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Maguire J, Harvey H, Jones A, Law R, Bashir M, O'Brien O, Sargent J, Grant C, Flavin R. Clinical boundaries in adult cases of large B cell lymphoma with IRF4 rearrangement. Histopathology 2024; 84:399-401. [PMID: 37876327 DOI: 10.1111/his.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
AIMS Large B-cell lymphoma with IRF4 rearrangement (LBCL-IRF4) is a recently described entity included in the revised 4th edition of the WHO Classification of Haematolymphoid Tumours (2017). Here we highlight the difficulties in classification of those cases which arise in adult patients with unusual clinical features. RESULTS We present three cases with morphological and immunohistochemical features consistent with large B-cell lymphoma arising in adult patients, which were found to have isolated IRF4 rearrangements on FISH analysis. Each patient presented with advanced-stage disease and had a history of immunosuppression; clinical features that are not typical of LBCL-IRF4 and which make the distinction from DLBCL, not otherwise specified (NOS) challenging. CONCLUSION We propose that the clinical boundaries of LBCL-IRF4 arising in adult patients need further delineation to allow distinction from true cases of DLBCL, NOS.
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Affiliation(s)
- Jessica Maguire
- Histopathology Department, St James's Hospital, Dublin 8, Ireland
| | - Harry Harvey
- Oncology Department, St James's Hospital, Dublin 8, Ireland
| | - Alfred Jones
- Haematology Department, Beaumont Hospital, Dublin 9, Ireland
| | - Ruth Law
- Histopathology Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Masoud Bashir
- Surgery Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | | | - Jeremy Sargent
- Haematology Department, Beaumont Hospital, Dublin 9, Ireland
| | - Cliona Grant
- Oncology Department, St James's Hospital, Dublin 8, Ireland
| | - Richard Flavin
- Histopathology Department, St James's Hospital, Dublin 8, Ireland
- Histopathology Department, Trinity College Dublin, Dublin 2, Ireland
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Sun R, Jin C, Qin H, Zhang W, Ning Z, Liu J, Wang A. Case Report: A long-term survival case of diffuse large B-cell lymphoma with left ventricular infiltration and spinal cord compression. Front Cardiovasc Med 2023; 10:1309613. [PMID: 38173814 PMCID: PMC10761417 DOI: 10.3389/fcvm.2023.1309613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma and may occur with lymph node and/or extranodal involvement. However, DLBCL with intracardiac mass is exceedingly rare. In the reported literature, the intracardiac infiltration of DLBCL mostly involves the right ventricle. Lymphoma that invades the heart has an aggressive nature, with symptoms that are easily ignored initially and can lead to multiple complications in severe cases, resulting in a poor prognosis. Early screening and diagnosis may significantly improve the survival rate. Early diagnosis may significantly improve outcomes. Case summary We presented a 68-year-old woman with back pain. PET/CT suggested increased FDG metabolism in the left ventricle, right adrenal gland, right erector spinae intramuscularis, multiple bones and multiple lymph nodes. Contrast-enhanced ultrasound showed a left ventricular apical mass with ventricular septum thickening. Cardiac MRI suggested a 1.6*1.1*2.1 cm mass in the apical-central portion of the left ventricle. Biopsy of the right neck mass confirmed the pathologic diagnosis of diffuse large B-cell lymphoma. However, before the pathologic diagnosis was confirmed, the patient was paralyzed due to spinal cord compression caused by the progression of bone metastases. Subsequently, pathology confirmed the diagnosis of diffuse large B-cell lymphoma, and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was treated immediately as first-line therapy. In addition, glucocorticoids and mannitol dehydration were administered to relieve the symptoms of spinal cord compression. After 8 cycles of R-CHOP, the tumor at all sites had almost complete regression. The patient was able to walk normally and had no tumor-related symptoms. Conclusions We present a case of DLBCL with a very high tumor load that involved multiple organs, including the left ventricle, but exhibited no cardiac-related symptoms. The combination of various imaging modalities is valuable for the diagnosis of cardiac infiltration. The mass in the left ventricle almost completely regressed after R-CHOP treatment, and no recurrence has occurred in the 5 years of follow-up so far.
