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Long-term remissions in patients with early relapse of diffuse large B-cell lymphoma following high-dose chemotherapy, autologous stem cell transplantation, and radiotherapy of residual disease

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Abstract

Purpose

The prognosis of an early relapse of diffuse large B-cell lymphoma (DLBCL) appears to be poor following autologous stem cell transplantation (ASCT). The aim of this study is to contribute data to the open question on whether additional radiotherapy can improve the outcome.

Patients and methods

Forty-eight patients with an early relapse (median 4 months after the end of initial immunochemotherapy, range 1–11) of DLBCL have been treated in our institution with high-dose therapy (usually the BEAM protocol) and ASCT since 2008 (median age 61 years, range 28–73). Twenty-three patients received ASCT in a second treatment line, 25 in a third line (19 refractory to second-line salvage therapy, 5 after second relapse). Fifteen of these 48 patients received radiotherapy (36–50 Gy, median 40) of residual masses after ASCT.

Results

Three-year overall survival (OS) and progression-free survival (PFS) after second-line ASCT were 61 and 57%, after third-line ASCT 47 and 44%, respectively, without significant differences. A prognostic factor was the International Prognostic Index (IPI) at the start of salvage therapy. Three-year OS and PFS in low-risk patients were 69 and 69%, in low-intermediate-risk 63 and 53%, and in high-intermediate-risk 23 and 23%, respectively (p = 0.033). Twenty-three patients achieved a sustained complete remission (13–146 months, median 62).

Conclusion

Sustained long-term remissions can be achieved in patients with early relapse of DLBCL following ASCT in a second or third treatment line, particularly in patients with low- and low-intermediate-risk IPI, following radiotherapy of residual disease after ASCT. Further investigations are required to clarify which patients need an alternative therapy (potentially CAR T‑cells or allogeneic transplantation).

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Acknowledgements

We thank Mona Temel and Ute Schubert for contributing to the collection of data and to the statistical evaluations.

Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany

    Bernd Metzner MD, PhD, Jochen Casper MD, PhD, Christoph Kimmich MD, Andrea Renzelmann MD, Bernd Rosien MD, Ruth Thole MD, Andreas Voss MD & Claus Henning Köhne MD, PhD

  2. University Clinic for Radiotherapy and Radiooncology, Pius-Hospital Oldenburg, Oldenburg, Germany

    Jutta Welzel MD & Kay Willborn MD

  3. Red Cross Blood Transfusion Service NSTOB, Oldenburg, Germany

    Thomas H. Müller MD, PhD & Eduard K. Petershofen MD

Authors
  1. Bernd Metzner MD, PhD
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  2. Jutta Welzel MD
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  3. Thomas H. Müller MD, PhD
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  4. Jochen Casper MD, PhD
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  5. Christoph Kimmich MD
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  6. Eduard K. Petershofen MD
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  7. Andrea Renzelmann MD
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  8. Bernd Rosien MD
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  9. Ruth Thole MD
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  10. Andreas Voss MD
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  11. Kay Willborn MD
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  12. Claus Henning Köhne MD, PhD
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Corresponding author

Correspondence to Bernd Metzner MD, PhD.

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Conflict of interest

B. Metzner, J. Welzel, T.H. Müller, J. Casper, C. Kimmich, E.K. Petershofen, A. Renzelmann, B. Rosien, R. Thole, A. Voss, K. Willborn, and C.H. Köhne declare that they have no competing interests.

Ethical standards

The protocol was approved by the Medical Ethics Committee of the Carl-von-Ossietzky University Oldenburg and carried out in accordance with the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Consent for publication was obtained from all individual participants included in the study.

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Data availability

The datasets generated or analyzed during this study are available from the corresponding author on reasonable request.

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Metzner, B., Welzel, J., Müller, T.H. et al. Long-term remissions in patients with early relapse of diffuse large B-cell lymphoma following high-dose chemotherapy, autologous stem cell transplantation, and radiotherapy of residual disease. Strahlenther Onkol 198, 39–46 (2022). https://doi.org/10.1007/s00066-021-01868-0

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