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Dufour J, Choquet S, Hoang-Xuan K, Schmitt A, Ahle G, Houot R, Taillandier L, Gressin R, Casasnovas O, Marolleau JP, Tamburini J, Serrier C, Perez E, Paillassa J, Gyan E, Chauchet A, Ursu R, Kas A, Soussain C, Houillier C. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 2023; 102:1159-1169. [PMID: 36991231 DOI: 10.1007/s00277-023-05108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtrière, Service d'Hématologie clinique, Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - A Schmitt
- Institut de Bergonie, Service d'Hématologie, Bordeaux, France
| | - G Ahle
- Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Service d'Hématologie, Rennes, France
| | - L Taillandier
- Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France
| | - R Gressin
- Hôpital Universitaire de Grenoble, Service d'Hématologie, Grenoble, France
| | - O Casasnovas
- Hôpital Universitaire de Dijon, Service d'hematologie clinique, Dijon, France
| | - J P Marolleau
- Hôpital Universitaire d'Amiens, Service d'Hematologie clinique, Amiens, France
| | - J Tamburini
- Hôpital Cochin, Service d'Hématologie, Paris, France
| | - C Serrier
- Centre Hospitalier de Perpignan, Service d'Hématologie, Perpignan, France
| | - E Perez
- Hôpital Universitaire de la Réunion, Service d'oncologie-hématologie, Paris, La Réunion, France
| | - J Paillassa
- Hôpital Universitaire d'Angers, Service d'Hématologie, Angers, France
| | - E Gyan
- Hôpital Universitaire de Tours, Service d'Hématologie, Tours, France
| | - A Chauchet
- Hôpital Universitaire de Besançon, Service d'Hématologie, Besançon, France
| | - R Ursu
- Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France
| | - A Kas
- Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - C Soussain
- Institut Curie, Service d'Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - C Houillier
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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Irawan C, Iskandar M, Harahap AS, Rumende CM, Ham MF. MUM1 Expression versus Hans Algorithm to Predict Prognosis in Indonesian Diffuse Large B-Cell Lymphoma Patients Receiving R-CHOP. Cancer Manag Res 2022; 14:925-935. [PMID: 35256863 PMCID: PMC8898019 DOI: 10.2147/cmar.s345745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Treatment response in diffuse large B-cell lymphoma (DLBCL) is heterogenous. The Hans algorithm (using 30% cut-offs for CD10, BCL6, and MUM1 protein expression) has been the most favored method to categorize DLBCL into germinal center B-cell (GCB) and non-GCB subtypes in order to predict prognosis. However, the algorithm’s ability to prognosticate is not always consistent. Methods This retrospective cohort study was conducted on DLBCL patients receiving R-CHOP therapy at Dr. Cipto Mangunkusumo Hospital, Jakarta from 2014 to 2017. We aimed to compare the prognostic value of Hans algorithm as well as the protein levels of CD10, BCL6, MUM1, and Ki67 at different cut-offs. Ninety-two patients were classified based on Hans algorithm and various proteins at different cut-off values were analyzed with regard to event-free survival at 24 months using survival analysis. The cut-off values were then compared using receiver operating characteristic curves. Results A significant survival difference was observed with MUM1 expression cut-off of 50% or more (log rank p = 0.035). CD10, BCL6, Ki67, and Hans algorithm showed AUCs below or near 0.5 (0.405, 0.436, 0.498, and 0.413, respectively), whereas MUM1 showed an AUC of 0.835, in predicting events within 24 months. MUM-1 cut-off of 70.5% yielded an optimal trade-off for sensitivity and specificity. Conclusion MUM1 expression of 50% or more can help predict prognosis in DLBCL patients receiving R-CHOP therapy and can be considered as for use as a single marker to predict prognosis.