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Affiliation(s)
- Rui Sun
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenxing Jin
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Henan Qin
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wenhe Zhang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhen Ning
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiwei Liu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Aman Wang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Lee JH, Yun J. Diffuse Large B-Cell lymphoma Misdiagnosed as a Hematoma: Case Report. Medicina (Kaunas) 2023; 59:1775. [PMID: 37893492 PMCID: PMC10608036 DOI: 10.3390/medicina59101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background: Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin's lymphoma, often presents diagnostic challenges due to its diverse clinical presentation. We present a case of DLBCL that was initially misdiagnosed as a hematoma, highlighting the importance of considering malignancy when faced with unresponsive soft tissue swelling. Methods: A 76-year-old man presented to the emergency department with right periorbital swelling and ecchymosis following a traumatic injury. Despite ongoing anticoagulant therapy (warfarin) for atrial fibrillation, the symptoms persisted. A CT scan of the facial bones revealed a large, irregular, homogeneous mass. Initially, the clinical history and radiologic findings suggested an extraconal hematoma. As a result, an incision and drainage procedure was performed, and the old blood was evacuated. However, the patient's symptoms continued to worsen. A follow-up CT scan showed enlargement of the lesion, prompting a surgical excisional biopsy. Results: Pathologic examination of the excised mass revealed a diffuse infiltrate of lymphocytes surrounding the tissue, confirming the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was subsequently referred to hematology for further management. Conclusions: Although rare, DLBCL is associated with a challenging prognosis. This case highlights the diagnostic complexities that can arise, particularly when factors such as prior injury and anticoagulant therapy confound the clinical picture. The initial misclassification of the condition as a hematoma led to a delay in diagnosis and the subsequent initiation of treatment. Therefore, it is imperative to remain vigilant and consider malignancy as a potential underlying cause of unresponsive soft tissue swelling. Timely recognition and accurate diagnosis are paramount to improving patient outcomes in DLBCL, an aggressive lymphoma with a diverse clinical presentation.
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Affiliation(s)
| | - Jiyoung Yun
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, School of Medicine, Inje University, Busan 47392, Republic of Korea;
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Shen H, Lian Y, Yin J, Zhu M, Yang C, Tu C, Peng Y, Li X, Zhang J. Cardiovascular Risk Stratification by Automatic Coronary Artery Calcium Scoring on Pretreatment Chest Computed Tomography in Diffuse Large B-Cell Lymphoma Receiving Anthracycline-Based Chemotherapy: A Multicenter Study. Circ Cardiovasc Imaging 2023; 16:e014829. [PMID: 36748459 DOI: 10.1161/circimaging.122.014829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Balancing the cardiovascular risk and benefit of anthracycline-based chemotherapy in patients with diffuse large B-cell lymphoma is an important clinical issue. We aimed to evaluate whether the pretreatment coronary artery calcium score (CACS) can stratify the risk of cancer therapy-related cardiac dysfunction (CTRCD) and major adverse cardiovascular events (MACEs) in patients with diffuse large B-cell lymphoma receiving anthracycline-based chemotherapy. METHODS The patients with diffuse large B-cell lymphoma from 4 hospitals were retrospectively enrolled. The CACS was automatically calculated on nongated chest computed tomography before treatment using artificial intelligence-CACS software and divided into 3 categories (0, 1-100, and >100). The associations between the CACS and CTRCD and between the CACS and MACEs were assessed by logistic regression and Fine-Gray competing-risk regression model. Nelson-Aalen cumulative risk curve was performed to assess the cumulative incidence of MACEs. RESULTS A total of 1468 patients (785 men and 683 women; 100% Asian) were enrolled, and 362 and 185 patients developed CTRCD and MACEs, respectively. Compared with a CACS of 0 (n=826), there was stepwise higher odds of CTRCD with a CACS between 1 and 100 (n=356; odds ratio, 2.587) and a CACS >100 (n=286; odds ratio, 5.239). The CACS was associated with MACEs (1-100 versus 0: subdistribution hazard ratio 3.726; >100 versus 0: subdistribution hazard ratio 7.858; all P<0.001). Competing risk-adjusted MACEs rates for patients with a CACS of 0, 1 to 100, and >100 were 1.21%, 8.43%, and 11.19%, respectively, at 3 years, and 3.27%, 16.01%, 31.12%, respectively, at 5 years. CONCLUSIONS The automatic CACS derived from chest computed tomography before treatment was helpful to identify high-risk patients of CTRCD and MACE and guide clinicians to implement cardiovascular protection strategies in patients with diffuse large B-cell lymphoma who received anthracycline-based chemotherapy.
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Affiliation(s)
- Hesong Shen
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, China (H.S., C.T., Y.P., X.L., J.Z.)
| | - Yanbang Lian
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, China (Y.L.)
| | - Jinxue Yin
- Department of Medical Imaging, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, China (J.Y.)
| | - Minghong Zhu
- Department of Radiology, Chongqing University Fuling Hospital, China (M.Z., C.Y.)
| | - Chun Yang
- Department of Radiology, Chongqing University Fuling Hospital, China (M.Z., C.Y.)
| | - Chunrong Tu
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, China (H.S., C.T., Y.P., X.L., J.Z.)
| | - Yangling Peng
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, China (H.S., C.T., Y.P., X.L., J.Z.)
| | - Xiaoqin Li
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, China (H.S., C.T., Y.P., X.L., J.Z.)
