Analysis of Risk Factors Related to Relapse and Refractory DLBCL and Study of DLBCL Maintenance Therapy
Authors: Zhang Jing , Chen Baoan 
Published: November 2020

Objectives
The aim of this part is to analyze the efficacy of R-CHOP regimen in the treatment of diffuse large B-cell lymphoma (DLBCL), and to explore the risk factors of relapse and refractory DLBCL by analyzing the clinical characteristics of patients, and to study the predictive efficacy of these factors on the prognosis of patients.
Methods
Clinical data of 71 patients with de novo DLBCL from December 2012 to December 2018 in the Department of Hematology, Zhongda Hospital Affiliated to Southeast University were collected and retrospectively analyzed. The patients with DLBCL were divided into two groups according to who were refractory or relapse after initial therapy. Then the response rate and high-risk factors of refractory and relapse lymphoma were analyzed by the chi-square test and Mann-Whitney U test. Besides, Overall survival (OS) curves and prognosis factors were estimated by the Kaplan-Meier method, Log-rank test and Cox proportional hazard regression analysis. Furthermore, the patients were divided into two groups according to the IPI score, and a comparative analysis of survival rate was performed between subgroups.
Results
1.There were 71 patients who were diagnosed with DLBCL, in which 45 cases achieved complete remission (CR), 11cases achieved partial remission (PR), and the total remission rate was 78.9%. By the end of the follow-up, 25 cases (35.2%) experienced refractory and relapse, and 17 cases (23.9%) died, with an average OS of 60 months and an average EFS of 52 months.
2.Univariate analysis showed that the B symptoms (P&lt; 0.001), low levels of Hb (P&lt; 0.001) and LMR (P&lt; 0.001), high levels of NLR (P= 0.042), β2-MG (P= 0.011), hs-CRP (P= 0.002) and LDH (P= 0.017) were significantly related with refractory and relapse. Multivariate Logistic analysis showed B symptoms (P= 0.033) and high levels of β2-MG (P= 0.048) were independent risk factors for refractory and relapse lymphoma.
3.Kaplan-Meier method analysis showed that the OS of patients with either B symptoms (P&lt; 0.001), low levels of Hb (P= 0.008) and LMR (P= 0.005), or high levels of β2-MG (P= 0.007), hs-CRP (P= 0.008) and LDH (P= 0.002) were significantly shorter than that of control group. Additionally, Cox regression methods analysis showed that B symptoms (P= 0.026) and high β2-MG (P= 0.038) were independent prognosis factors for DLBCL.
4.Kaplan-Meier analysis of survival between the low-risk IPI and high-risk IPI groups showed that the OS of patients with B symptoms in both IPI low-risk group (P = 0.013) and IPI high-risk group (P = 0.027) weresignificantly shorter than those without B symptoms. Moreover, there was no significant difference in the OS of patients with either low levels of Hb and LMR,or high levels of LDH, β2-MG, and hs-CRP in both group (P &gt; 0.05).
Conclusion
B symptoms and high levels of β2-MG are independent risk factors for relapse and refractory, and are expected to be incorporated into the new prognostic score system.
Part two: Clinical study of maintenance therapy for DLBCL
Objectives
The aim of this part was to explore the efficacy of different maintenance therapies on DLBCL, and evaluate the safety of rituximab and traditional Chinese medicine maintenance therapy.
Methods
Clinical data of 71 patients with de novo DLBCL from December 2012 to December 2018 in the Department of Hematology, Zhongda Hospital Affiliated to Southeast University were collected and retrospectively analyzed. Follow-up and study whether patients have undergone maintenance therapy and maintenance therapy regimen.
Results
Of the 71 patients with DLBCL, 11 cases received maintenance therapy after CR, of which 6 cases were maintained with rituximab and 5 cases maintained with traditional Chinese medicine (TCM). The median follow-up time was 27 months. By the end of the follow-up, none of the 11 cases had relapsed and no treatment-related adverse reactions occurred. In particular, 2 patients received autologous hematopoietic stem cell transplantation after achieving CR, and then took TCM for maintenance therapy. No tumor recurrence was seen during follow-up and the clinical indicators were normal and stable.
Conclusion
Rituximab and TCM have good efficacy and safety in the maintenance treatment of DLBCL. TCM maintenance treatment shows unique advantages, and it is expected to be widely used in clinic after further verification in the future.
Key words
Diffuse large B-cell lymphoma; maintenance therapy; rituximab; traditional Chinese medicine

Disclosures
No relevant conflicts of interest to declare.