scholarly journals Secondary Skin Involvement in Non-Hodgkin's Lymphoma Does Not Impact Outcomes: SEER Database Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2895-2895
Author(s):  
Arushi Khurana ◽  
Taha Al-Juhaishi ◽  
Danielle Shafer
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
B Cell ◽  
Cell Population ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Secondary Site ◽  
Seer Database ◽  
Skin Involvement ◽  
Non Hodgkin's Lymphoma

Abstract Background: Non-Hodgkin's Lymphoma (NHL) comprises a diverse group of malignancies with varied presentations and clinical behavior. Different prognostic factors have been defined including age, LDH, gender, CNS involvement and molecular/genetic characteristics. We aim to study the incidence and impact of skin involvement as a secondary site in patients with mature B and T-cell NHLs. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with mature B/T/NK-cell NHL with skin as secondary site of involvement between 1973 and 2014. B-cell and T-cell lymphomas of all stages were included. Overall survival (OS) was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Results: Total of 6429 patients were included with secondary skin involvement. B-cell NHL was more common with 76%. Median age for B-cell and T-cell NHL was 65 years (48-82), and 64 years (46-82), respectively. Slight male preponderance was noted in both subtypes (B-cell-56.7%% and T-cell-61.7%). Diffuse large B cell lymphoma (DLBCL) was the most common histology among B-cell NHLs, (DLBCL, N=1920 39.6%), followed by follicular (FL, N=1381, 28.5%) and extra nodal marginal zone (EN MZL, N=1314, 27.1%) Among T cell NHL histologies, peripheral T-cell NOS was the most common (PTCL, N=819, 51.6%) followed by anaplastic large cell ALK+ (ALCL+, N=341, 21.5%), and Sezary syndrome (N=293, 18.5%) Median overall survival was 6.1 [5.2 - 7.2.; 95% CI] years in T-cell population compared to B-cell population which was 13.3 [12.6-14.0; 95% CI] years. Survival was different by histologic subtype and correlated with SEER database relative survival for the overall population described in the SEER Cancer Statistics Review 1973-2011. Conclusion:- Skin involvement is relatively common in both B and T-cell NHLs. DLBCL, FL, MZL, PTCL-NOS and ALCL+ are the more commonly involved subtypes, correlating with their relative incidences. Outcomes in patients with secondary skin involvement tends to mimic known survival patterns in different histological subtypes conferring no additional prognostic significance. Skin as an extra nodal site of involvement should not change management for these patients. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Population-Based Study of Prognosis and Survival in Primary Hepatobiliary Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4863-4863
Author(s):  
Ariel Sindel ◽  
Taha Al-Juhaishi ◽  
Roy Sabo ◽  
Victor Youssef Yazbeck
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
B Cell ◽  
Survival Time ◽  
Hodgkin’S Lymphoma ◽  
Median Overall Survival ◽  
Hodgkin's Lymphoma ◽  
Seer Database ◽  
Stage 1 ◽  
End Results

