Relapsed diffuse large B-cell lymphoma--10 years later.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), and it accounts for approximately 25% of NHL cases.1 The incidence of DLBCL in the United States is approximately 7 cases per 100,000 person-years, with a male predominance.2 Caucasian Americans have higher rates than African Americans, Asians, and American Indians, in order of decreasing incidence. Incidence increases with age, with a median age of presentation of 64 years.3,4 There also appears to be a familial aggregation of patients with DLBCL and other NHL subtypes. A large population-based observational study from Sweden and Denmark reported that relatives of probands with aggressive NHL had an approximately 3.5-fold increased risk of developing NHL.4 DLBCL can occur de novo as well as through the transformation of many different types of low-grade B-cell lymphomas. Initial evaluation for treatment options in patients with DLBCL depends on the precise histologic subtype, the extent and sites of disease, and the performance status of the patient. Advanced disease is traditionally defined as Ann Arbor stage III or IV and accounts for approximately 70% of patients with DLBCL. Ann Arbor stage III indicates that the cancer has spread to both sides of the diaphragm. Ann Arbor stage IV is defined by disseminated involvement of 1 or more extralymphatic organs, including any involvement of the bone marrow, liver, or nodular involvement of the lungs. Advanced stage DLBCL is treated primarily with systemic chemotherapy plus rituximab (Rituxan, Genentech). Although there have been significant advances in the treatment of patients with DLBCL, relapse can occur. Long-term disease-free survival occurs in at least 50% of patients diagnosed with DLBCL, and when the lymphoma is localized at time of diagnosis, this can reach more than 80% of patients.5,6 Relapse usually occurs in the first 2–3 years after treatment, and late relapse occurring more than 5 years after treatment is rare.7 Relapse typically occurs at a different site from initial presentation.8 Cure rates do differ by age. In this report we describe a patient with relapsed DLBCL 10 years after initial diagnosis and treatment.