R CHOP re treatment offers durable responses in patients with late relapse diffuse large b cell lymphoma, with a 2-year time to progression of 54% in a real-world cohort. The findings indicate that selected patients with diffuse large B cell lymphoma who relapse more than 2 years after diagnosis may achieve meaningful benefit from a second course of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy.
Patient Characteristics and Treatment Delivery
Investigators identified 65 patients with de novo diffuse large B cell lymphoma who were initially treated with a rituximab-based regimen and subsequently developed late relapse, defined as more than 2 years from diagnosis. At relapse, the median age was 77 years, with a range of 52–89 years. Most patients had advanced disease, with 81% presenting with stage III–IV disease. Over half (52%) had an Eastern Cooperative Oncology Group performance status of 2–4, and 78% had an International Prognostic Index score of 3–5.
The median interval from original diagnosis to relapse was 7.4 years, with a range of 2.5–15.9 years. At relapse, patients received a median of five cycles of R CHOP like therapy, with a range of 1–6 cycles.
Clinical Outcomes After R CHOP Re Treatment
The overall response rate to R CHOP re treatment was 72%, with 57% achieving complete response. After a median follow up of 31 months, 2-year time to progression was 54%-, and 2-year progression free survival was 46%. Two-year disease specific survival reached 64%, while 2-year overall survival was 54%.
Patients relapsing more than 5 years from diagnosis experienced significantly improved time to progression compared with those relapsing between 2 and 5 years: 2-year time to progression was 66% versus 9% (hazard ratio: 0.30; 95% CI: 0.14–0.64; p=0.001).
Implications For Treatment Selection
These data suggest that many patients with late relapse diffuse large B cell lymphoma can achieve durable disease control with further R CHOP like therapy. This approach may be particularly relevant for older patients or those with comorbidities who are not candidates for more intensive or costly secondary strategies. Careful assessment of time to relapse appears critical when considering R CHOP re treatment in this setting.
Reference
Champagne JN et al. Retreatment with R-CHOP–like therapy in patients with late relapse of diffuse large B-cell lymphoma. Blood Adv. 2026;103:620-6.
