ADVANCED DIFFUSE LARGE-CELL LYMPHOMA TREATED WITH 12-WEEK COMBINATIONCHEMOTHERAPY - NATURAL-HISTORY OF RELAPSE AFTER INITIAL COMPLETE RESPONSE AND PROGNOSTIC VARIABLES DEFINING OUTCOME AFTER RELAPSE

Purpose. To define both the natural history of and prognostic factors affecting outcome post relapse from a complete response in advanced st age diffuse large-cell lymphoma. Patients and methods: A total of 468 patients aged 17-74 years received the 12-week duration chemotherapy r egimens MACOP-B, VACOP-B and ACOP-12 between 1 April 1981 and 31 Decem ber 1995 for advanced stage diffuse large, mixed or immunoblastic lymp homa. Of these 402 entered a complete remission, 97 (24%) of whom subs equently relapsed. Initial staging data, follow-up, and relapse inform ation were analyzed to define the natural history of relapse and also subjected to univariate and multivariate correlation with overall (OS) and failure free survival (FFS). Results: Eleven percent of the relap ses were low grade. All other relapses were of intermediate grade with 75% occurring within the first two years, the remainder up until the eleventh year. Median and five-year OS from the time of relapse for in termediate grade relapse were 12 months and 20%; for FFS they were eig ht months and 18% respectively. Adverse independent factors, for both OS and FFS were: less than one year to relapse, decreasing performance status at relapse, and more than three nodal sites at relapse. Conclu sions. Low-grade relapse is not uncommon in patients who initially pre sented with diffuse large cell lymphoma. As the management of low-and intermediate grade disease is so different biopsy proof of the nature of the relapse is of value. The prognostic factors identified need to be taken into consideration when analyzing results from trials of seco ndary treatment so as to avoid erroneous conclusions about comparative treatment efficacy.