CD10 and Bcl-2 expression combined with the International Prognostic Index can identify subgroups of patients with diffuse large-cell lymphoma with very good or very poor prognoses

PURPOSE: To evaluate clinical outcome of patients with limited-stage diffuse large-cell lymphoma (DLCL) treated with three cycles of chemotherapy followed by involved-region irradiation (IRRT). PATIENTS AND METHODS: Adults with limited-stage DLCL were treated with brief doxorubicin-containing chemotherapy regimens between 1980 and 1998. IRRT was administered 3 to 4 weeks after the third chemotherapy treatment in a dose equivalent to 30 Gy in 10 fractions. RESULTS: Three hundred and eight patients (median age, 64 years) were included, and 299 experienced complete remission. After a median follow-up of 86 months, 64 patients developed progressive disease, and 104 patients died (43 from lymphoma, three from toxicity, and 58 from other causes). Actuarial overall and progression-free survival (PFS) rates were, respectively, 80% and 81% at 5 years and 63% and 74% at 10 years. For subgroups identified using the Miller modification of the International Prognostic Index (IPI), the overall survival rates at 5 and 10 years were, respectively, 97% and 89% (no factors), 77% and 56% (one or two factors), and 58% and 48% (three or four factors), and the 5-year and 10-year PFS rates were, respectively, 94% and 89% (no factors), 79% and 73% (one or two factors), and 60% and 50% (three or four factors). Men with testicular presentation, had a definitely inferior outcome. CONCLUSION: Long-term outcome with three cycles of doxorubicin-based chemotherapy and IRRT confirms that this is a successful approach for the majority of patients with limited-stage DLCL. Subgroups with worse prognoses can be identified, and these patients should be offered alternative treatment approaches.

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Predictive value for survival of a risk model of two serological markers, beta-2-microglobulin (B2M) and lactic dehydrogenase (LDH), in diffuse large cell lymphoma (DLCL)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.10599 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 10599-10599

Author(s):

M. A. Rodriguez ◽

S. Temple ◽

L. Fayad ◽

F. Hagemeister ◽

P. McLaughlin ◽

...

Keyword(s):

Risk Model ◽

Factor Model ◽

Cell Lymphoma ◽

International Prognostic Index ◽

Significant Risk ◽

Prognostic Index ◽

Large Cell ◽

Prognostic Indicator ◽

Diffuse Large Cell Lymphoma ◽

Large Cell Lymphoma

10599 Background: The International Prognostic Index (IPI), the standard tumor risk model in patients (pts) with diffuse large cell lymphoma (DLCL), has 5 factors (age, LDH, performance status, extra nodal sites, and stage). We previously proposed a simpler two-factor model, based on LDH and B2M (JCO10;1989). B2M is a component of HLA class I antigens, expressed in lymphocytes, and a known prognostic indicator in some lymphoid malignancies. The benefits of this model are: objective measures; lab method widely available; simplicity; biologic marker. Methods: We applied the model to a large cohort of DLCL patients with prospective baseline B2M, and treated with doxorubicin-based (chemo) regimens, with and without rituximab. 718 pts with DLCL were sequentially treated at MDACC by IRB approved chemo protocols from 1988–2000. In 2001, rituximab plus chemo (RCHOP) became standard. 311 DLCL pts were sequentially treated with RCHOP from 2001–2005. Cox regression analyses for univariate and multivariate models of IPI factors and B2M were done. Kaplan-Meier survival projections were in three risk categories: low (normal [nl] LDH and B2M); intermediate (either LDH or B2M > nl); or high (LDH and B2M > nl). Results: In both treatment groups, IPI factors and B2M were significant as univariate factors. In the RCHOP group, however, the IPI multivariate model showed age, stage, and extra-nodal sites were not significant risk factors, while B2M and LDH remained highly significant (p<0.01). The 5 year survival projections by risk category were: (*) combines intermediate low and intermediate-high categories Conclusions: This simple two-factor model predicts risk for patients with DLCL, treated with or without rituximab, comparably to the IPI. B2M should be considered an important prognostic indicator in DLCL, particularly in rituximab treated patients. Exploratory analyses to revise the IPI model are indicated. [Table: see text] No significant financial relationships to disclose.

