Late Relapses following High Dose Chemotherapy and Autologous Stem Cell Transplant in Patients with Diffuse Large B Cell Lymphoma in the Rituximab Era

Abstract Background The standard of care for diffuse large B cell lymphoma (DLBCL) relapsing after front line therapy is high dose chemotherapy and autologous stem cell transplant (ASCT). Evidence suggests that early relapses (i.e. within 1 year) following this approach portends exceptionally poor outcomes. However, there are limited data examining relapses >1 year after ASCT for patients with refractory or relapsed DLBCL, particularly in the rituximab era. We sought to examine the impact of early (≤1 year) and late (>1 year) relapse following ASCT in a single-institution cohort of patients with relapsed and refractory DLBCL treated with chemo-immunotherapy. Methods A retrospective analysis was performed on 85 consecutive patients who underwent ASCT for biopsy confirmed relapsed or refractory DLBCL between 2001-2010 at the University of Rochester Medical Center. All patients received rituximab as a part of treatment. Twenty-seven patients relapsed post-ASCT, and they were divided into two groups: those relapsing ≤1 year and >1 year post-ASCT. Results Median follow-up was 6.4 years. For all patients, overall survival (OS) from time of post-ASCT relapse was 5.2 years. For patients relapsing at ≤1 year post-ASCT, median OS was 0.6 years and progression free survival (PFS) was 0.4 years (n=27). For patients relapsing at >1 year post-ASCT, median OS was 5.9 years, and PFS was 2.9years (n=8).. Conclusions Patients with relapsed or refractory DLBCL experiencing relapse >1 year post-ASCT had good outcomes. Despite the relative rarity in incidence, there remains a significant risk of relapse of DLBCL post-ASCT, suggesting the need for continued monitoring for the possibility of later progression.