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, China (H.S., C.T., Y.P., X.L., J.Z.)
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Abeles EB, Umrau K, Gray ML, Boahene KD. Primary diffuse large B-cell lymphoma of the nasal bone and palate: An unusual clinical presentation. J Oral Maxillofac Pathol 2022; 26:572-575. [PMID: 37082085 PMCID: PMC10112089 DOI: 10.4103/jomfp.jomfp_410_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 04/22/2023] Open
Abstract
Primary bone lymphomas account for 3-5% of extranodal non-Hodgkin lymphomas in adults and are typically present in the axial skeleton and weight-bearing bones. We present a unique case of primary bone diffuse large B-cell lymphoma (DLBCL) of the nasal bone and palate. We discuss the pathologic and radiologic findings and review the current literature and clinical management to highlight how this unusual clinical entity should be considered in differential diagnoses of head and neck bone masses.
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Affiliation(s)
- Elisabeth B. Abeles
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kavita Umrau
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mingyang L. Gray
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kofi D. Boahene
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Milani CM, Stadler CF, da Silva LLG, Milani PA. Non-Hodgkin lymphoma of a palate: A case report of a highly destructive lesion. J Oral Maxillofac Pathol 2022; 26:289-290. [PMID: 35968180 PMCID: PMC9364655 DOI: 10.4103/jomfp.jomfp_332_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 11/04/2022] Open
Abstract
Non-Hodgkin lymphoma (NHL) is a haematolymphoid neoplasm that can affect nodal and extra-nodal sites. It is a rare disease in the oral cavity, accounting for only 2% of all extra-nodal lymphomas. Its aetiology is multi-factorial, being strongly associated with viral infections. The average age group most affected is 66 years old, with a slight predilection for males. The most common histological sub-type in the oral cavity is diffuse large B-cell lymphoma, with Waldeyer's ring being the most affected site in the nodal form, and extranodally, it may involve the tongue, hard/soft palate, maxilla, and mandible. It presents as a nodular lesion with a smooth or ulcerated surface. The initial treatment approach is chemotherapy, but this may vary according to the stage of lymphoma. The aim of this study was to report a case of NHL in the palate of a 54-year-old female patient, with extensive tissue destruction.
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Affiliation(s)
- Cintia M. Milani
- Professor of Stomatology and Oral Surgery, Faculty of Dentistry, Universidade Tuiuti do Paraná, Curitiba, Brazil,Address for correspondence: Dr. Cintia M. Milani, Av Prof Pedro Viriato Parigot de Souza, 276, Curitiba - 80740-050, Paraná, Brazil. E-mail:
| | | | | | - Paulo A.P. Milani
- Professor of Prosthesis, Faculty of Dentistry, Universidade Tuiuti do Paraná, Curitiba, Brazil
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Go SI, Park MJ, Park S, Kang MH, Kim HG, Kang JH, Kim JH, Lee GW. Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B-cell lymphoma. J Cachexia Sarcopenia Muscle 2021; 12:2211-2219. [PMID: 34676685 PMCID: PMC8718032 DOI: 10.1002/jcsm.12837] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/19/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer cachexia is known to adversely affect the clinical course in patients with malignant lymphoma. The cachexia index (CXI) is a potential biomarker of cancer cachexia, and its implications for the prognosis and treatment outcome of lung cancer and aggressive lymphoma has been assessed in previous studies. METHODS A total of 267 patients diagnosed with diffuse large B-cell lymphoma who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) immunochemotherapy were retrospectively reviewed. The CXI was calculated as the skeletal muscle index (SMI) × serum albumin/neutrophil-lymphocyte ratio (NLR). Although previous studies measured the SMI using the muscles of the L3 vertebral level, the present study used both the L3 vertebral muscles and the pectoralis muscles (PM) at the T4 vertebral level to measure the SMI. Depending on the type of muscles used, the CXI was termed the L3-CXI or PM-CXI. Using sex-specific cutoff values for CXI, the patients were categorized as follows: (i) high-CXI group (high L3-CXI and high PM-CXI), (ii) intermediate-CXI group (high L3-CXI and low PM-CXI), and (iii) low-CXI group (low L3-CXI and low PM-CXI). RESULTS Complete responses to R-CHOP were obtained in 145/173 (83.8%), 25/36 (69.4%), and 27/57 (47.4%) patients in the high-CXI, intermediate-CXI, and low-CXI groups, respectively (P < 0.001). Treatment-related anaemia (15.6%, 30.6%, and 26.3%, P = 0.038), thrombocytopenia (21.4%, 36.1%, and 43.9%, P < 0.001), febrile neutropenia (23.7%, 44.4%, and 36.8%, P = 0.022), and any nonhaematologic toxicity (31.2%, 44.4%, and 54.4%, P = 0.001) of Grade 3 or more were more common in the lower CXI groups than in the higher-CXI groups. Early treatment discontinuation for reasons other than lymphoma progression also occurred more frequently in the low-CXI group (24/57, 42.1%) compared with the intermediate-CXI (5/36, 13.9%) and high-CXI (18/173, 10.4%) groups (P < 0.001). Median overall survival in the high-CXI, intermediate-CXI, and low-CXI groups was not reached, 50.6 months, and 14.5 months, respectively (p < 0.001). Multivariable analysis showed that low CXI was an independent negative prognostic factor for overall survival (hazard ratio 2.103, 95% confidence interval 1.278-3.460, P = 0.003). CONCLUSIONS We suggest that in patients with diffuse large B-cell lymphoma, the CXI is a biomarker for cancer cachexia that can predict survival, treatment response, treatment-related toxicity, and compliance with R-CHOP. Patients were more clearly stratified by this new CXI category compared with the classifications described in previous studies.