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Affiliation(s)
- Cosphiadi Irawan
- Hematology and Medical Oncology Division, Internal Medicine Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Martha Iskandar
- Hematology and Medical Oncology Division, Internal Medicine Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
- Correspondence: Martha Iskandar, Tel +628161924095, Email
| | - Agnes Stephanie Harahap
- Anatomical Pathology Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Cleopas Martin Rumende
- Internal Medicine Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Maria Francisca Ham
- Anatomical Pathology Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
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Nair R, Bhurani D, Rajappa S, Kapadia A, Reddy Boya R, Sundaram S, Menon H, Raman GS, Seshachalam A, Nimmagadda R. Diffuse Large B-Cell Lymphoma: Clinical Presentation and Treatment Outcomes From the OncoCollect Lymphoma Registry. Front Oncol 2022; 11:796962. [PMID: 35186714 PMCID: PMC8847307 DOI: 10.3389/fonc.2021.796962] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the commonest subtype of lymphoma, standard CHOP was the treatment of choice, 42% of patients received rituximab, and 29% of patients were lost to follow-up during therapy, were reported in a study that collected retrospective data at 13 public and private hospitals for patients diagnosed with lymphoma between January 2005 and December 2009. The OncoCollect Registry was set up in 2017 to address the challenges in the collection of retrospective data through chart review, recording access to anthracycline and rituximab-based treatment, and to study outcomes and any improvement in the patient follow-up. Methodology The OncoCollect Lymphoma group registry was set up at a national level with 9 participating centers. Lymphoma patients registered at these centers between 2011 and 2017 were included. The clinical features, prognostic stratification, associated comorbidities, response to first-line treatment, and 3-year outcomes of adult patients with DLBCL were analyzed. Results Of the 5,886 lymphoma patients registered in the OncoCollect registry, 2,581 (44%) had DLBCL. A total of 1,961 were evaluable for frontline therapy. The median age at presentation was 57 years. Gender ratio was 1.6:1. At presentation, 43% were early stage, 70% had low and low intermediate IPI, 53% had extranodal disease, and 30.9% had one or more comorbidities (data available for 1,136 patients). The commonest extra nodal site was gastro-intestinal (23.98%) followed by head and neck (19.24%). The overall response rate was 79.29%. Complete remission was seen in 61.75%, partial response in 17.5%, stable disease in 4.3%, and progression in 7.9%. Patients who received anthracycline-based therapy (86.7%) and rituximab-based therapy (83.7%) had a 3-year event-free survival (EFS) of 69.67% and 68.48%, respectively. With a median follow-up of 33 months, the 3-year overall Survival (OS) and EFS were 75.37% and 66.58%, respectively. Conclusions DLBCL remains the commonest (44%) lymphoma subtype and is curable with standard anthracycline- and rituximab-based therapies. The availability of rituximab has increased the proportion of patients receiving standard chemoimmunotherapy.
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Affiliation(s)
- Reena Nair
- Department of Clinical Hematology, Tata Medical Center, Kolkata, India
| | - Dinesh Bhurani
- Department of Haematology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Asha Kapadia
- Department of Medical Oncology, PD Hinduja National Hospital and Medical Research Center, Mumbai, India
| | - Rakesh Reddy Boya
- Department of Medical Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, India
| | | | - Hari Menon
- Department of Medical Oncology, CyteCare Cancer Hospitals, Bengaluru, India
| | - Ganapathi S Raman
- Department of Medical Oncology, Kumaran Hospital (P) Ltd. (MCCF), Chennai, India
| | - Arun Seshachalam
- Department of Medical Oncology, Dr GVN Cancer Institute, Trichy, India
| | - Ramesh Nimmagadda
- Department of Medical Oncology, Apollo Cancer Institute, Chennai, India
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Rajendran T, Kini JR, Abna A, Prasad K. Clinical benefit of R-CHOP without splenectomy in stage I primary splenic diffuse large B-cell lymphoma. BMJ Case Rep 2022; 15:e246610. [PMID: 34983812 PMCID: PMC8728438 DOI: 10.1136/bcr-2021-246610] [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] [Accepted: 12/21/2021] [Indexed: 11/04/2022] Open
Abstract
Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is a relatively rare malignancy, and there are no optimal approaches for diagnosis and management. There are less invasive splenic biopsies that effectively obviate diagnostic and elective splenectomies. We report a man in his 50s with 2-day history of pain in the abdomen and who was found to have a splenic mass on PET-CT. A CT-guided core needle splenic biopsy confirmed the diagnosis of PS-DLBCL. He was managed with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) alone, without splenectomy. The patient attained complete remission, and he is disease free at 6 years of follow-up.
