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Leo I. Gordon, MD, FACP


ASH 2022: Does Time to Relapse Affect Response to Second-Line Chemotherapy in DLBCL?

By: Kayci Reyer
Posted: Wednesday, December 21, 2022

According to research presented at the 2022 American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 156), some patients with diffuse large B-cell lymphoma (DLBCL) may benefit from a response-adapted approach to second-line therapy. This approach may help patients who are chemosensitive or chemorefractory achieve superior outcomes despite their time to disease relapse.

“The poor outcomes of [refractory and early relapse] DLBCL are the result of a high proportion of patients with chemorefractory disease,” noted Paolo F. Caimi, MD, of the Cleveland Clinic Foundation, and colleagues. “However, DLBCL patients who achieve [a complete response] after [rituximab/ifosfamide/carboplatin/etoposide (R-ICE)] salvage can achieve long-term disease control, regardless of the time to relapse from initial therapy, in particular if they proceed to [autologous stem cell transplantation].”

The study included 291 patients with relapsed or refractory DLBCL, including refractory and early-relapse disease (n = 182) and late-relapse disease (n = 109), who received R-ICE chemotherapy. Respective overall and complete response rates were 62% and 30% in the refractory and early-relapse group and 86% and 45% in the late-relapse group. At a median follow-up of 53 months, median progression-free survival was significantly higher in the late-response group (31 months vs. 6 months). The late-response group also had superior median overall survival (68 months vs. 36 months). Rates of median progression-free and overall survival among patients who achieved a complete response following R-ICE chemotherapy were still higher in the late-response group (not reached vs. 43 months and 102 months vs. 85 months, respectively).

Median progression-free survival among patients who experienced a complete response followed by autologous stem cell transplantation was 71 months, and median overall survival for this group was not reached. The time of relapse did not appear to make a statistically significant difference in survival outcomes in this patient subset. Multivariate analysis indicated the response to chemotherapy was associated with an increased risk of disease progression or death, although no such link was observed between early relapse and increased risk.

Disclosure: For full disclosures of the study authors, visit

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