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Conconi A, Chiappella A, Ferreri AJM, Stathis A, Botto B, Sassone M, Gaidano G, Balzarotti M, Merli F, Tucci A, Vanazzi A, Tani M, Bruna R, Orsucci L, Cabras MG, Celli M, Annibali O, Liberati AM, Zanni M, Ghiggi C, Pisani F, Pinotti G, Dore F, Esposito F, Pirosa MC, Cesaretti M, Bonomini L, Vitolo U, Zucca E. IELSG30 phase 2 trial: intravenous and intrathecal CNS prophylaxis in primary testicular diffuse large B-cell lymphoma. Blood Adv 2024; 8:1541-1549. [PMID: 38181782 DOI: 10.1182/bloodadvances.2023011251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Primary testicular diffuse large B-cell lymphoma (PTL) is characterized by high risk of contralateral testis and central nervous system (CNS) relapse. Chemoimmunotherapy with intrathecal (IT) CNS prophylaxis and contralateral testis irradiation eliminates contralateral recurrences and reduces CNS relapses. The IELSG30 phase 2 study investigated feasibility and activity of an intensified IT and IV CNS prophylaxis. Patients with stage I/II PTL who had not received treatment received 2 cycles of IV high-dose methotrexate (MTX) (1.5 g/m2) after 6 cycles of the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, every 21 days). IT liposomal cytarabine was administered on day 0 of cycles 2 to 5 of 21-day R-CHOP regimen. Contralateral testis radiotherapy (25-30 Gy) was recommended. Fifty-four patients (median age: 66 years) with stage I (n = 32) or II (n = 22) disease were treated with R-CHOP, 53 received at least 3 doses of IT cytarabine, 48 received at least 1 dose of IV MTX, and 50 received prophylactic radiotherapy. No unexpected toxicity occurred. At a median follow-up of 6 years, there was no CNS relapse; 7 patients progressed, and 8 died, with 5-year progression-free and overall survival rates of 91% (95% confidence interval [CI], 79-96) and 92% (95% CI, 81-97), respectively. Extranodal recurrence was documented in 6 patients (in 2 without nodal involvement). In 4 cases, the relapse occurred >6 years after treatment. Causes of death were lymphoma (n = 4), second primary malignancy (n = 1), cerebral vasculopathy (n = 1), unknown (n = 2). Intensive prophylaxis was feasible and effective in preventing CNS relapses. Late relapses, mainly at extranodal sites, represented the most relevant pattern of failure. This trial was registered at www.clinicaltrials.gov as #NCT00945724.
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Affiliation(s)
| | - Annalisa Chiappella
- Haematology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Barbara Botto
- SC Ematologia, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marianna Sassone
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Gaidano
- SCDU Ematologia, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Monica Balzarotti
- UO Ematologia, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Merli
- Hematology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Tucci
- Division of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Anna Vanazzi
- Division of Clinical Haemato-Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Tani
- UO Ematologia, Dipartimento Oncologia ed Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Riccardo Bruna
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Lorella Orsucci
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Melania Celli
- Ospedale degli Infermi, Hematology Unit, Rimini, Italy
| | - Ombretta Annibali
- Area Ematologia Medicina Trasfusionale e Terapia cellulare Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Marina Liberati
- SC Oncoematologia, Azienda Ospedaliera Santa Maria, Università degli studi di Perugia, Terni, Italy
| | - Manuela Zanni
- Antonio e Biagio e Cesare Arrigo Hospital, Hematology Unit, Alessandria, Italy
| | - Chiara Ghiggi
- IRCCS Ospedale Policlinico San Martino UO Ematologia e Terapie Cellulari, Genoa, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | - Fabiana Esposito
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Maria Cristina Pirosa
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Turin, Italy
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
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Bian Z, Gu B, Shi G, Guo J, Li D, Zeng H, Jiang B, Min D, Su H, Zhang Y. The single-cell landscape reveals unique tumor subsets and microenvironments associated with poor clinical outcomes in primary testicular diffuse large B-cell lymphoma. Genes Dis 2024; 11:80-83. [PMID: 37588237 PMCID: PMC10425787 DOI: 10.1016/j.gendis.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/16/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Zhouliang Bian
- Department of Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Benhong Gu
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiahui Guo
- Department of Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Dong Li
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Hanlin Zeng
- Department of Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Bin Jiang
- Department of Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
| | - Daliu Min
- Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Hengchuan Su
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yanjie Zhang
- Department of Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
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Zhi Y, Bao S, Mao J, Chai G, Liu C, Zhu J. Development and validation of a survival nomogram in patients with primary testicular diffuse large B-cell lymphoma. J Int Med Res 2023; 51:3000605231197052. [PMID: 37676929 PMCID: PMC10492492 DOI: 10.1177/03000605231197052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE We developed and validated a nomogram for overall survival (OS) and cancer-specific survival (CSS) prediction in patients with primary testicular diffuse large B-cell lymphoma (PT-DLBCL). METHODS Patients diagnosed with PT-DLBCL were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were analyzed to establish a nomogram of OS and CSS. Patients were reclassified into high- and low-risk groups; survival was compared using Kaplan-Meier curves and log-rank tests. RESULTS We collected 1099 PT-DLBCL cases (2000-2019) from SEER and randomized into training (n = 771) and validation (n = 328) cohorts. In univariate and multivariate Cox regression analyses, five prognostic indicators (age, treatment modality, diagnosis year, Ann Arbor stage, laterality) were used to establish a nomogram of OS and CSS. The nomogram demonstrated excellent discrimination and calibration, with concordance indices in the training and validation cohorts of 0.702 (95% confidence interval [CI], 0.677-0.727) and 0.705 (95% CI 0.67-0.74) for OS and 0.694 (95% CI 0.663-0.725) and 0.680 (95% CI 0.63-0.72) for CSS. The calibration curve and ROC analysis indicated good predictive capability of the nomogram. CONCLUSIONS The constructed prognostic model showed good predictive value for PT-DLBCL to assist clinicians in developing individualized treatment strategies.
