Journal of Clinical Oncology, Vol 15, 1745-1753, Copyright © 1997 by American Society of Clinical Oncology
Late relapse in patients with diffuse large-cell lymphoma treated with MACOP-B
AY Lee, JM Connors, P Klimo, SE O'Reilly and RD Gascoyne
Department of Medicine, British Columbia Cancer Agency, Vancouver Clinic, Canada.
PURPOSE: To examine the clinical course of patients who experienced a late
relapse after initial curative chemotherapy for advanced-stage diffuse
large-cell lymphoma. PATIENTS AND METHODS: Between April 1981 and June
1986, 127 patients with de novo advanced-stage diffuse large- cell lymphoma
were treated with a 12-week chemotherapy program (methotrexate,
doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin
[MACOP-B]). The overall survival rate at 10 years is 52%. One hundred six
patients (83%) entered a complete remission (CR) and 43 of them relapsed.
With a median follow-up duration of 146 months, 26 patients relapsed early
and 17 relapsed late, ie, after a continuous CR (cCR) of greater than 24
months. All late relapses occurred in patients with B-cell lymphoma.
RESULTS: After 24 months from diagnosis, the rate of late relapse averaged
2.2% per year and reached a projected 22% actuarial risk of late relapse
after 10 years. The median time to late relapse was 69 months (range, 38 to
141). Ten patients relapsed with aggressive histologic subtypes and were
treated with curative intent using anthracycline-based chemotherapy. Four
remain in second CR, one is alive with disease, and five died of disease or
while on treatment. The 6-year overall survival rate from the time of
relapse (SFR) for these 10 patients is 42%. Six patients relapsed with
low-grade follicular lymphoma. These patients received various treatments
intended to control, but not necessarily cure disease. One is in second CR,
one is alive with disease, and four died of disease or while on treatment.
The 6-year overall SFR rate for these six patients is 40%. bcl-2
translocation and Bcl-2 protein expression at diagnosis did not predict for
the type of late relapse. One patient did not undergo repeat biopsy at
relapse and died 9 months later despite aggressive therapy. CONCLUSION:
Curative therapy should be attempted in patients who relapse late with
aggressive-histology lymphoma and those who relapse with follicular
histology may benefit from palliative treatment. The behavior of
late-relapse lymphoma is similar to de novo lymphoma, with outcome dictated
by the histologic subtype at relapse.