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Sungwoo Park
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Myoung Hee Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jung Hoon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
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Huang SF, Liu WC. A rare case of primary cutaneous diffuse large B-cell lymphoma, leg type, presenting as cellulitis: a case report. J Surg Case Rep 2021; 2021:rjab227. [PMID: 34104408 PMCID: PMC8177962 DOI: 10.1093/jscr/rjab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 02/05/2023] Open
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type, accounts for only 4% of all cutaneous lymphomas and bears a worse prognosis than other cutaneous B-cell lymphomas. Diagnosis at an early stage may be difficult due to its nonspecific manifestations. We report an 88-year-old female who was brought to our emergency department due to two rapidly growing painful skin lesions with local redness and swelling on her right lower leg. We performed incisional biopsy of the two right lower leg skin lesions and sent the specimens for histopathological examination. The pathological examination was compatible with diffuse large B-cell lymphoma. Primary cutaneous diffuse large B-cell lymphoma, leg type, is a rare condition that can present as skin cellulitis, thereby misleading clinicians and resulting in delayed treatment. This diagnosis should be considered when assessing skin lesions.
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Affiliation(s)
- Shih-Feng Huang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Chung Liu
- Correspondence address. No. 386, Ta-Chung 1st Rd., Kaohsiung, Taiwan. Tel: +886-7-3422121-3000; Fax: +886-7-3422288; E-mail:
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Messori A, Chiumente M, Mengato D. Axicabtagene ciloleucel in non-Hodgkin lymphoma: the restricted mean survival time as a tool for estimating progression-free life expectancy better than the median. Ther Adv Med Oncol 2020; 12:1758835920930643. [PMID: 32547648 PMCID: PMC7271675 DOI: 10.1177/1758835920930643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea Messori
- HTA Unit, Regional Health Service, Via San Salvi 12, Firenze, 50135, Italy
| | - Marco Chiumente
- Scientific Direction, Italian Society for Clinical Pharmacy and Therapeutics, Milano, Italy
| | - Daniele Mengato
- Department of Hospital Pharmacy, Bolzano Central Hospital, Bolzano, Italy
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12
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Yang CF, Hsiao LT, Chang HY, Hsu CY. Large B-cell lymphoma presenting primarily in bone marrow is frequently associated with haemophagocytic lymphohistiocytosis and has distinct cytogenetic features. Pathology 2020; 52:561-567. [PMID: 32561209 DOI: 10.1016/j.pathol.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 11/25/2022]
Abstract
The criteria for primary bone marrow large B-cell lymphoma (PBMLBCL) have not yet been clearly established. We aimed to investigate the clinicopathological features of PBMLBCLs (27 cases) and large B-cell lymphomas (LBCLs) with secondary marrow involvement (55 cases). PBMLBCL was defined as LBCLs presenting initially in bone marrow without lymphadenopathy, extramedullary tumour or localised bone tumour, and no evidence of transformation from low grade B-cell lymphoma. Compared with the patients in the secondary group, more patients in the primary group had haemophagocytic lymphohistiocytosis, cytogenetic aberrations, cytopenias, and atypical lymphocytes in peripheral blood. The most common chromosome abnormality in both groups was 6q deletion. The primary group had additional chromosome 10, 2, and 3 abnormalities. The acquired chromosome 10 aberration was associated with the risk of haemophagocytic lymphohistiocytosis. The 1-year survival rate was lower in the primary group than in the secondary group; however, the difference was not significant when the cases without chemotherapy plus rituximab were excluded. Moreover, multivariate analysis revealed that relatively high white blood cell count, not receiving chemotherapy plus rituximab, and cytogenetic aberrations were poor prognostic factors in the secondary group, but only not receiving chemotherapy plus rituximab was retained in the primary group. In conclusion, PBMLBCL is genetically and clinically distinct. Although patients with PBMLBCL generally have a poor outcome, the disease is treatable and some patients become long-term survivors.
