1
|
Premužić V, Bašić-Kinda S, Radman I, Dujmović D, Ilić I, Živković N, Maleta L, Kralik M, Dobrenić M, Galunić-Bilić L, Rončević P, Vodanović M, Aurer I. Glomerular filtration rate is an independent prognostic factor in patients with B-large cell lymphoma. Medicine (Baltimore) 2023; 102:e33675. [PMID: 37335743 DOI: 10.1097/md.0000000000033675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Chronic kidney dysfunction is associated with increased mortality in multiple cancer types. Preliminary evidence suggests the same to be true for B-large cell lymphomas (B-LCL). To analyze the relationship of glomerular filtration rate (GFR) and outcome of B-LCL in detail we collected data on outcomes of 285 consecutive patients with newly diagnosed B-LCL treated at our institution with standard rituximab-containing regimens who did not have preexisting kidney disease or urinary tract obstruction at presentation. Median age was 59, range 18 to 87, 145 were male and 140 females. Forty-four had GFR < 60 mL/min, 123 had 60 to 90 mL/min, and 118 > 90 mL/min. Median follow-up of surviving patients was 49 months and estimated 3-year survival 76%. In univariate analysis age (P < .001), GFR (P = .014), stage (P < .001), performance status (P = .044), chemotherapy regimen (P < .01), and international prognostic index (IPI) (P < .001) were statistically significant prognostic factors. In multivariate analysis, age and GFR remained the only independent prognostic factors. Subtracting 1 from the IPI score of patients who had GFR > 90 mL/min and IPI > 1 resulted in a prognostic index that divides patients into 3 prognostic groups (low risk = 0-1, intermediate risk = 2-3 and high risk = 4-5) with an acceptable patient distribution frequency (38%, 39%, and 23%, respectively) and improved statistical significance and separation in comparison to IPI (5-year survival rates of 92%, 74%, and 42%, respectively). GFR is an important independent prognostic factor for B-LCL that should be taken into account in clinical decision making and data analysis and probably be incorporated in prognostic indices.
Collapse
Affiliation(s)
- Vedran Premužić
- Division of Nephrology, Department of Internal Medicine, University Hospital Centre Zagreb
- Medical School, University of Zagreb
| | - Sandra Bašić-Kinda
- Division of Hematology, Department of Internal Medicine, UHC Zagreb, Croatia
| | - Ivo Radman
- Division of Hematology, Department of Internal Medicine, UHC Zagreb, Croatia
| | - Dino Dujmović
- Division of Hematology, Department of Internal Medicine, UHC Zagreb, Croatia
| | - Ivana Ilić
- Medical School, University of Zagreb
- Department of Pathology, University Hospital Centre Zagreb
| | | | - Lucija Maleta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UHC Zagreb, Croatia
| | | | - Margareta Dobrenić
- Medical School, University of Zagreb
- Department of Nuclear Medicine, UHC Zagreb, Croatia
| | | | - Pavle Rončević
- Division of Hematology, Department of Internal Medicine, UHC Zagreb, Croatia
| | - Marijo Vodanović
- Division of Hematology, Department of Internal Medicine, UHC Zagreb, Croatia
| | - Igor Aurer
- Medical School, University of Zagreb
- Division of Hematology, Department of Internal Medicine, UHC Zagreb, Croatia
| |
Collapse
|
2
|
Kim M, Ahn SY, Ahn JS, Song GY, Jung SH, Lee JJ, Kim HJ, Lee JH, Shin MG, Song SY, Yang DH. Diagnostic Accuracy and Prognostic Relevance of Immunoglobulin Heavy Chain Rearrangement and 18F-FDG-PET/CT Compared With Unilateral Bone Marrow Trephination for Detecting Bone Marrow Involvement in Patients With Diffuse Large B-Cell Lymphoma. J Korean Med Sci 2022; 37:e2. [PMID: 34981678 PMCID: PMC8723897 DOI: 10.3346/jkms.2022.37.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In diffuse large B-cell lymphoma (DLBCL), bone marrow involvement (BMI) has an important clinical implication as a component of staging and International Prognostic Index. This study aimed to determine whether molecular analysis of immunoglobulin heavy chain (IgH) genes and positron emission tomography-computed tomography (PET/CT) could overcome the limitation of defining morphologic BMI by trephination biopsy and could increase the diagnostic accuracy or prognostic prediction. METHODS A total of 94 de novo patients with DLBCL underwent PET/CT, polymerase chain reaction (PCR) test for detection of IgH gene rearrangement, and unilateral bone marrow (BM) trephination at diagnosis. RESULTS A total of 9 patients (9.6%) were confirmed to present morphologic BMI (mBMI) based on trephination biopsy. On the other hand, 21 patients (22.3%) were confirmed to have IgH clonality (IgH BMI), while 16 (17.0%) were classified with BMI based on the assessment of PET/CT (PET BMI). Each IgH rearrangement PCR and PET/CT showed the high negative predictive value of detecting the BMI. However, the combined assessment of IgH rearrangement and PET/CT could increase the diagnostic accuracy and specificity with 87.2% and 97.0%, respectively. The survival outcome of patients with double positive PET BMI and IgH BMI was significantly worse than that with either single positive PET BMI or IgH BMI, and even less than patients with neither PET BMI nor IgH BMI (3-year PFS: 50.0% vs. 75.4% vs. 97.9%, P = 0.007, 3-year OS: 50.0% vs. 75.6% vs. 80.1%, P = 0.035, respectively). CONCLUSION This study suggests that the combined evaluation of PET/CT and IgH rearrangement could give additional information for predicting therapeutic outcomes in patients with negative morphologic BMI as an important part of the prognosis.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy/methods