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Affiliation(s)
- Yongjin Zhi
- Department of Hematology, Taizhou People’s Hospital affiliated to Nanjing Medical University, Taizhou, Jiangsu Province, China
| | - Shuojing Bao
- Department of General Practice, Zhangdian People’s Hospital, Taizhou, Jiangsu Province, China
| | - Jingcheng Mao
- Department of Hematology, Taizhou People’s Hospital affiliated to Nanjing Medical University, Taizhou, Jiangsu Province, China
| | - Gufan Chai
- Department of Hematology, Taizhou People’s Hospital affiliated to Nanjing Medical University, Taizhou, Jiangsu Province, China
| | - Chengjiang Liu
- Department of General Practice, Anhui Medical University, Heifei, Anhui Province, China
| | - Jianfeng Zhu
- Department of Hematology, Taizhou People’s Hospital affiliated to Nanjing Medical University, Taizhou, Jiangsu Province, China
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Yang S, Chang W, Zhang B, Shang P. What factors are associated with the prognosis of primary testicular diffuse large B-cell lymphoma? A study based on the SEER database. J Cancer Res Clin Oncol 2023; 149:10269-10278. [PMID: 37270733 DOI: 10.1007/s00432-023-04907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is a relatively rare urological tumor with a high degree of malignancy and a poor prognosis. This study aimed to investigate the prognostic risk factors for survival of patients with PT-DLBCL, and then to construct a predictive model and verify its reliability. METHODS First, we selected subjects from the SEER database (2000-2018) and analyzed the survival of PT-DLBCL patients by Kaplan-Meier test. Then, we analyzed prognostic factors by Cox regression. Finally, the data from the training cohort were used to construct a prediction model and represented with a nomogram. We evaluated the nomogram using the consistency index (C-index), decision curve analysis (DCA), and the area under the subject operating characteristic curve (ROC). In addition, calibration curves were plotted to assess the agreement between the column plot model and the actual model. RESULTS We identified five independent risk factors for patient prognosis affecting OS and CSS in patients with PT-DLBCL by univariate and multivariate analysis, including age, transversality, Ann Arbor staging, chemotherapy, and radiotherapy. According to the above factors, we constructed prognostic nomograms, and found that age contributed the most to the survival of patients with PT-DLBCL. The C-indexes for the nomogram of OS and CSS in the training cohort were 0.758 (0.716-0.799) and 0.763 (0.714-0.812), and in the validation cohort were OS and CSS 0.756 (0.697-0.815) and 0.748 (0.679-0.817). CONCLUSION We produced the first nomogram of PT-DLBCL, and it can be used to evaluate the CSS and OS of patients to determine the prognosis of patients.
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Affiliation(s)
- Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Wei Chang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China.