Abstract Background: Primary Hepatobiliary Lymphoma (PHBL) is a rare disease. In review of the literature, there are only few retrospective studies. On prior studies, the median age at presentation was 62 years and was associated with a median overall survival of 162 months. In this study, we sought to characterize standard prognostic factors and their effects on overall survival utilizing the Surveillance, Epidemiology and End Results (SEER) database. Methods The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients diagnosed with PHBL between 1973 and 2014. B-Cell and T-Cell lymphomas of all stages were included. Patient characteristics and demographics are summarized. Overall survival (OS) was estimated using the Kaplan-Meier method for all patients and for sub-groups. Comparisons are made between the survival functions between the levels of these categorical measurements using the log-rank test, where we adjust the significance level to account for multiple comparisons using the Bonferroni correction. Results: A total of 1751 patients were included. The mean age was 64 years (2-97), with the majority of patients being male (n=1081, 62%) and Caucasian (n=1278, 73%). B-cell Non-Hodgkin's Lymphoma was the predominant lymphoma (n=1297, 75%), followed by Not Otherwise Specified (n=338, 19%), and T-cell NHL and Hodgkin's Lymphoma were nearly identical at n=54 and 50 respectively. Staging at presentation varied with the majority being 1 and 4 (n=703, 40% and n=698, 40%), this was followed by stage 2 (n=196, 11%). The median overall survival time was 16 months (95% CI; 12, 23). By diagnoses, the median survival time (Figure 1) for B-Cell NHL was 23 months (95% CI; 17, 33) and was significantly longer survival than patients with T-Cell NHL (1 month, 95% CI; 0, 8, p=0.0014) and NOS (9 months, 95% CI; 6, 12, p=0.0076) but was not significantly different than patients with Hodgkin's Lymphoma (12 months, 95% CI; 1, 71 p=0.15). By staging, patients with stage 1 (38 months, 95% CI; 24, 52) did not have a statistically significant difference in survival in comparison to stage 2 (15 months, 95% CI; 9, 48, p=0.85) or 3 (10 months, 95% CI; 2, 34, p=0.0173). Results were not statistically significant regarding gender nor ethnicity. On a multivariant analysis, surgery, chemotherapy, or radiation were all associated with better survival when adjusted for patient age, sex, race, disease type and cancer stage. However, there did not appear to be a statistical significance when compared to each other. Conclusion PHBL is a rare lymphoma affecting mostly elderly, Caucasian males. B-Cell NHL subtype and stage 1 were associated with a more favorable prognosis. However, compared to DLBCL, PHBL seem to have a poorer outcome. While treatment alone conferred a longer survival, the type of treatment option did not have an overall change to prognosis. Disclosures No relevant conflicts of interest to declare.

High-dose intense doxorubicin-based regimens in aggressive non-Hodgkin's lymphoma: A systematic overview

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19528-e19528
Author(s):  
H. A. Azim ◽  
R. A. Malek ◽  
L. Santoro ◽  
S. Gandini ◽  
R. G. Bociek ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Randomized Trials ◽  
Outcome Measure ◽  
Chemotherapy Regimen ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

e19528 Background: Aggressive non-Hodgkin's lymphoma represents around 60% of lymphomas in the Western world and even more in Egypt. CHOP has been long been recognized as the standard chemotherapy regimen in this disease. The addition of rituximab (R) to CHOP in the treatment of B-cell subtypes has resulted in a significant improvement in all treatment endpoints. Nevertheless, still a significant fraction of patients in the developing world are not offered R due to economical reasons. Thus CHOP is still offered to these patients as well as those with T-cell subtypes. Data from the early 1990s have suggested that the dose intensity (DI) of doxorubicin may have a prognostic value. Hence we conducted a metaanalysis on chemotherapy regimens incorporating higher DI doxorubicin and compare them to CHOP in terms of complete response (CR) rate, event free survival (EFS) and overall survival (OAS). Methods: A MEDLINE and COCHRANE library search was performed using the search terms ‘CHOP‘, ‘lymphoma‘ and ‘randomized trials‘. Eligible trials were randomized trials, having CHOP as a control arm and any chemotherapy regimen administering doxorubicin at a higher DI than that of CHOP (16mg/m2/week) as the investigational arm. Pooling of data was performed using the mixed effect model. The outcome measure for pooling the CR rate was the odds ratio (OR) while the hazard ratio (HR) was the outcome measure for EFS and OAS. Confidence intervals were estimated according to the method developed by Parmar. Results: Eight trials published until February 2008 met the inclusion criteria. They included 3,668 patients randomly assigned to either CHOP (1,660 patients) or DI doxorubicin-based regimen (2008 patients). Patients receiving DI doxorubicin-based regimen had a significantly better overall survival (HR; 0.79; 95% CI: 0.66–0.94). As for the EFS and CR analyses, there was a trend in favor of patients who received the DI regimens; however the difference was not statistically significant (HR: 0.86; 95% CI: 0.71–1.03 & OR: 0.8; 95% CI: 0.63–1.02 respectively). Conclusions: High DI doxorubicin-based regimens are associated with a better OAS compared to CHOP. Such approach should be considered in patients with aggressive B-cell lymphomas not offered R as well as those with T-cell lymphomas. No significant financial relationships to disclose.

scholarly journals Prognostic significance of bcl-2 protein expression in aggressive non- Hodgkin's lymphoma. Groupe d'Etude des Lymphomes de l'Adulte (GELA)