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Affiliation(s)
- Ching-Fen Yang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Haemophilia Comprehensive Care Centre, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Chang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yi Hsu
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Yi J, Yi P, Wang W, Wang H, Wang X, Luo H, Fan P. A Multicenter Retrospective Study of 58 Patients With Primary Thyroid Diffuse Large B Cell Lymphoma. Front Endocrinol (Lausanne) 2020; 11:542. [PMID: 32982962 PMCID: PMC7483576 DOI: 10.3389/fendo.2020.00542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Primary thyroid diffuse large B cell lymphoma (DLBCL) is a rare type of extranodal lymphoma; optimal treatment methods and the key prognostic factors have not been established. Methods: The clinical data of 58 patients with primary thyroid DLBCL from January 2007 to December 2017 were collected. The Kaplan-Meier method and log-rank tests were used for the survival analysis. Cox regression analysis was performed to evaluate the prognostic factors. Results: The follow-up time was 6-120 months; 5-year overall survival (OS) and progression-free survival (PFS) were 73 and 61%, respectively. Single-factor analysis showed that IPI, Ki-67, treatment modalities, Hans classification, Myc/Bcl-2 protein co-expression, and administration of rituximab had a significant effect on the 5-year OS and PFS (P < 0.05), while age, sex, Bcl-2 protein expression, Myc protein expression, tumor stage, tumor size, Hashimoto's thyroiditis, and B symptoms were not associated with prognosis (P > 0.05). Multivariate risk regression analysis revealed that Myc/Bcl-2 protein co-expression, treatment modalities, and rituximab were independent prognostic factors (P < 0.05). Conclusions: Patients with primary thyroid DLBCL who received combination chemotherapy with radiotherapy had a better prognosis. Surgical treatment alone was not associated with the prognosis and is used only for diagnosis. Rituximab could improve the survival time of patients.
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Affiliation(s)
- Jianing Yi
- Surgical Department of Breast and Thyroid Gland, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China
| | - Pingyong Yi
- Department of Oncology, Changsha Kexin Cancer Hospital, Changsha, China
| | - Wei Wang
- Department of Oncology, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Huan Wang
- Surgical Department of Breast and Thyroid Gland, Xiangya Second Hospital of Central South University, Changsha, China
| | - Xinyu Wang
- Surgical Department, Xiangya Hospital of Central South University, Changsha, China
| | - Hanjia Luo
- Department of Oncology, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Peizhi Fan
- Surgical Department of Breast and Thyroid Gland, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China
- *Correspondence: Peizhi Fan
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Zhang Y, Bi L, Qiu Y, Zhao T, Cao M, Ding J, Meng F, Cai H. Primary pulmonary intravascular large B-cell lymphoma: A report of three cases and literature review. Oncol Lett 2018; 15:3610-3613. [PMID: 29467882 PMCID: PMC5796294 DOI: 10.3892/ol.2018.7753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/22/2017] [Indexed: 01/18/2023] Open
Abstract
The present study aimed to investigate the clinicopathological features of primary intravascular large B-cell lymphoma (IVLBCL) of the lung. The clinical and histopathological data of three patients, and the literature was reviewed. The Ethics Committees of Drum Tower Hospital approved the current study based on the three cases. Fever and respiratory symptoms were the main presenting symptoms. Serum lactate dehydrogenase and C-reactive protein were significantly increased. Diffuse ground glass opacities or nodular consolidations were seen on high resolution computed tomography. Lung biopsy revealed lymphoma cells in the lumen of small blood vessels. Tumor cells expressed cluster of differentiation 20 and melanoma associated antigen (mutated) 1. Primary pulmonary IVLBCL is extremely rare and its prognosis is poor. Full recognition of its clinical character and improvement of the diagnostic awareness may help to reduce missed diagnosis, and facilitate appropriate treatment.
