Retreatment with R-CHOP-like therapy yields durable remissions in patients with late relapse diffuse large B-cell lymphoma (DLBCL), according to a retrospective study presented at the 66^th ASH Annual Meeting & Exposition. 

“Most patients with DLBCL who experience relapsed/refractory disease following R-CHOP will do so within 24 months of diagnosis, but late relapses (> 2 years [y]) can occur and are typically associated with better outcomes,” lead author Jean-Nicolas Champagne, MD, BC Cancer Vancouver, Canada, and co-authors wrote. “The objective of this retrospective study was to evaluate outcomes in patients treated with R-CHOP-like therapy for late relapse DLBCL in British Columbia.”

Researchers utilized the BC Cancer Centre for Lymphoid Cancer Database to identify patients with de novo DLBCL who were treated with an initial R-CHOP-like regimen. The study focused on patients who developed a late relapse of DLBCL between January 2005 and April 2024 and subsequently received second-line R-CHOP-like therapy with curative intent. This typically included R-CHOP or R-CEOP, where etoposide is used as a substitute for doxorubicin once the maximum lifetime exposure to anthracyclines has been reached.

The analysis included 53 patients, 30 of whom were male, with a median age of 77 years at relapse. Patients experienced relapse after a median of 7.4 years following their initial diagnosis. Findings revealed that 80% of patients with available information had stage III-IV disease, 53% had poor performance status (ECOG 2-4), and 80% had high IPI ranging from 3 to 5.

Fifteen patients (28%) began treatment on R-CHOP before transitioning to R-CEOP. The remainder (n = 38) started directly on R-CEOP. The median total number of treatment cycles was 5, and 36% of patients (n =19) did not complete their planned regimen, primarily due to toxicity or intolerance (n = 12; 63%).

Response rates were as follows: 60% of patients achieved a complete response (CR), 11% achieved partial response (PR), 4% had standard response (SR), and 9% had progressive disease (PD). Median time-to-progression (TTP) was 45 months, with 2-year TTP and overall survival (OS) rates and disease-specific survival (DSS) rates of 55% and 67%, respectively. Patients relapsing more than 5 years after diagnosis had significantly better outcomes, with a 2-year TTP of 68%, compared to 11% for those relapsing within 2–5 years (HR 0.27; p = 0.003). “Patients who relapsed more than 5 years from initial diagnosis had a significantly better TTP than patients who relapsed between 2-5 years with 2-year TTP respectively,” the authors noted.

“In patients with late-relapse DLBCL, a retreatment strategy with R-CHOP-like therapy is a reasonable option,” the authors concluded. “This approach results in durable remission in a high proportion of patients, thereby avoiding the need for more intensive therapies, particularly in pts who experience relapse more than 5 years from initial diagnosis.”

Source:

Champagne JN, Villa D, Gerrie A, et al. Retreatment with R-CHOP-like therapy in patients with late relapse of diffuse large b-cell lymphoma (DLBCL). Poster presented at ASH Annual Meeting & Exposition; December 7, 2024; San Diego, California. Abstract 109.