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Clinical, biologic, and histologic features of late relapses in diffuse
large cell lymphoma
F Cabanillas, WS Velasquez, FB Hagemeister, P McLaughlin and JR Redman
Department of Hematology, University of Texas M.D. Anderson Cancer Center,
Houston 77030.
After completing chemotherapy and achieving a complete remission (CR),
patients with diffuse intermediate-grade lymphoma and immunoblastic
lymphoma are usually considered cured if they are able to maintain that
remission continuously for 24 months. Recently, we observed a number of
patients with these disorders who relapsed after a continuous CR of greater
than or equal to 30 months from the beginning of therapy or 24 months from
completing chemotherapy. This finding led us to examine 503 consecutive
cases to determine the risk of late relapse and their clinical and biologic
features. We found that the overall risk of late relapse of those who
attained CR was 6.8%, but several features at presentation were associated
with a high risk: (1) the presence of a divergent histology; (2) a
sclerosing large cell lymphoma; (3) a diagnosis based on an extranodal site
with no nodal tissue available for examination. When none of these features
were present, the risk of late relapse was minimal (only 3%). When any of
these features was present, the risk was 14%. Most striking was the 43%
late relapse rate of patients with divergent histology. All but one of the
eight B-cell tumors studied at relapse showed kappa light chain
restriction. Five of these eight has a low S phase at the time of relapse,
suggesting chemotherapeutic selection of a clone of cells with a low
proliferative potential that could have given rise to the late relapse.
Nucleic acid flow cytometry and immunophenotypic studies on three tumors at
initial diagnosis and after relapse failed to support the hypothesis of a
second de novo lymphoma and were consistent with a true recurrence of the
original tumor. The results of salvage chemotherapy in this group of late
relapses showed a high CR rate (57%) but no evidence of a trend for cure in
the time to treatment failure curve. In contrast to the experience with
Hodgkin's disease, retreatment with the same or a similar regimen used for
the original induction was not associated with durable response. Clinicians
should be aware of the potential for a late relapse in cases with divergent
histology and the need for new treatment strategies for such cases.
Volume 79,
Issue 4,
pp. 1024-1028,
02/15/1992
Copyright © 1992 by The American Society of Hematology
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