Blood ◽  
1996 ◽  
Vol 87 (1) ◽  
pp. 265-272 ◽  
Author(s):  
O Hermine ◽  
C Haioun ◽  
E Lepage ◽  
MF d'Agay ◽  
J Briere ◽  
...  
Keyword(s):  
Overall Survival ◽  
Protein Expression ◽  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Prognostic Significance ◽  
Hodgkin's Lymphoma ◽  
Independent Effect ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Large B Cell

Abstract Little is known about the expression of bcl-2 protein in intermediate and high grade non-Hodgkin's lymphoma (NHL) and its clinical and prognostic significance. We performed immunohistochemical analysis of bcl-2 expression in tumoral tissue sections of 348 patients with high or intermediate grade NHL. These patients were uniformly treated with adriamycin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) in the induction phase of the LNH87 protocol. Fifty eight cases were excluded due to inadequate staining. Of the 290 remaining patients, 131 (45%) disclosed homogeneous positivity (high bcl-2 expression) in virtually all tumor cells, whereas 65 (23%) were negative and 94 (32%) exhibited intermediate staining. High bcl-2 expression was more frequent in B-cell NHL (109 of 214, 51%) than in T- cell NHL (6 of 35, 17%) (P = .0004), and was heterogeneously distributed among the different histological subtypes. Further analysis was performed on the 151 patients with diffuse large B-cell lymphoma (centroblastic and immunoblastic) to assess the clinical significance and potential prognostic value of bcl-2 expression in the most frequent and homogeneous immunohistological subgroup. High bcl-2 expression, found in 44% of these patients (67 of 151), was more frequently associated with III-IV stage disease (P = .002). Reduced disease-free survival (DFS) (P < .01) and overall survival (P < .05) were demonstrated in the patients with high bcl-2 expression. Indeed, the 3-year estimates of DFS and overall survival were 60% and 61%, respectively (high bcl-2 expression) versus 82% and 78%, respectively (negative/intermediate bcl-2 expression). A multivariate regression analysis confirmed the independent effect of bcl-2 protein expression on DFS. Thus bcl-2 protein expression, as demonstrated in routinely paraffin-embedded tissue, appears to be predictive of poor DFS, in agreement with the role of bcl-2 in chemotherapy-induced apoptosis. It might be considered as a new independent biologic prognostic parameter, which, especially in diffuse large B-cell NHL, could aid in the identification of patient risk groups.

scholarly journals Prognostic significance of bcl-2 protein expression in aggressive non- Hodgkin's lymphoma. Groupe d'Etude des Lymphomes de l'Adulte (GELA)

Blood ◽  
1996 ◽  
Vol 87 (1) ◽  
pp. 265-272 ◽  
Author(s):  
O Hermine ◽  
C Haioun ◽  
E Lepage ◽  
MF d'Agay ◽  
J Briere ◽  
...  
Keyword(s):  
Overall Survival ◽  
Protein Expression ◽  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Prognostic Significance ◽  
Hodgkin's Lymphoma ◽  
Independent Effect ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Large B Cell

Little is known about the expression of bcl-2 protein in intermediate and high grade non-Hodgkin's lymphoma (NHL) and its clinical and prognostic significance. We performed immunohistochemical analysis of bcl-2 expression in tumoral tissue sections of 348 patients with high or intermediate grade NHL. These patients were uniformly treated with adriamycin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) in the induction phase of the LNH87 protocol. Fifty eight cases were excluded due to inadequate staining. Of the 290 remaining patients, 131 (45%) disclosed homogeneous positivity (high bcl-2 expression) in virtually all tumor cells, whereas 65 (23%) were negative and 94 (32%) exhibited intermediate staining. High bcl-2 expression was more frequent in B-cell NHL (109 of 214, 51%) than in T- cell NHL (6 of 35, 17%) (P = .0004), and was heterogeneously distributed among the different histological subtypes. Further analysis was performed on the 151 patients with diffuse large B-cell lymphoma (centroblastic and immunoblastic) to assess the clinical significance and potential prognostic value of bcl-2 expression in the most frequent and homogeneous immunohistological subgroup. High bcl-2 expression, found in 44% of these patients (67 of 151), was more frequently associated with III-IV stage disease (P = .002). Reduced disease-free survival (DFS) (P < .01) and overall survival (P < .05) were demonstrated in the patients with high bcl-2 expression. Indeed, the 3-year estimates of DFS and overall survival were 60% and 61%, respectively (high bcl-2 expression) versus 82% and 78%, respectively (negative/intermediate bcl-2 expression). A multivariate regression analysis confirmed the independent effect of bcl-2 protein expression on DFS. Thus bcl-2 protein expression, as demonstrated in routinely paraffin-embedded tissue, appears to be predictive of poor DFS, in agreement with the role of bcl-2 in chemotherapy-induced apoptosis. It might be considered as a new independent biologic prognostic parameter, which, especially in diffuse large B-cell NHL, could aid in the identification of patient risk groups.

