False-negative FDG-PET in histologically proven extensive large cell bone marrow involvement in diffuse large B-cell lymphoma

PURPOSE The aims of this study were as follows: (1) to analyze clinical, histopathologic characteristics, treatment outcome, and prognostic factors of patients with follicular large-cell lymphoma (FLCL); and (2) to compare them with those of patients with diffuse large B-cell lymphoma (DLCL) treated in the same therapeutic trial. PATIENTS AND METHODS Eighty-nine FLCL patients who were histologically reviewed and who received an intensive chemotherapy regimen according to the LNH 87 protocol were analyzed and compared with 1,096 B-cell DLCL patients included in the same protocol. RESULTS After intensive induction treatment, 59 patients (67%) achieved a complete remission [CR]. Estimated 5-year survival was 59%, and estimated 5-year freedom from progression (FFP) was 39%. Prognostic factors associated with shorter FFP were age greater than 60 years (P = .02), advanced clinical stage (P = .01), abnormal lactic dehydrogenase (LDH) level (P = .02), abnormal beta-2 microglobulin (P = .02), B symptoms (P = .03), bone marrow involvement (P = .04), and high expression of bcl-2 protein (P = .05). When compared with B-cell DLCL patients, FLCL patients were younger (P = .02), had a better Eastern Cooperative Oncology Group (ECOG) status (P = .05), less bulky mass (P = .04), more advanced clinical stages (P < .001), and more bone marrow involvement (P = .02). No significant difference was observed between FLCL and DLCL patients for response to therapy (67% v 67% of CR), 5-year overall survival (58% v 51%), 5-year disease-free survival (53% v 57%), or FFP survival (39% v 43%). CONCLUSION FLCL patients have a favorable response rate and survival when treated with intensive chemotherapy. Their outcome is similar to that of B-cell DLCL patients, and a long-term FFP is observed for a substantial number of patients. Some adverse prognostic factors (including those of the International Prognostic Index, bone marrow involvement, and beta-2 microglobulin) have been identified to define a subset of patients who require other therapeutic approach.

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Occult bone marrow involvement in patients with diffuse large B-cell lymphoma: results of a pilot study

Pathology ◽

10.1080/00313020701684417 ◽

2007 ◽

Vol 39 (6) ◽

pp. 580-585 ◽

Cited By ~ 14

Author(s):

Dipti Talaulikar ◽

Jane E. Dahlstrom ◽

Bruce Shadbolt ◽

Michelle McNiven ◽

Amy Broomfield ◽

...

Keyword(s):

Bone Marrow ◽

Pilot Study ◽

B Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Cytomorphology and Molecular Characterization of CLTC-ALK Rearrangement in 2 Cases of ALK-Positive Diffuse Large B-cell Lymphoma with Extensive Bone Marrow Involvement

Annals of Laboratory Medicine ◽

10.3343/kjlm.2008.28.2.89 ◽

2008 ◽

Vol 28 (2) ◽

pp. 89-94 ◽

Cited By ~ 5

Author(s):

Hee-Suk Choung ◽

Hee-Jin Kim ◽

Won-Seog Kim ◽

Kihyun Kim ◽

Sun-Hee Kim

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

Alk Rearrangement ◽

Large B Cell Lymphoma ◽

Alk Positive ◽

Large B Cell

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Reply: Critical Views on the Prognostic Potential and Interpretation of Bone Marrow 18F-FDG PET in Diffuse Large B-Cell Lymphoma

Journal of Nuclear Medicine ◽

10.2967/jnumed.114.150086 ◽

2014 ◽

Vol 56 (1) ◽

pp. 164-164 ◽

Cited By ~ 2

Author(s):

J. J. Cerci ◽

S. Fanti ◽

F. Redondo ◽

T. Gyorke ◽

R. Carr

Keyword(s):

Bone Marrow ◽

B Cell ◽

Fdg Pet ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

18F Fdg ◽

Large B Cell

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High-Grade Diffuse Large B-Cell Lymphoma in Elderly Patients: Russian Multicenter Trial Results in R-EPOCH/R-HMA Protocol

Blood ◽

10.1182/blood.v128.22.5386.5386 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5386-5386

Author(s):

Olga A. Gavrilina ◽

Eugene E. Zvonkov ◽

Elena N. Parovichnikova ◽

Nelly G. Gabeeva ◽

Vera V. Troitskaya ◽

...

Keyword(s):

Bone Marrow ◽

Elderly Patients ◽

B Cell ◽

Older Patients ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

High Grade ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background: The number of elderly patients with diffuse large B-cell lymphoma (DLBCL) in our aging society continues to rise. Median of age for patients with diffuse large B-cell lymphoma (DLBCL) is 60. Approximately 50% of older patients with DLBCL are defined as high-grade by IPI and these forms are characterized by aggressive course and poor response to standard chemotherapy (CT). Intensive protocols cannot be performed due to their toxicity for older patients with comorbidity. Addition of R-HMA to R-DA-EPOCH favourably changes the outcome in patients with untreated high-grade diffuse large B-cell lymphoma and didn't have higher toxicity [ASH 2015 # 2708]. Aim: To evaluate the efficacy and toxicity of R-EPOCH/R-HMA protocol in older patients with untreated high-grade diffuse large B-cell lymphoma. Patients and Methods: 19 untreated older DLBCL patients from 4 centers were enrolled in a prospective study between August 2013 - July 2016; stage II-IV; ECOG 0-3; median age 66 years (60-78); age ≥70y/60<70y 21%/79%; M/F 52%/48%; IPI: 52% high-intermediate and 48% high risk; 26% with bone marrow involvement. Severe comorbidity was diagnosed in 8 (42%) patients (coronary heart disease, hypertonic disease, chronic obstructive pulmonary disease and arrhythmia). All patients underwent 4-6 courses (2-3 cycles) of chemotherapy: R-EPOCH (standard dose and scheme), R-HMA (R 375 mg/m2 d1, MTX 500 mg/m2 24 hours d 2, AraC 1000 mg/m2 q 12 hrs d 3-4). In 3 cases of DLBCL with bone marrow involvement BEAM conditioning and autologous stem cell transplantation were applied. Results: The median follow-up is 18 months (3-37). There was no mortality associated with toxicity. The main non-hematological toxicities of R-HMA were infections (mucositis, pneumonia, sepsis, enteropathy) grades 1-2 and 3-4 in 90% and 10%, respectively. Hematological toxicity grade 4 for less than 4 days we observed only after courses R-HMA. Complete remission (CR) was achieved in 18 (100%) patients and 1 patient in the treatment now. There are four failures in patients older than 60 years: three relapses (after 6 and two after 14 month CR) and one death after 7 month CR by reasons not related with DLBCL. With a median follow 18 months overall and event-free survival of 19 older patients constituted 93,8% and 75,9%, respectively (Fig.1). There is no difference in older patients according to stage, IPI, LDH level, ECOG status for OS and EFS. So the combination of R-EPOCH/R-HMA may be considered as optimal intensive approach in older patients. Conclusions: TheR-EPOCH/R-HMA protocol demonstrated acceptable toxicity and high efficacy in older patients with high-grade DLBCL. Figure 1 Overall (A) and Event-free (B) survival in elderly patients with DLBCL. Figure 1. Overall (A) and Event-free (B) survival in elderly patients with DLBCL. Disclosures No relevant conflicts of interest to declare.

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