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Affiliation(s)
- Tara Rajendran
- Division of Medical Oncology, Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Mangalore, Karnataka, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Mangalore, Karnataka, India
| | - Aysha Abna
- Department of Radio-diagnosis and Imaging, Father Muller Medical College, Mangalore, Karnataka, India
| | - Krishna Prasad
- Division of Medical Oncology, Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Mangalore, Karnataka, India
- Department of Medical Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
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5
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Gogia A, Nair S, Arora S, Kumar L, Sharma A, Gupta R, Biswas A, Mallick S. Impact of Cell-of-Origin on Outcome of Patients With Diffuse Large B-Cell Lymphoma Treated With Uniform R-CHOP Protocol: A Single-Center Retrospective Analysis From North India. Front Oncol 2021; 11:770747. [PMID: 34926277 PMCID: PMC8675100 DOI: 10.3389/fonc.2021.770747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/10/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction There is a scarcity of data from India on the impact of cell of origin (COO) on outcomes of diffuse large B-cell lymphoma (DLBCL). This study was conducted to evaluate the impact of COO on outcomes of DLBCL patients treated with uniform rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (RCHOP) protocol. Materials and Methods This retrospective analysis included patients who received uniform RCHOP chemoimmunotherapy during the study period (2014–2020) at the Department of Medical Oncology at All India Institute of Medical Sciences (AIIMS), New Delhi, India. The patients were classified as germinal center B-cell like (GCB) or activated B-cell (ABC) type using the Hans classification. Results Four hundred seventeen patients with median age of 48 years (range, 18–76) and a male-female ratio of 2:1 were included in the analysis. B symptoms and bulky disease were seen in 42.9% and 35.5%. Extranodal involvement was seen in 50.8% of cases. ECOG performance status (0-2) was present in 65%, and 51% presented with advanced disease. GCB subtype was seen in 43%, and 47% were ABC type. Low- and intermediate-risk international prognostic index (IPI) score was seen in 76% of cases. The overall response rate to RCHOP was 85.8%, including a complete response rate of 74.8%. After a median follow-up of 30 months, the 3-year event-free survival (EFS) and overall survival (OS) were 80% and 88%, respectively. The presence of B symptoms and poor ECOG performance status (3-4) was associated with inferior CR rate. Low albumin (p < 0.001), age >60 years (p = 0.001), bulky disease (p < 0.001), and extranodal involvement (p = 0.001) were associated with inferior EFS, whereas a high IPI risk score was associated with an inferior OS (p < 0.001). EFS and OS were not significantly different between the GCB and ABC subtypes. Grade III/IV anemia, neutropenia, and thrombocytopenia were seen in 7.6%, 13.6%, and 2.7% of patients, respectively. Febrile neutropenia was seen in 8.9% of patients, and there were four treatment-related deaths. Conclusions Cell of origin for DLBCL has no impact on CR, EFS, and OS if patients are appropriately treated with standard doses and frequency of RCHOP. RCHOP is well tolerated in our patients, and results are comparable with the Western data.
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Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
- *Correspondence: Ajay Gogia,
| | - Sukesh Nair
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalabh Arora
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Saumyaranjan Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Mahmood H, Habib M, Aslam W, Khursheed S, Fatima S, Aziz S, Habib M, Faheem M. Clinicopathological spectrum of Diffuse Large B Cell lymphoma: a study targeting population yet unexplored in Pakistan. BMC Res Notes 2021; 14:354. [PMID: 34507605 PMCID: PMC8434720 DOI: 10.1186/s13104-021-05768-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL). The aim of this study was to assess the clinico pathological characteristics of DLBCL specifically, among the affected individuals residing in Northern areas of Pakistan who had not been previously included in major lymphoma studies due to their remote location. Results Mean age of the patients was 49.7 years. Male: female ratio was 1.5:1. Primary site was lymph node in 99 (71.74%) patients, out of which, 36 (26.09%) patients had B symptoms and 19 (13.77%) patients had stage IV disease. 39 (28.26%) patients had primary extra nodal involvement, 4 (2.90%) patients had B symptoms and 3 (2.17%) had stage IV disease. Extra nodal sites involved in primary extra nodal DLBCL were gastrointestinal tract (GIT) 19 (48.72%), tonsils 6 (15.38%), spine 4 (10.26%), soft tissue swelling 3 (7.69%), parotid gland 2 (5.13%), thyroid 2 (5.13%) central nervous system (CNS) 1 (2.56), breast 1 (2.56%) and bone marrow 1 (2.56%). Our study revealed increased percentage of patients with nodal DLBCL in stage IV and with B symptoms. Few patients with primary extra nodal DLBCL had B symptoms and stage IV disease at presentation. GIT was the most common site of involvement in primary extra nodal DLBCL. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05768-5.
