Minimal Loss of Lifetime for Patients With Diffuse Large B-Cell Lymphoma in Remission and Event Free 24 Months After Treatment: A Danish Population-Based Study

Abstract

Purpose The general outlook for patients with diffuse large B-cell lymphoma (DLBCL) in first remission is important information for patients and for planning post-treatment follow-up. The purpose of this study was to evaluate the survival of patients with DLBCL in remission compared with a matched general population. Methods A total of 1,621 patients from the Danish Lymphoma Registry who were newly diagnosed with DLBCL between 2003 and 2011 were included in this study. All patients were ≥ 16 years of age at diagnosis and had achieved complete remission or complete remission unconfirmed after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like therapy. Results The 5-year post-treatment DLBCL survival was inferior to survival in the matched general population (78%; 95% CI, 76 to 80; v 87%; standardized mortality ratio, 1.75; P < .001). Excess mortality was present but reduced for patients achieving post-treatment event-free survival for 24 months (pEFS24; standardized mortality ratio, 1.27; P < .001). In age-stratified analyses, the survival of patients < 50 years of age was normalized to the general population after achieving pEFS24 ( P = .99). During the first 8 years after pEFS24, the average loss of lifetime was 0.31 mo/y (95% CI, 0.11 to 0.50 mo/y). Excess mortality diminished when analyzing death from lymphoma as competing event to death from other causes, suggesting that early and late relapse is responsible for increased mortality in patients with DLBCL. Conclusion Although this population-based study does not support complete normalization of survival for patients with DLBCL achieving pEFS24, the estimated loss of residual lifetime was low for patients in continuous remission 2 years after ending treatment. Therefore, pEFS24 is an appealing and relevant milestone for patient counseling and could be a surrogate end point in clinical trials.

Late relapse in patients with diffuse large B‐cell lymphoma: impact of rituximab on their incidence and outcome

“…Analogous to the Danish registry study (Jakobsen et al , ), the OS of DLBCL patients in our study was worse than that of the general population, while the survival curve of patients younger than 50 years who achieved a durable CR mirrored the one displayed by the matched general population.…”

“…However, patients in continuous remission at ≥2 years after the end of therapy showed favourable outcomes. In the age-stratified analyses, the survival of patients younger than 50 years, achieving a posttreatment event-free survival >2 years, was similar to that of the general population (Jakobsen et al, 2017).…”

Simplicity at the cost of predictive accuracy in diffuse large B‐cell lymphoma: a critical assessment of the R‐IPI,IPI, andNCCN‐IPI

“…(2016) reported similar effects using event‐free survival (EFS) at 24 months as endpoint. The EFS at 24 months was chosen since, in other studies, DLBCL survival normalized relative to that of a matched background population at this milestone time point . Maurer et al.…”

R-CHOP 14 with or without radiotherapy in nonbulky limited-stage diffuse large B-cell lymphoma

“…In our trial, with an EFS higher than 90% at 5 years for CR patients, we confirm the excellent outcome of patients with low-burden DLBCL who do not present with early relapse and who achieve a survival nearly equivalent to that of the general population. 32,33 This trial was designed at a time when shortening the interval between R-CHOP cycles was questioned (ie, by 2 or 3 weeks). Although we did not observe increased toxicity with a 2-week interval schedule (R-CHOP 14), a 3-week delivery (R-CHOP 21) now seems to be the best option on the basis of recent For personal use only.…”