First-line treatment of diffuse large B-cell lymphoma (DLBCL) with rituximab may be associated with a lower incidence of late relapse, according to study results published in the British Journal of Haematology.

Most patients who relapse with DLBCL do so within the first couple of years following diagnosis, but sometimes late relapses occur.

In this study, researchers examined the records of 1113 patients treated for DLBCL in Europe between 1970 and 2015. The researchers identified 196 patients who had experienced relapse after achieving first complete remission (CR)among 699 patients who had achieved CR.

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Of the cases of relapse, 18.4% were late relapses, defined as occurring 5 or more years after diagnosis. Late relapses reflected 3.2% of all cases of DLBCL in this study and 5.1% of patients who had achieved CR.

Compared with patients who showed early relapse, patients experiencing late relapses were significantly more likely to have normal lactate dehydrogenase levels at initial diagnosis. Late-relapsing patients were also more likely to present with lower International Prognostic Index scores and to be diagnosed at earlier Ann Arbor stages compared with early-relapsing patients.

Patients with late relapses had a better 5-year cause-specific survival (CSS) rate (53%) after relapse than did early-relapsing patients (31%). Median CSS after relapse was 5.2 years for late-relapsing patients and 1.1 years for early-relapsing patients (P =.033). Median follow-up time was 12.5 years (range, 6.8-23).

The researchers found that initial treatment with rituximab had occurred at a significantly lower rate for patients with late relapse (29%) compared with early-relapsing patients (53%; P =.014).

The study results showed a generally superior prognosis with late relapse in DLBCL. In their report, the authors wrote, “the risk for late relapse is lowered by the introduction of rituximab, possibly reflecting a biologically distinct DLBCL subset.” They recommended further exploration of possible genetic differences with relapse patterns.


  1. Vannata B, Conconi A, Winkler J, et al. Late relapse in patients with diffuse large B-cell lymphoma: impact of rituximab on their incidence and outcome [published online August 5, 2019]. Br J Haematol. doi:10.1111/bjh.16106