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Affiliation(s)
- H Mahmood
- Clinical Oncology, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - M Habib
- Hematology (Pathology), Shifa College of Medicine (Shifa Tameer-e-Millat University), Islamabad, Pakistan.
| | - W Aslam
- Hematology (Pathology), Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - S Khursheed
- Histopathology (Pathology), Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - S Fatima
- Nuclear Medicine, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - S Aziz
- Pathology, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - M Habib
- Restorative Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - M Faheem
- Clinical Oncology, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
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Narang V, Singh A, Sood N, Garg B, Kaur H, Jain K, Grover S. Primary Extranodal Non-Hodgkin Lymphomas: A First Tertiary Care Experience from Punjab, North India. South Asian J Cancer 2021; 9:230-232. [PMID: 34136424 PMCID: PMC8203326 DOI: 10.1055/s-0041-1723073] [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] [Indexed: 12/01/2022] Open
Abstract
Background
Primary extranodal lymphomas are less frequently encountered and difficult to diagnose in routine practice. The histopathological and immunohistochemical studies are essential in addition to clinical details to diagnose. The incidence is varied in different parts of India along with variation in histopathological spectrum.
Methodology
The clinical features and histopathological findings of patients diagnosed with primary extranodal lymphoma over 3-year period were retrieved from archives of pathology department and analyzed.
Results
During the 3-year study period, a total of 135 cases of non-Hodgkin lymphomas were evaluated, and of these, 41.4% (56/135) of cases presented with primary extranodal involvement. The mean age of primary extranodal lymphoma presentation was 61.3 ± 17.5 with M:F ratio of 1:1.1 Most common extranodal site involved was gastrointestinal tract 32.1%, 18/56 (small intestine [17.8%, 10 cases] and large intestine [8.9%, 5 cases]). Non-Hodgkin lymphomas of B cell type were the predominant subtype (48/56, 85.7%), while 8/56 (14.2%) cases were of T cell lineage. Of the B cell non-Hodgkin lymphoma diffuse, large B cell lymphoma was the predominant subtype constituting ~83.3% (40/48).
Conclusion
Primary extranodal lymphomas exhibit varied histomorphological and clinical presentation. The present study is first such analysis from Punjab that intends to compare with studies from other parts of India.
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Affiliation(s)
- Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Aminder Singh
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bhavna Garg
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kunal Jain
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumit Grover
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Istiadi H, Sadhana U, Puspasari D, Miranti IP, Karlowee V, Listiana DE, Prasetyo A. Role of Cell-Origin Profiling Using Immunohistochemistry to Predict the Survival of Patients with Diffuse Large B-Cell Lymphoma in Indonesia. Yonago Acta Med 2021; 64:200-206. [PMID: 34025195 DOI: 10.33160/yam.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/26/2021] [Indexed: 11/05/2022]
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in Asia and Indonesia. DLBCL could be further classified according to cell of origin as the germinal center B-cell (GCB) subtype or the non-germinal center B-cell (non-GCB) subtypes; of these, the non-GCB subtype usually has poorer prognosis. The purpose of this study is to determine the relationship between the cell-origin subtype and 3-year overall survival of patients with DLBCL at Kariadi General Hospital Semarang. Methods This research represents an observational analytical study of 36 patients with DLBCL who visited Kariadi General Hospital between January and August 2017. Data on age of diagnosis, tumor location, disease stage, and 3-year overall survival were collected. DLBCL subtype was determined via immunohistochemical examination of CD10, BCL6, and MUM1 protein expression. Data analyses, including the chi squared test and Kaplan-Meier curves, were conducted. Results The study population included 18 patients with GCB-subtype DLBCL and 18 patients with non-GCB-subtype DLBCL. No significant difference (P = 0.171) between disease stage and cell-origin subtype was noted between groups. Patients with the non-GCB subtype had a 3-year overall survival that was significantly worse than that of patients with the GCB subtype (P = 0.026). Moreover, the 3-year survival rate of patients with the non-GCB subtype of the disease was 38.9% while that of patients with the GCB subtype was 77.8%. Patients with advanced stages of DLBCL also had a 3-year overall survival that was significantly worse than those of patients with early stages of the disease (P < 0.001), with the 3-year survival rate of patients with advanced stage was 14.3%. Conclusion Patients with non-GCB-subtype DLBCL or advanced stages of the disease have a lower 3-year overall survival rate and poorer prognosis compared with those with other subtypes or earlier stages of the disease.