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Follicular Large Cell Lymphoma: An Aggressive Lymphoma That Often Presents With Favorable Prognostic Features

Blood ◽

10.1182/blood.v93.7.2202 ◽

1999 ◽

Vol 93 (7) ◽

pp. 2202-2207 ◽

Cited By ~ 44

Author(s):

J. Rodriguez ◽

P. McLaughlin ◽

F.B. Hagemeister ◽

L. Fayad ◽

M.A. Rodriguez ◽

...

Keyword(s):

Clinical Features ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

International Prognostic Index ◽

Prognostic Index ◽

Large Cell ◽

Score System ◽

Prognostic Features ◽

Aggressive Lymphomas ◽

Large Cell Lymphoma

Abstract It is debated whether follicular large cell lymphoma (FLCL) has a clinical behavior that is distinct from indolent follicular lymphomas, and whether there is a subset of patients who can be potentially cured. We report here our experience with 100 FLCL patients treated at our institution since 1984 with three successive programs. We evaluated the predictive value of pretreatment clinical features, including two risk models, the Tumor Score System and the International Prognostic Index (IPI). With a median follow-up of 67 months, the 5-year survival is 72% and the failure-free survival (FFS) is 67%, with a possible plateau in the FFS curve, particularly for patients with stage I-III disease. Features associated with shorter survival included age ≥60, elevated lactic dehydrogenase (LDH) or beta-2-microglobulin (β2M), advanced stage, and bone marrow involvement. Stage III patients had significantly better survival than stage IV patients (P < .05). By the IPI and Tumor Score System, 80% of the patients were in the lower risk groups; both systems stratified patients into prognostic groups. Patients with FLCL have clinical features and response to treatment similar to that reported for diffuse large cell lymphoma. Prognostic risk systems for aggressive lymphomas are useful for FLCL. A meaningful fraction of patients may possibly be cured when treated as aggressive lymphomas.

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Is CONUT Score a Prognostic Index in Patients with Diffuse Large Cell Lymphoma?

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-2101-406 ◽

2021 ◽

Keyword(s):

Cell Lymphoma ◽

Prognostic Index ◽

Large Cell ◽

Diffuse Large Cell Lymphoma ◽

Large Cell Lymphoma ◽

Conut Score

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Diffuse Large-Cell Lymphoma of the Testis

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.9.2854 ◽

1999 ◽

Vol 17 (9) ◽

pp. 2854-2854 ◽

Cited By ~ 63

Author(s):

Carlo Tondini ◽

Andrés J.M. Ferreri ◽

Licia Siracusano ◽

Pinuccia Valagussa ◽

Roberto Giardini ◽

...

Keyword(s):

Cell Lymphoma ◽

Systemic Disease ◽

International Prognostic Index ◽

Large Cell ◽

High Dose ◽

Diffuse Large Cell Lymphoma ◽

Contralateral Testis ◽

Limited Stage ◽

Ann Arbor ◽

Large Cell Lymphoma

PURPOSE: To evaluate clinical outcome of patients with testicular diffuse large-cell lymphoma treated with conventional-dose systemic chemotherapy. PATIENTS AND METHODS: This study is a retrospective analysis of adult patients with testicular diffuse large-cell lymphoma who were treated with a doxorubicin-based chemotherapy regimen at our institution, the Istituto Nazionale Tumori of Milan. Twenty-nine assessable patients, with a median age of 61 years, were identified. Sixteen patients had limited stage (Ann Arbor stage I/II) disease, whereas 13 patients had a testicular mass and distant organ involvement (Ann Arbor stage IV). Patients were retrospectively classified according to the International Prognostic Index. RESULTS: After a median follow-up of 82 months, 22 patients presented disease progression and 22 patients had died. Actuarial median time to treatment failure and overall survival were 44 and 41 months for patients with limited stage and 9 and 16 months for patients with advanced stage, respectively. Eight patients failed initial treatment, and 14 patients relapsed from clinical remission after a median disease-free time of 17 months (range, 6 to 98 months). Median survival time after progression of lymphoma was 5 months (range, 0 to 22 months). In nine (41%) of the 22 failing patients, the initial site of relapse was either the CNS or the contralateral testis; the remaining patients experienced relapse in multiple extranodal sites. CONCLUSION: Poor prognosis of patients with diffuse large-cell lymphoma calls for more effective treatment strategies, such as high-dose chemotherapy programs for younger patients or specifically designed chemotherapy regimens for patients not suitable for high-dose treatment, with the purpose to provide control of both systemic disease and disease of the CNS and contralateral testis. The potential benefit of contralateral testicular irradiation has to be taken into account in the treatment planning.

