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The interval between progression and therapy initiation is the key prognostic parameter in relapsing diffuse large B cell lymphoma: analysis from the Czech Lymphoma Study Group database (NIHIL)

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Abstract

Relapsing diffuse large B cell lymphomas (rDLBCL) represent a heterogeneous disease. This heterogeneity should be recognized and reflected, because it can deform the interpretation of clinical trial results. DLBCL patients with the first relapse and without CNS involvement were identified in the Czech Lymphoma Study Group (CLSG) database. Interval-to-therapy (ITT) was defined as the time between the first manifestation of rDLBCL and the start of any treatment. The overall survival (OS) of different ITT cohorts (< 7 vs. 7–21 vs. > 21 days) was compared. In total, 587 rDLBCLs (51.8% males) progressed with a median of 12.8 months (range 1.6 to 152.3) since the initial diagnosis (2000–2017). At the time of relapse, the median age was 67 years (range 22–95). First-line therapy was administered in 99.3% of the patients; CHOP and anti-CD20 were given to 69.2% and 84.7% of the patients, respectively. The salvage immune/chemotherapy was administered in 88.1% of the patients (39.2% platinum-based regimen). The median ITT was 20 days (range 1–851), but 23.2% of patients initiated therapy within 7 days. The 5-year OS was 17.4% (range 10–24.5%) vs. 20.5% (range 13.5–27.4%) vs. 42.2% (range 35.5–48.8%) for ITT < 7 vs. 7–21 vs. > 21 days (p < 0.001). ITT was associated with B symptoms (p 0.004), ECOG (p < 0.001), stage (p 0.002), bulky disease (p 0.005), elevated LDH (p < 0.001), and IPI (p < 0.001). The ITT mirrors the real clinical behavior of rDLBCL. There are patients (ITT < 7 days) with aggressive disease and a poor outcome. Conversely, there are rDLBCLs with ITT ≥ 21 days who survive for a long time.

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Funding

This work was supported by research grant AZV 16-31092A, on behalf of the Czech Lymphoma Study Group.

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Authors and Affiliations

  1. Department of Internal Medicine – Hematology and Oncology, Masaryk University and University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic

    Andrea Janikova, Jozef Michalka & Natasa Kopalova

  2. Institute of Biostatistics and Analyses, Faculty of Medicine Masaryk University, Brno, Czech Republic

    Zbynek Bortlicek & Renata Chloupkova

  3. Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Faculty Hospital in Motol, Prague, Czech Republic

    Vit Campr

  4. 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic

    Pavel Klener, Katerina Benesova, Jitka Hamouzova, Robert Pytlik & Marek Trneny

  5. 4th Department of Internal medicine – Hematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic

    David Belada

  6. Department of Hematology, University Hospital Olomouc, Olomouc, Czech Republic

    Vit Prochazka

  7. Department of Oncology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic

    Jan Pirnos

  8. Department of Clinical Hematology, Teaching Hospital Ostrava, Ostrava, Czech Republic

    Juraj Duras

  9. Internal Clinic of Hematology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic

    Heidi Mocikova

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  1. Andrea Janikova
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Correspondence to Andrea Janikova.

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Conflict of interest

Author J. A. declares that she has no conflict of interest. Author M. J. declares that he has no conflict of interest. Author B. Z. declares that he has no conflict of interest. Author C. R. declares that she has no conflict of interest. Author C. V. declares that he has no conflict of interest. Author K. N. declares that she has no conflict of interest. Author K. P. declares that he has no conflict of interest. Author B. K. declares that she has no conflict of interest. Author H. J. declares that she has no conflict of interest. Author B. D. has received consulting honoraria from Roche, Takeda, Gilead Sciences, Janssen-Cilag, and Debiopharm. Author P. V. has received speaker honoraria from Roche and Gilead Sciences, and consulting for Roche and Takeda. Author P. R. declares that he has no conflict of interest. Author P. J. declares that he has no conflict of interest. Author D. J. declares that he has no conflict of interest. Author M. H. declares that she has no conflict of interest. Author T. M. has received speaker honoraria from Janssen, Gilead Sciences, Takeda, Bristol-Myers-Squibb, Amgen, Abbvie, Roche, Morphosys, Incyte. Consulting and Advisory for Takeda, Bristol-Myers-Squibb, Incyte, Abbvie, Amgen, Roche, Gilead Sciences, Janssen, Celgene, Morphosys.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Janikova, A., Michalka, J., Bortlicek, Z. et al. The interval between progression and therapy initiation is the key prognostic parameter in relapsing diffuse large B cell lymphoma: analysis from the Czech Lymphoma Study Group database (NIHIL). Ann Hematol 99, 1583–1594 (2020). https://doi.org/10.1007/s00277-020-04099-y

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