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Affiliation(s)
- Hermawan Istiadi
- Anatomical Pathology Department, Faculty of Medicine, Diponegoro University, Semarang 50244, Indonesia
| | - Udadi Sadhana
- Anatomical Pathology Department, Faculty of Medicine, Diponegoro University, Semarang 50244, Indonesia
| | - Dik Puspasari
- Anatomical Pathology Laboratory, Kariadi General Hospital, Semarang 50244, Indonesia
| | - Ika Pawitra Miranti
- Anatomical Pathology Department, Faculty of Medicine, Diponegoro University, Semarang 50244, Indonesia
| | - Vega Karlowee
- Anatomical Pathology Department, Faculty of Medicine, Diponegoro University, Semarang 50244, Indonesia
| | - Devia Eka Listiana
- Anatomical Pathology Laboratory, Kariadi General Hospital, Semarang 50244, Indonesia
| | - Awal Prasetyo
- Anatomical Pathology Department, Faculty of Medicine, Diponegoro University, Semarang 50244, Indonesia
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Liu Y, Shen J, Awal Issah M, Liu T, Zhou H, Fu H. CD56-positive diffuse large B-cell lymphoma/leukemia with BCL6/MYC double-hit and multiple gene mutations: an indicator of poor prognosis? J Int Med Res 2021; 48:300060520918087. [PMID: 32363958 PMCID: PMC7218936 DOI: 10.1177/0300060520918087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common adult non-Hodgkin lymphoma (NHL) and is highly invasive, with a poor prognosis. The main clinical treatment for DLBCL involves chemotherapy or a combination of chemotherapy and targeted drugs. CD56 expression is considered as an indicator of poor prognosis in patients with acute myeloid leukemia and anaplastic large cell lymphoma; however, its role in DLBCL remains unclear. We report on a patient with CD56-positive DLBCL/leukemia with BCL6/MYC double-hit, and DDX3X, LRP1B, SIN3A, and GNA13 gene mutations (stage IVA, prognostic index aaIPI = 2 points). The patient was treated with cyclophosphamide and prednisone pre-chemotherapy plus R-Hyper-CVAD AB and DA-EPOCH regimens. Lumbar puncture combined with intrathecal injection was performed to prevent central nervous system infiltration during hospitalization, and complete remission was confirmed. We also reviewed the literature to clarify the relevance of the unique clinical features associated with this case.
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Affiliation(s)
- Yanquan Liu
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, National and Fujian Provincial Key Laboratory of Hematology, Fuzhou, Fujian province, China
| | - Jianzhen Shen
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, National and Fujian Provincial Key Laboratory of Hematology, Fuzhou, Fujian province, China
| | - M Awal Issah
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, National and Fujian Provincial Key Laboratory of Hematology, Fuzhou, Fujian province, China
| | - Tingbo Liu
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, National and Fujian Provincial Key Laboratory of Hematology, Fuzhou, Fujian province, China
| | - Huarong Zhou
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, National and Fujian Provincial Key Laboratory of Hematology, Fuzhou, Fujian province, China
| | - Haiying Fu
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, National and Fujian Provincial Key Laboratory of Hematology, Fuzhou, Fujian province, China
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10
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Freeman T, Legasto CS, Schickli MA, McLaughlin EM, Giglio P, Puduvalli V, Gonzalez J. High-dose methotrexate-based regimens with or without vincristine for the treatment of primary central nervous system lymphoma. Neurooncol Adv 2020; 2:vdaa077. [PMID: 32715297 DOI: 10.1093/noajnl/vdaa077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) is a rare malignancy with few treatment options. One regimen used for induction is rituximab, high-dose methotrexate (HD-MTX), procarbazine, and vincristine (R-MPV). A common institutional practice is removing vincristine (VCR) from this regimen due to its poor CNS penetration and associated toxicities. The aim of this study was to evaluate how the omission of VCR from HD-MTX-based induction impacted clinical outcomes. Methods In a retrospective review, patients with PCNSL who received HD-MTX-based induction therapy between January 1, 2010 and May 31, 2018 were evaluated. Patients were stratified according to treatment into 2 groups, VCR-containing therapy versus no VCR. The primary endpoint was complete response (CR) rate following the completion of induction chemotherapy. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and adverse event rate. Results Twenty-nine patients were included: 16 patients in the VCR group and 13 in the non-VCR group. A CR was achieved in 7 (44%) and 5 (38%) (odds ratio [OR] = 1.24; 95% confidence interval [CI]: 0.28-5.53) patients, respectively. Median OS was 85.3 (95% CI: 20.2-85.3) versus 67.1 months (95% CI: 10.5-NR) and median PFS was 60.7 (95% CI: 9.4-NR) versus 23.7 months (95% CI: 4.7-NR) in the VCR group versus non-VCR group, respectively. The incidence of any grade peripheral neuropathy was higher in the VCR group. Conclusions CR rate, OS, and PFS were similar between groups regardless of VCR inclusion. Adverse events were higher in the VCR group. Larger studies are required to further evaluate the efficacy of VCR in PCNSL induction regimens.