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Follicular Large Cell Lymphoma: An Aggressive Lymphoma That Often Presents With Favorable Prognostic Features

Blood ◽

10.1182/blood.v93.7.2202.407a07_2202_2207 ◽

1999 ◽

Vol 93 (7) ◽

pp. 2202-2207

Author(s):

J. Rodriguez ◽

P. McLaughlin ◽

F.B. Hagemeister ◽

L. Fayad ◽

M.A. Rodriguez ◽

...

Keyword(s):

Clinical Features ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

International Prognostic Index ◽

Prognostic Index ◽

Large Cell ◽

Score System ◽

Prognostic Features ◽

Aggressive Lymphomas ◽

Large Cell Lymphoma

It is debated whether follicular large cell lymphoma (FLCL) has a clinical behavior that is distinct from indolent follicular lymphomas, and whether there is a subset of patients who can be potentially cured. We report here our experience with 100 FLCL patients treated at our institution since 1984 with three successive programs. We evaluated the predictive value of pretreatment clinical features, including two risk models, the Tumor Score System and the International Prognostic Index (IPI). With a median follow-up of 67 months, the 5-year survival is 72% and the failure-free survival (FFS) is 67%, with a possible plateau in the FFS curve, particularly for patients with stage I-III disease. Features associated with shorter survival included age ≥60, elevated lactic dehydrogenase (LDH) or beta-2-microglobulin (β2M), advanced stage, and bone marrow involvement. Stage III patients had significantly better survival than stage IV patients (P < .05). By the IPI and Tumor Score System, 80% of the patients were in the lower risk groups; both systems stratified patients into prognostic groups. Patients with FLCL have clinical features and response to treatment similar to that reported for diffuse large cell lymphoma. Prognostic risk systems for aggressive lymphomas are useful for FLCL. A meaningful fraction of patients may possibly be cured when treated as aggressive lymphomas.

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Prognostic Factors in HIV-Related Diffuse Large-Cell Lymphoma: Before Versus After Highly Active Antiretroviral Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.9355 ◽

2005 ◽

Vol 23 (33) ◽

pp. 8477-8482 ◽

Cited By ~ 84

Author(s):

Soon-Thye Lim ◽

Roksana Karim ◽

Anil Tulpule ◽

Bharat N. Nathwani ◽

Alexandra M. Levine

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Cell Lymphoma ◽

International Prognostic Index ◽

Large Cell ◽

Diffuse Large Cell Lymphoma ◽

Highly Active ◽

Large Cell Lymphoma

Purpose To compare the prognostic factors for survival and the validity of the International Prognostic Index (IPI) in patients with HIV-related diffuse large-cell lymphoma (HIV-DLCL) treated with curative intent in the pre–highly active antiretroviral therapy (HAART) era versus the HAART era. Patients and Methods We retrospectively reviewed 192 patients with HIV-DLCL diagnosed from 1982 to 2003. Pre-HAART era included 120 patients who did not receive HAART, whereas the HAART era included 72 patients diagnosed after January 1997 who received HAART. Results There were no statistically significant differences in terms of either lymphoma or HIV-related characteristics in the two time periods. The complete response rate improved from 32% in the pre-HAART to 57% in the HAART era (P = .0006), and median survival time improved from 8.3 to 43.2 months (P = .0005). In groups with low-, low-intermediate–, and high-intermediate–risk IPI disease, 3-year overall survival rates were 20%, 22%, and 5% in the pre-HAART era and 64%, 64%, and 50% in the HAART era, respectively. On multivariate analysis, factors independently associated with decreased survival in both periods were increasing IPI scores and failure to attain complete remission, whereas CD4 less than 100 cells/μL predicted shorter survival in only the pre-HAART era. Conclusion Prognostic factors and overall survival of patients with HIV-DLCC have changed. Clinical outcomes in patients with HIV-DLCL are now approaching the outcomes of patients with de novo lymphoma.

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