Late toxicities in non-Hodgkin lymphoma: extended follow-up matters

colleagues1 report an impressive 10-year followup of the phase 3 DSHNHL 2002-1 trial, which compared R-CHOEP-14 (conventional chemotherapy [cyclosphosphamide, doxorubicin, vincristine, etoposide, and prednisolone] plus rituximab) with the doseintensified regimen R-MegaCHOEP (high-dose chemotherapy plus rituximab followed by autologous haematopoietic stem-cell transplantation) in patients aged 18?60 years with high-risk aggressive B-cell non-Hodgkin lymphoma. The study affirms several observations about diffuse large B-cell lymphoma and its therapy: intensified chemotherapy is not associated with superior outcomes;2?4 relapse with indolent lymphoma is favorable;5 CNS relapses are associated with poor prognosis;6 and patients remaining in remission at 1?2 years after treatment have excellent outcomes.7 These findings are important, but not novel. The high merit of this report lies in its long follow-up, which eloquently underscores why and how cumulative and long-term toxicities should be studied. In diffuse large B-cell lymphoma, the immediate curative goal of therapy eclipses the potential for late toxicity. However, late sequelae of treatment, particularly in young patients, can affect morbidity, mortality, and quality of life in survivors.8 Systematically collected clinical trial and real-world data on late and cumulative toxicities are fundamental in establishing evidence-based survivorship care plans, counselling, and surveillance

Automated summary

This study compared two different treatment approaches for high-risk aggressive B-cell non-Hodgkin lymphoma and confirmed observations and findings regarding lymphoma and its treatment. The long-term follow-up highlighted the importance of studying cumulative and long-term toxicities.