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Affiliation(s)
- Tracelyn Freeman
- Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Carlo S Legasto
- Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA.,Department of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | | | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Pierre Giglio
- Department of Neuro-Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Vinay Puduvalli
- Department of Neuro-Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Javier Gonzalez
- Department of Neuro-Oncology, The Ohio State University, Columbus, Ohio, USA.,National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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11
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Mandloi SS, Thumaty DB, Nisha Y, Kayal S, Ganesan P, Jacob SE, Basu D, Dubashi B. Clinico-Pathologic Profile and Treatment Outcomes of Patients with Diffuse Large B Cell Lymphoma Based on Cell of Origin Classification. Indian J Hematol Blood Transfus 2020; 37:226-231. [PMID: 33867728 DOI: 10.1007/s12288-020-01322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCLs) constitute 40% of all non-Hodgkin lymphoma and it represent a heterogeneous group of neoplasms rather than a single clinicopathological entity. We analysed the outcomes and clinical features based on the cell of origin in a series of patients with DLBCL from our institute. Medical case records of all newly diagnosed DLBCL treated in our institute from January 2015 to July 2017 were analysed for this study. Cell of origin classification was based on immunohistochemistry using Hans algorithm. Kaplan-Meier curves were used to determine survival. Ninety-five patients were diagnosed to have DLBCL subtype. Immunophenotypic subtyping was available for 71 patients. The median age at diagnosis was 56 years with no difference between Germinal centre B cell (GCB) and non-Germinal centre B cell (non-GCB) subtypes. Approximately 44% of patients had extra-nodal disease, stomach being the commonest site. Forty percent of patients had stage III/IV disease. Bulky disease and extra-nodal presentation was predominantly seen with non-GCB subtype (46% vs 20% and 36% vs 29% respectively). Rituximab was used in 75% of the patients with DLBCL. The 2-year disease-free survival was 70% versus 53% (p = 0.38) in GCB versus non-GCB subtype. This is one of the few data on DLBCL patients reported from India which has described outcomes based on the cell of origin. The disease-free survival in our country appears to be superior in GCB subtype which needs to be confirmed in a larger subset of patients.
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Affiliation(s)
| | | | - Yadav Nisha
- Department of Medical Oncology, JIPMER, Puducherry, India
| | - Smita Kayal
- Department of Medical Oncology, JIPMER, Puducherry, India
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12
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Fukuta T, Nishimura N, Shirouchi Y, Inoue N, Uryu H, Kusano Y, Mishima Y, Yokoyama M, Tsuyama N, Takeuchi K, Terui Y. Insignificance of surveillance imaging in patients with diffuse large B-cell lymphoma who achieved first complete remission: a retrospective cohort study. Int J Hematol 2020; 111:567-573. [PMID: 31939076 DOI: 10.1007/s12185-020-02819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the value of scheduled imaging for patients who achieved first complete remission after CHOP-like chemotherapy plus rituximab. In this retrospective cohort study, we included 759 patients newly diagnosed with de novo diffuse large B-cell lymphoma (DLBCL) at the Cancer Institute, Japanese Foundation for Cancer Research. Relapsed patients were divided into two groups based on method of diagnosis: clinical symptoms (symptom group, n = 57) or scheduled imaging (imaging group, n = 27). Our primary goal was to compare overall survival and relapse-free survival between the two groups. No significant difference in outcomes was found between the symptom and imaging groups. Median overall survival [7.5 years; 95% confidence interval (CI) 4.0-9.7 vs. 9.1 years; 95% CI 2.7 to not reached; P = 0.747), and median relapse-free survival (1.8 years; 95% CI 1.4-2.5 vs. 2.4 years; 95% CI 1.2-4.4; P = 0.108). Surveillance imaging in patients with DLBCL who achieved first complete remission did not demonstrate an advantage in terms of overall survival or relapse-free survival.
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Affiliation(s)
- Takanori Fukuta
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Noriko Nishimura
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yuko Shirouchi
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Norihito Inoue
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Hideki Uryu
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yoshiharu Kusano
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yuko Mishima
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masahiro Yokoyama
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Naoko Tsuyama
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.,Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuhito Terui
- Department of Hematology and Oncology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
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