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Affiliation(s)
- Yingwei Zhang
- Department of Respiratory Diseases, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Lintao Bi
- Department of Oncology and Hematology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130031, P.R. China
| | - Yuying Qiu
- Department of Respiratory Diseases, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Tingting Zhao
- Department of Respiratory Diseases, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Mengshu Cao
- Department of Respiratory Diseases, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Jingjing Ding
- Department of Respiratory Diseases, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Fanqing Meng
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Hourong Cai
- Department of Respiratory Diseases, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
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15
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Yoon N, Ahn S, Yong Yoo H, Jin Kim S, Seog Kim W, Hyeh Ko Y. Cell-of-origin of diffuse large B-cell lymphomas determined by the Lymph2Cx assay: better prognostic indicator than Hans algorithm. Oncotarget 2017; 8:22014-22022. [PMID: 28423544 PMCID: PMC5400642 DOI: 10.18632/oncotarget.15782] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/29/2017] [Indexed: 01/20/2023] Open
Abstract
Diffuse large B-cell lymphomas (DLBCLs) are clinically heterogeneous and need a biomarker that can predict the outcome of treatments accurately. To assess the prognostic significance of the cell-of-origin type for DLBCLs, we applied the Lymph2Cx assay using a NanoString gene expression platform on formalin-fixed paraffin wax-embedded pretreatment tissues obtained from 82 patients with de novo DLBCL, not otherwise specified. All patients were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) as the first line of chemotherapy. Based on the expression levels of Bcl-6, CD10, and MUM-1 measured by immunohistochemistry, cases were subdivided into germinal center B-cell (GCB) and non-GCB types according to the Hans algorithm. NanoString assay was performed on 82 cases. The Lymph2Cx assay successfully classified 82 cases into three categories: activated B-cell (ABC), GCB, and unclassified types. The concordance rate between the Lymph2Cx assay and the Hans algorithm was 73.6%. The Lymph2Cx-defined ABC type had significantly poorer outcomes compared with the GCB type (5-year overall survival, GCB vs. ABC, 96.6% vs. 77.1%, P = 0.020; 5-year disease-free survival, GCB vs. ABC, 96.6% vs. 79.2%, P = 0.018). In contrast, no significant differences were observed in survival between the two patient subgroups with DLBCL types classified by the Hans algorithm. The Lymph2Cx assay is a robust, reliable method for predicting the outcome of patients with DLBCL treated with R-CHOP chemotherapy.
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Affiliation(s)
- Nara Yoon
- Departments of Pathology, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Soomin Ahn
- Departments of Patholgy, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae Yong Yoo
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Suk Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kocurek A, Małkowski B, Giza A, Jurczak W. Primary mediastinal B-cell lymphoma - metabolic and anatomical features in 18FDG-PET/CT and response to therapy. Contemp Oncol (Pozn) 2016; 20:297-301. [PMID: 27688726 DOI: 10.5114/wo.2016.61849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Determining the role of PET/CT imaging in the evaluation of treatment efficacy in primary mediastinal B-cell lymphoma (PMBCL). Material and methods Retrospective analysis of seven PMBCL patients, treated at the University Hospital in Krakow, with interim PET/CT after the third course of chemo-immunotherapy.The analysis was based on the calculation of exact tumour volume and metabolic activity, compared with initial values (directly after diagnosis). Results Patients (five females, two males, average age 26.2 years, range 18–40 years), in clinical stage IIBX at diagnosis, were treated with eight cycles of R-CHOP-14 regimen, with radiotherapy consolidation (7/7) and central nervous system prophylaxis (6/7). The observed decrease in tumour volume between the initial staging and the interim PET ranged 72–89%. The mean ΔSUVmax reduction between initial (when available) and interim PET was 87% (range 84–89%). In 3/7 cases in the interim PET/CT, the uptake of the tumour was higher than the liver (Deauville Criteria score 4–5), and in 4/7 it was lower than the liver but higher than mediastinal blood pool structures (score 3 according to Deauville Criteria). After a median follow-up of 58 months – OS and EFS is 100%. Conclusions The excellent clinical outcome in the study group corresponds with very good metabolic and volumetric response in the interim PET. The ΔSUVmax seems to be easier in implementation and has a more significant impact than other measurements.
