Recurrence and Metastasis of Diffuse Large B-Cell Lymphoma

Diffuse large  B-cell lymphoma recurrence and metastasis

Recurrence and metastasis

1. Prognostic prediction for recurrence and death A small number of cases show disease progression during initial Rituximab + chemotherapy, including R-CHOP, but in most patients with diffuse large B-cell lymphoma, complete remission is achieved with treatment, and the condition is followed after completion of the planned treatment cycles. In some patients, the disease never becomes a problem again and they are cured; on the other hand, in some patients, the disease may eventually recur. According to recent research, most recurrences of diffuse large B-cell lymphoma occur within 24 months after diagnosis, and although the frequency is markedly lower thereafter, late recurrence is also possible. The most representative method for predicting a patient’s recurrence rate is the standard International Prognostic Index.

The five unfavorable IPI factors are: age over 60 years, elevated serum LDH above the normal range, Ann Arbor stage III or IV, poor performance status of 2 or higher as defined by the Eastern Cooperative Oncology Group, and involvement of two or more extranodal sites. Cases with 0 to 1 of these five factors are classified as low risk, those with 2 as low-intermediate risk, those with 3 as high-intermediate risk, and those with 4 or 5 as high risk. The likelihood of recurrence differs by risk group, and survival rates also vary accordingly. For example, in the low-risk group, when adequate treatment with R-CHOP is given, the cure rate approaches 90%, showing excellent treatment outcomes. In contrast, in the high-risk group, the 5-year survival rate is known to be less than half. Of course, the standard IPI cannot perfectly predict the treatment outcome of an individual patient, and in addition to the IPI, it is known that several other factors, such as the genetic origin of diffuse large B-cell lymphoma, also contribute to differences in treatment outcomes.

2. Treatment after recurrence When recurrence occurs, chemotherapy is first administered again to induce remission of the lymphoma; this is called salvage therapy. There are various salvage regimens that combine different anticancer drugs that respond to lymphoma treatment, and most of them have similar effects, so there is no special standard treatment.

Even if complete remission is achieved again through salvage therapy, if no additional treatment is performed, recurrence occurs again in most cases. After remission is achieved a second time, younger patients with preserved physical function undergo autologous hematopoietic stem cell transplantation in order to gain another chance at cure. If autologous hematopoietic stem cell transplantation is successfully completed after re-remission, cure can be expected in about 30 to 40% of cases. If the disease recurs again after autologous hematopoietic stem cell transplantation, allogeneic hematopoietic stem cell transplantation, in which stem cells are donated from another person, may be considered after remission is achieved again with salvage therapy. This procedure has limitations because the risk of acute and chronic treatment-related complications is substantial, and the risk is higher in older adults or those with poor overall condition, but it offers a chance of cure in some patients.

If transplantation cannot realistically be performed because of poor general condition due to older age or other reasons, salvage therapy, remission, watchful waiting, and then salvage therapy again after progression are repeated. In such cases, the chance of cure is very low, and the realistic goals are symptom improvement and maintaining quality of life.

So far, I have explained the recurrence and metastasis of diffuse large B-cell lymphoma. In the next part, we will look at the common cold, which people often catch in winter.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal