing relapse at ≤ 1 year after ASCT, the median OS was 0.6 year and progression-free survival was 0.4 year. For the 8 patients developing relapse at > 1 year after ASCT, the median OS was 5.9 years and progression-free survival was 2.9 years.
  
  
  
  Patients with relapsed or refractory DLBCL experiencing relapse > 1 year after ASCT had good outcomes. Despite the relative rarity in incidence, a significant risk of relapse of DLBCL after ASCT remains, suggesting the need for continued monitoring because of the possibility of later progression.
authors.affiliation: Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Hunter
authors.affiliation: Division of Epidemiology, Department of Public Health Sciences, University of Rochester, Rochester, NY.
authors.forename: Megan
authors.initials: M
authors.lastname: Herr
authors.affiliation: Division of Epidemiology, Department of Public Health Sciences, University of Rochester, Rochester, NY.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Meacham
authors.affiliation: Department of Medicine, Yale New Haven Medical Center, New Haven, CT.
authors.forename: Ferdous
authors.initials: F
authors.lastname: Barlaskar
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Evans
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY.
authors.forename: W Richard
authors.initials: WR
authors.lastname: Burack
authors.affiliation: Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.affiliation: Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Becker
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY; Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Milner
authors.affiliation: Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
authors.affiliation: Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Sughosh
authors.initials: S
authors.lastname: Dhakal
authors.affiliation: Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Barr
authors.affiliation: Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.affiliation: Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY. Electronic address: Carla_Casulo@URMC.Rochester.edu.
authors.forename: Carla
authors.initials: C
authors.lastname: Casulo
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage*; D033581:Stem Cell Transplantation / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Autologous stem cell transplant; DLBCL; Early relapse; Refractory; Relapse