Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma, as it represents 30%-40% of all non-Hodgkin lymphoma cases. Patients diagnosed with DLBCL may be cured in up to 50%-60% of the patients who achieve a complete remission after front-line treatment. However elderly patients may display a worse prognosis, 1 even in the era of chemo-immunotherapy, 2,3 with elderly males having the worst overall survival (OS) of all patient subgroups. Data on the prognosis of DLBCL patients in the longer run and especially among an elderly population after front-line R-CHOP (rituximab associated with doxorubicin, cyclophosphamide, vincristine and prednisone) are scarce, even taking into account that approximately half of the patients with DLBCL are older than 60 years old. A prospective long-term follow-up programme on data of the LNH03-6B trial, 4 in which 60to 80-year-old patients were randomized, was implemented to collect vital status among patients alive at the end of the trial. In this recent report, the 10-year progression-free survival (PFS) and overall survival (OS) were 40.4% and 49.8% respectively, slightly higher than those in the R-CHOP arm of the LNH-98.5 trial (10-year PFS and OS: 36.5% and 43.5% respectively), which involved a similar population. 5 Nevertheless, considering the treatment outcomes for this population of patients with a number of competing risks for death and only 3.7% of relapses beyond five years after front-line treatment, it is important to investigate long-term DLBCL-specific mortality hazard as compared with the expected mortality hazard in the general population. Indeed,
Hans status, IPI, CtDNA and TMTV, only an elevated IPI (P = 0.02) and high CtDNA load (P = 0.04) remained significant.
Conclusion:Despite a limited follow-up, this institutional study conducted in a large cohort of patients with aggressive B-cell lymphoma treated in real life, emphasizes that high CtDNA load and high TMTV are strong predictors of poor outcome. These characteristics at baseline could help tailoring therapy in these patients.
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