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Liu KT, Chang YC, Lin YC, Chang JL. Unusually aggressive primary testicular diffuse large B-cell lymphoma initially presenting as systemic disseminating metastases in older adult men: a case report. Ann Med Surg (Lond) 2023; 85:4106-4111. [PMID: 37554871 PMCID: PMC10406097 DOI: 10.1097/ms9.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Primary testicular lymphoma (PTL) accounts for 1-2% of all nonHodgkin lymphomas (NHL), 4% of extranodal nonHodgkin lymphomas, and ~9% of testicular malignancies. A rare subtype of PTL is primary testicular diffuse large B-cell lymphoma (PT-DLBCL), which may initially present as disseminating metastasis in older adult males and has a poor prognosis. CASE PRESENTATION Herein, the authors describe the case of a 64-year-old man with the chief complaint of a painless unilateral scrotal mass. Computed tomography scans of the abdomen and a pelvic examination demonstrated a left testicular tumor with multiple lymphadenopathies partially aggregated in the para-aortic area and disseminated to multiple soft tissues and organs. Subsequently, the patient underwent a left radical orchiectomy. Pathological and immunohistochemical examinations confirmed the diagnosis of left PT-DLBCL with systemic disseminating metastases. CLINICAL DISCUSSION PTL often aggressively spreads to other extranodal organs, such as the contralateral testis, central nervous system, lung, pleura, Waldeyer's ring, and soft tissues. In men over 60 years of age, PT-DLBCL is the most common testicular malignancy. However, extensive systemic metastasis as the initial presentation is extremely rare. PT-DLBCL has a dismal prognosis and requires radical orchiectomy followed by multimodal therapy and central nervous system prophylaxis or systemic intervention to improve survival. CONCLUSION The diagnosis of PT-DLBCL through preoperative and imaging examinations is often challenging. Thus, histopathology and immunohistochemical markers play a crucial and valuable role in the definite diagnosis and differential diagnosis of PTLs.
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Affiliation(s)
- Kuang-Ting Liu
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital
- Hsin Sheng Junior College of Medical Care and Management
| | - Yueh-Ching Chang
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Chieh Lin
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital
- Department of Biomedical Engineering, Ming Chuan University, Taoyuaan City
| | - Junn-Liang Chang
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital
- Taipei Veterans General Hospital Taoyuan Branch
- Department of Biomedical Engineering, Ming Chuan University, Taoyuaan City
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
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Guo D, Hong L, Ji H, Jiang Y, Lu L, Wang X, Huang H. The Mutation of BTG2 Gene Predicts a Poor Outcome in Primary Testicular Diffuse Large B-Cell Lymphoma. J Inflamm Res 2022; 15:1757-1769. [PMID: 35300216 PMCID: PMC8923029 DOI: 10.2147/jir.s341355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Dan Guo
- Department of Hematology, The Affiliated Hospital of Nantong University, Jiangsu, People’s Republic of China
| | - Lemin Hong
- Department of Hematology, The Affiliated Hospital of Nantong University, Jiangsu, People’s Republic of China
| | - Hao Ji
- Department of Urology, Tumor Hospital Affiliated to Nantong University, Nantong, People’s Republic of China
| | - Yuwen Jiang
- Department of Hematology, The Affiliated Hospital of Nantong University, Jiangsu, People’s Republic of China
| | - Ling Lu
- Department of Hematology, The Affiliated Hospital of Nantong University, Jiangsu, People’s Republic of China
| | - Xinfeng Wang
- Department of Hematology, The Affiliated Hospital of Nantong University, Jiangsu, People’s Republic of China
- Correspondence: Xinfeng Wang; Hongming Huang, Department of Hematology, The Affiliated Hospital of Nantong University, No. 20, Xisi Street, Nantong, 226001, Jiangsu, People’s Republic of China, Email ;
| | - Hongming Huang
- Department of Hematology, The Affiliated Hospital of Nantong University, Jiangsu, People’s Republic of China
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Contrast-enhanced and microvascular ultrasound imaging features of testicular lymphoma: report of five cases and review literature. BMC Urol 2022; 22:6. [PMID: 35067228 PMCID: PMC8785503 DOI: 10.1186/s12894-022-00957-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background To retrospectively investigate the grey-scale, Doppler, contrast-enhanced and microvascular ultrasound of five patients with primary testicular lymphoma of our institute through review literature analysis. Methods From January to November 2020, five patients with primary testicular lymphoma confirmed by histology were preoperatively investigated with a standardized sonographic protocol including contrast-enhanced and microvascular ultrasound. Results Conventional ultrasound showed localized hypoechogenicity represented with solitary (2 of 5), multiple lesions (2 of 5), or entire testicular involvement (1 of 5). Increased blood flow appeared in color Doppler ultrasound with straight vascular sign (4 of 5). In contrast-enhanced ultrasound images confirmed this pattern (4 of 5) and presented hyper enhancement with enlarged range. On microvascular ultrasound imagings, all lesions were presented with straight and parallel course of intralesional vessels (5 of 5). Conclusions Here, we identified an increased vascularity with enlarged range on contrast-enhanced ultrasound along with a linear nonbranching pattern by vascular sign on microvascular ultrasonographic of testicular lymphoma.
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