Patients With Relapsed Large B-Cell Lymphoma After 12 Months Have a Similarly Poor Prognosis to Those Relapsing Within 12 Months

Chimeric antigen receptor T-cell therapy (CART) has replaced salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (HDT-ASCT) as the preferred second-line treatment for early relapsed (< 12 months) large B-cell lymphoma (LBCL). However, for patients with a late relapse (> 12 months), CART is inaccessible until third line. We analyzed 877 patients from the HemoBase registry (diagnosed 2005-2020) to assess differences in long-term outcomes of early versus late relapse in second line. Early relapse occurred in 120/654 patients (18%) who completed first-line treatment, with 2- and 5-year overall survival (OS) of 22% and 18%. Late relapse occurred in 70 patients (11%), showing slightly better 2-year OS of 36% but similarly poor 5-year OS of 20%. Only 13% of early and 16% of late relapsed patients completed HDT-ASCT, achieving 5-year OS of 71% and 49%, respectively. Most patients initiating salvage immunochemotherapy did not reach HDT-ASCT and had dismal survival (5-year OS 8% early, 18% late), comparable to HDT-ASCT-ineligible patients (10% early, 14% late). These real-world data highlight poor outcomes with previous second-line therapies and support alternative strategies like CART in second line for patients with both early relapsing (< 12 months) and late relapsing (> 12 months) LBCL.