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Barton S, Hawkes EA, Cunningham D, Peckitt C, Chua S, Wotherspoon A, Attygalle A, Horwich A, Potter M, Ethell M, Dearden C, Gleeson M, Chau I. Rituximab, Gemcitabine, Cisplatin and Methylprednisolone (R-GEM-P) is an effective regimen in relapsed diffuse large B-cell lymphoma. Eur J Haematol 2015; 94:219-26. [PMID: 25039915 DOI: 10.1111/ejh.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with relapsed diffuse large B-cell lymphoma (DLBCL) have a poor prognosis. Gemcitabine, methylprednisolone, cisplatin +/- rituximab (GEM-P+/-R) is a salvage regimen with limited overlap in toxicity with first-line therapy and short duration of inpatient delivery. METHODS We assessed the efficacy and safety of GEM-P+/-R in a retrospective single-centre analysis including patients meeting criteria of ≥ 18 yr of age, histologically proven DLBCL, treated between 2001 and 2011 in second-line with gemcitabine 1000 mg/m(2) day 1, 8 and 15, methylprednisolone 1000 mg day 1-5, cisplatin 100 mg/m(2) day 15 (replaced with carboplatin AUC5 if contraindication/toxicity) +/- rituximab 375 mg/m(2) day 1 and 15, every 28 d. RESULTS Forty-five patients aged 25-74 received a median of three cycles of GEM-P+/-R; 64% received rituximab. In 44 evaluable patients receiving GEM-P+/-R, overall response rate (ORR) was 48%; in 28 evaluable patients treated with rituximab + GEM-P (R-GEM-P), ORR was 61%. With median follow-up of 50.5 months (95% CI: 28.3-72.7), 3-yr overall survival (OS) from start of GEM-P+/-R was 31.4% (95% CI: 16.5-46.3); in patients treated with R-GEM-P, 3-yr OS was 49.1% (95% CI: 28.7-69.5). Predominant grade ≥ 3 toxicities were haematological; thrombocytopenia 69%, neutropenia 60% and febrile neutropenia 7%. CONCLUSION R-GEM-P is a deliverable regimen with useful activity in second-line treatment of DLBCL. Our data suggest that rituximab should be given concurrently.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols
- Carboplatin/administration & dosage
- Carboplatin/adverse effects
- Cisplatin/administration & dosage
- Cisplatin/adverse effects
- Deoxycytidine/administration & dosage
- Deoxycytidine/adverse effects
- Deoxycytidine/analogs & derivatives
- Drug Administration Schedule
- Drug Substitution
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Methylprednisolone/administration & dosage
- Methylprednisolone/adverse effects
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/pathology
- Recurrence
- Retrospective Studies
- Rituximab
- Salvage Therapy/methods
- Survival Analysis
- Thrombocytopenia/chemically induced
- Thrombocytopenia/pathology
- Treatment Outcome
- Gemcitabine
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Affiliation(s)
- Sarah Barton
- The Royal Marsden NHS Foundation Trust, London, Surrey, UK
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Williams JN, Rai A, Lipscomb J, Koff JL, Nastoupil LJ, Flowers CR. Disease characteristics, patterns of care, and survival in very elderly patients with diffuse large B-cell lymphoma. Cancer 2015; 121:1800-8. [PMID: 25675909 DOI: 10.1002/cncr.29290] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/03/2015] [Accepted: 01/12/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered standard therapy for diffuse large B-cell lymphoma (DLBCL), patterns of use and the impact of R-CHOP on survival in patients aged >80 years are less clear. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to characterize presentation, treatment, and survival patterns in patients with DLBCL who were diagnosed between 2002 and 2009. Chi-square tests compared characteristics and initial treatments among patients with DLBCL who were aged >80 years and ≤80 years. Multivariable logistic regression models examined factors associated with treatment selection in patients aged >80 years; standard and propensity score-adjusted multivariable Cox proportional hazards models examined relationships between treatment regimen, treatment duration, and survival. RESULTS Among 4635 patients with DLBCL, 1156 (25%) were aged >80 years. Patients aged >80 years were less likely to receive R-CHOP and more likely to be observed or receive the combination of rituximab, cyclophosphamide, vincristine, and prednisone (P<.0001 for both). Marital status, stage of disease, disease site, performance status, radiotherapy, and growth factor support were associated with initial R-CHOP in patients aged >80 years. In propensity score-matched multivariable Cox proportional hazards models examining relationships between treatment regimen and survival, R-CHOP was the only regimen found to be associated with improved overall survival (hazard ratio, 0.45; 95% confidence interval, 0.33-0.62) and lymphoma-related survival (hazard ratio, 0.58; 95% confidence interval, 0.38-0.88). CONCLUSIONS Although patients with DLBCL who were aged >80 years were less likely to receive R-CHOP, this regimen conferred the longest survival and should be considered for this population. Further studies are needed to characterize the impact of treatment of DLBCL on quality of life among patients in this age group.
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Affiliation(s)
| | - Ashish Rai
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jean L Koff
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Loretta J Nastoupil
- Division of Cancer Medicine, Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chen Y, Ding C, Lin Q, Yang K, Li Y, Chen S. Primary intravascular large B-cell lymphoma of the lung: a review and case report. J Thorac Dis 2014; 6:E242-5. [PMID: 25364541 DOI: 10.3978/j.issn.2072-1439.2014.08.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/14/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the clinicopathological features of primary intravascular large B-cell lymphoma (IVLBCL) of the lung. METHODS Histopathological and clinical data based on lung biopsy were analyzed and used to diagnose a patient with IVLBCL of the lung. RESULTS Fever and respiratory symptoms were the main presentations, lung biopsy revealed lymphoma cells in the lumen of small blood vessels. Tumor cells expressed Bcl-2, the Bcl-6, CD20, Ki67, MUM-1, Pax5, CD, CD30, and vascular endothelial CD34. CONCLUSIONS Primary pulmonary IVLBCL of the lung is extremely rare, on chest CT it manifests as diffuse ground glass shadow, or nodular consolidations in the lung, lactate dehydrogenase and C-reactive protein was found to increase, fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is an important and significant diagnostic modality in its early diagnosis. Also, bronchial lung biopsy has the advantage of less trauma and high sensitive rate. R-CHOP is the main treatment for lung primary pulmonary IVLBCL of the lung; however, its prognosis is relatively poor.