- Bone Marrow Examination
- Bone Marrow Neoplasms/diagnostic imaging
- Bone Marrow Neoplasms/genetics
- Bone Marrow Neoplasms/immunology
- Bone Marrow Neoplasms/pathology
- Female
- Fluorodeoxyglucose F18
- Gene Rearrangement, B-Lymphocyte, Light Chain
- Humans
- Immunoglobulin Heavy Chains
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Positron Emission Tomography Computed Tomography/methods
- Prognosis
- Prospective Studies
- Radiopharmaceuticals
- Young Adult
Collapse
Affiliation(s)
- Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jun Hyung Lee
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Myung-Geun Shin
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
| |
Collapse
|
3
|
Kim HY, Jang MA, Kim HJ, Kim SJ, Kim WS, Kim SH. Clinical impact of CD5 expression in Korean patients with diffuse large B-cell lymphoma. Blood Res 2017; 52:193-199. [PMID: 29043234 PMCID: PMC5641511 DOI: 10.5045/br.2017.52.3.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/02/2017] [Accepted: 06/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) accounts for 5-10% of DLBCL cases and has poor patient outcomes. However, most studies on CD5+ DLBCL were performed in Japanese patients and only few data are available for Korean population. In this study, we investigated the clinical characteristics and prognostic impact of CD5 expression in Korean patients with bone marrow (BM) involvement of DLBCL. METHODS Patients who were initially diagnosed with BM involvement of de novo DLBCL from 2005 to 2013 were included. Clinicopathological features and outcomes of patients were compared between CD5+ and CD5 negative (CD5-) DLBCL. RESULTS Among a total of 57 patients, the number of patients with CD5+ and CD5- DLBCL were 13 and 44, respectively. Clinical and laboratory features of CD5+ DLBCL were not significantly different from those of CD5- DLBCL. The 3-year overall survival (OS) rates for CD5+ and CD5- DLBCL were 20.2% and 59.0%, respectively (P=0.031), and 3-year progression-free survival (PFS) rates for CD5+ and CD5- DLBCL were 23.1% and 50.1%, respectively (P=0.055). CONCLUSION CD5+ DLBCL with BM involvement showed an inferior survival tendency compared to CD5- DLBCL, and thorough evaluation of CD5 expression might be helpful to predict the prognosis of patients with DLBCL.
Collapse
Affiliation(s)
- Hyun-Young Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Mi-Ae Jang
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Hong J, Lee S, Chun G, Jung JY, Park J, Ahn JY, Cho EK, Shin DB, Lee JH. Baseline renal function as a prognostic indicator in patients with newly diagnosed diffuse large B-cell lymphoma. Blood Res 2016; 51:113-21. [PMID: 27382556 PMCID: PMC4931929 DOI: 10.5045/br.2016.51.2.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/16/2016] [Accepted: 05/24/2016] [Indexed: 12/02/2022] Open
Abstract
Background The association between baseline renal impairment (RI) and the prognosis of diffuse large B-cell lymphoma (DLBCL) was previously not defined. The aim of this study was to evaluate the prognostic value of RI in patients with DLBCL treated with three-weekly rituximab plus cyclophosphamide, Adriamycin, vincristine, and prednisolone immunochemotherapy (R-CHOP21). Methods Patients with newly diagnosed de novo DLBCLs treated with ≥1 cycle of R-CHOP21 were analyzed retrospectively. Pretreatment blood samples were collected and the glomerular filtration rate (GFR) was calculated. RI was defined by a GFR of <60 mL/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Results Of the 185 patients enrolled in the present study, 19 patients (10.3%) had RI. The reasons for baseline RI were pre-existing CKD (N=5), acute kidney injury due to either obstruction (N=2) or electrolyte imbalance (N=2) related to DLBCL, and undefined causes (N=10). Patients with baseline RI showed inferior overall survival (OS) compared to those without RI (P<0.001). In multivariate analysis, RI was identified as an International Prognostic Index (IPI)-independent prognostic indicator. A baseline hemoglobin level of <10 g/dL and the presence of RI effectively discriminated a portion of the patients with far inferior event-free survival and OS among the patients having high or high-intermediate risk cancers according to either the standard- or the National Comprehensive Cancer Network-IPI. Conclusion Pretreatment RI was an independent prognostic marker for inferior OS in patients with DLBCL treated with R-CHOP21 immunochemotherapy.
Collapse
Affiliation(s)
- Junshik Hong
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Sojung Lee
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Gayoung Chun
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Jinny Park
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Jeong Yeal Ahn
- Department of Laboratory Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Eun Kyung Cho
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Bok Shin
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea
| |
Collapse
|
5
|
Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy. J Geriatr Oncol 2015; 6:470-8. [DOI: 10.1016/j.jgo.2015.10.183] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/23/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
|