What is the longest survival reported for a patient with T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL)?

Longest Reported Survival After THRLBCL Diagnosis

The longest documented survival for T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is 13.8 years, reported in a recent retrospective analysis from Memorial Sloan Kettering Cancer Center. 1

Key Survival Data from the Literature

The most robust survival data comes from a 2025 study that followed 67 THRLBCL patients with a median follow-up of 5.4 years (range 0.5-13.8 years), indicating at least one patient survived beyond 13 years from diagnosis. 1

Modern outcomes in the rituximab era show substantially improved survival compared to historical data:

• 5-year overall survival: 79% in patients treated with rituximab-based regimens 1
• 5-year event-free survival: 59% in the overall cohort 1
• Patients treated with higher-intensity R-CHOP/R-ICE regimens achieved 5-year OS of 100% and 5-year EFS of 80% 1

Historical Context and Prognostic Evolution

Earlier studies from the pre-rituximab and early rituximab era showed significantly worse outcomes:

• A 2007 series reported 5-year OS of only 46% and 5-year EFS of 39% with CHOP or R-CHOP therapy 2
• Median time to relapse was 6 months (range 2-28 months) in this cohort 2
• A 2004 study showed 3-year OS of 64% and 3-year EFS of 48% with CHOP-based therapy 3

The dramatic improvement in long-term survival reflects:

• Introduction of rituximab into standard treatment regimens 1
• Use of higher-intensity, non-cross-resistant chemotherapy combinations 1
• Better supportive care and salvage options including CAR T-cell therapy 4

Factors Associated with Long-Term Survival

Patients most likely to achieve prolonged survival have:

• Treatment with intensive regimens: R-CHOP/R-ICE achieved 95% complete response rates versus 70% with R-CHOP alone 1
• Good performance status at diagnosis and treatment 4
• Early-stage disease at presentation, though this is uncommon in THRLBCL 2
• Achievement of complete remission with first-line therapy 1

Important Clinical Caveats

THRLBCL remains diagnostically challenging:

• Initial pathology was incorrect in 82% of referred cases in one series, often misdiagnosed as Hodgkin lymphoma or peripheral T-cell lymphoma 2
• Immunohistochemistry is essential for accurate diagnosis 2, 5

Disease characteristics that complicate prognosis:

• 61% present with extranodal disease 2
• 52% have splenic involvement at diagnosis 2
• 62% have IPI score ≥2 at presentation 2
• Primary refractory disease occurs in 45% of cases 4

For relapsed/refractory disease:

• CAR T-cell therapy shows 2-year OS of 42% and 2-year PFS of 29%, with approximately 30% achieving durable responses 4
• Cumulative incidence of progression remains high at 69% by 2 years post-CAR T 4