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Affiliation(s)
- Yanfan Chen
- 1 Department of Respiration, Zhejiang Chinese Medical University, Hangzhou 310000, China ; 2 Department of Respiration, 3 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Cheng Ding
- 1 Department of Respiration, Zhejiang Chinese Medical University, Hangzhou 310000, China ; 2 Department of Respiration, 3 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Quan Lin
- 1 Department of Respiration, Zhejiang Chinese Medical University, Hangzhou 310000, China ; 2 Department of Respiration, 3 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Kaiyan Yang
- 1 Department of Respiration, Zhejiang Chinese Medical University, Hangzhou 310000, China ; 2 Department of Respiration, 3 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yuping Li
- 1 Department of Respiration, Zhejiang Chinese Medical University, Hangzhou 310000, China ; 2 Department of Respiration, 3 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shaoxian Chen
- 1 Department of Respiration, Zhejiang Chinese Medical University, Hangzhou 310000, China ; 2 Department of Respiration, 3 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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Oh DH, Ghosh S, Chua N, Kostaras X, Tilley D, Chu M, Owen CJ, Stewart DA. Comparative effectiveness analysis of different salvage therapy intensities used for diffuse large B-cell lymphoma in Northern or Southern Alberta: an instrumental variable analysis. Leuk Lymphoma 2014; 56:1756-62. [PMID: 25284495 DOI: 10.3109/10428194.2014.971409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To date, no clinical trial has addressed salvage therapy intensity for relapsed/refractory diffuse large B-cell lymphoma (DLBCL). We sought to determine whether the more intensive salvage chemotherapy approach used in Southern Alberta (SAB) compared to the conventional dose salvage approach used in Northern Alberta (NAB) affects the rates of autologous stem cell transplant (ASCT) and survival in patients with relapsed DLBCL. Using instrumental variable analysis, we examined 147 consecutive patients with relapsed/refractory DLBCL from 2004 to 2010 who received salvage therapy in SAB (n = 70) or NAB (n = 77). Patients treated in SAB had higher rates of: salvage chemotherapy response (85.0% vs. 54.0%, p = 0.001), ASCT (61.4% vs. 41.6%, p = 0.016) and 4-year overall survival (41% vs. 20%, p = 0.002) than those in NAB, respectively. This study supports the hypothesis that selective use of intensive salvage chemotherapy leads to higher rates of ASCT and survival in this population.
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Affiliation(s)
- Danielle H Oh
- Department of Oncology and Medicine, University of Calgary, Tom Baker Cancer Centre , Calgary, AB , Canada
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Shin HJ, Lee WS, Lee HS, Kim H, Lee GW, Song MK, Kim JS, Yhim HY, Chung JS. Busulfan-containing conditioning regimens are optimal preparative regimens for autologous stem cell transplant in patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2014; 55:2490-6. [PMID: 24432893 DOI: 10.3109/10428194.2014.882504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We retrospectively examined the outcomes of 56 patients with diffuse large B-cell lymphoma (DLBCL) who underwent autologous stem cell transplant (ASCT) with BEAM/BEAC (carmustine, etoposide, cytarabine, melphalan/cyclophosphamide) or busulfan (Bu)-containing conditioning regimens. The Bu group had lower disease-related mortality and more frequent achievement of complete remission (CR) after ASCT from partial remission (PR) or refractory status before ASCT compared with the BEAM/BEAC group. The estimated 2-year EFS (59.3% vs. 15.0%) and overall survival (OS) (70.2% vs. 42.0%) in pre-ASCT rituximab-exposed patients with DLBCL were higher in the Bu group. In patients with high-risk DLBCL exposed to rituximab with first remission, the Bu group had better EFS (p = 0.004) and OS (p = 0.053) rates, while survival rates for relapsed/refractory patients did not differ between groups. Bu regimens are highly effective for preparing patients with DLBCL with previous exposure to rituximab for ASCT, especially in high-risk patients who achieved a first remission.
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Affiliation(s)
- Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute, Pusan National University Hospital , Busan , Korea
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