Reduced Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation (allo-SCT) for Patients with Refractory or Relapsed Non-Hodgkin’s Lymphoma (NHL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5356-5356
Author(s):  
Hugues de Lavallade ◽  
Reda Bouabdallah ◽  
Catherine Faucher ◽  
Sabine Furst ◽  
Jean El-Cheikh ◽  
...  
Keyword(s):  
T Cell ◽  
B Cell ◽  
Cumulative Incidence ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Cell Group ◽  
High Grade ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Abstract This study aimed to evaluate the role of RIC allo-SCT for relapsed or refractory non-Hodgkin’s lymphoma (NHL). We report here our experience in 25 consecutive patients transplanted in a single center for high grade (n=17) or follicular NHL (FL; n=8). In the high grade NHL group, median age was 46 (range, 24–63) years, and all 17 patients received 2 or more previous chemotherapy regimens prior to RIC allo-SCT. In addition, 12 patients (71%) had failed autologous SCT and 6 patients (35%) had chemoresistant disease at time of allo-SCT. Among the 8 patients transplanted for a heavily pretreated follicular NHL (FL), median age was 52 (range, 34–59) years and median number of prior lines of therapy was 3 (range, 2–5), with 3 patients (38%) having chemoresistant diseases and 4 patients (50%) relapsing after autologous SCT. Among the 17 patients with aggressive high grade NHL, we compared the outcome of T-cell and B-cell aggressive NHL. With a median follow-up of 15.4 (range, 3.4-65.2) months, the cumulative incidence of non-relapse mortality was 6%, (95%CI, 0.3%-31%) and the Kaplan-Meier estimate of progression-free survival (PFS) was significantly higher in the T-cell as compared to the B-cell group (P= 0.03; 100% vs. 40% at 3 years). In the FL group, the cumulative incidence of non-relapse mortality was 25% (95%CI, 3%–65%). Six patients (75%) showed objective disease response with complete remission (CR) occurring concomitantly to graft-versus-host disease, including one CR after donor lymphocytes infusion. With a median follow-up of 19 (range, 7–85) months, 6 patients from the FL group are still alive of whom 5 in CR. We conclude that a potent graft-vs.-lymphoma (GVL) may be achieved in FL patients, even those with chemoresistant disease or who have relapsed after autologous SCT. In the high grade NHL group, strategies aiming to enhance the GVL effect (Rituximab-based RIC and/or Rituximab maintenance therapy) in the B cell subtype are still needed. However, RIC allo-SCT is a feasible and promising strategy for aggressive NHL, with particularly low toxicity, and T-cell aggressive NHL benefiting most from a potent GVL effect, likely overcoming the poor prognosis usually associated with this phenotype.

Long Term Clinical Outcomes in Patients with Massive Splenomegaly and Non-Hodgkin's Lymphoma Treated with Splenectomy.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2692-2692 ◽  
Author(s):  
Jacob Smeltzer ◽  
Thomas M Habermann ◽  
Taner Timucin ◽  
David Nagorney ◽  
Kay Ristow ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
Clinical Outcomes ◽  
Hodgkin’S Lymphoma ◽  
Median Overall Survival ◽  
Hodgkin's Lymphoma ◽  
Massive Splenomegaly ◽  
Abdominal Symptoms ◽  
Non Hodgkin's Lymphoma

Abstract Abstract 2692 Background: Massive splenomegaly is occasionally encountered in patients with Non-Hodgkin's Lymphoma (NHL) and can be associated with abdominal symptoms, anemia and thrombocytopenia. The spleen may also be a primary focus of the disease itself. Splenectomy offers the benefit of localized treatment of the disease as well as relief of symptoms from splenomegaly and associated cytopenias. The safety and long term clinical outcomes of splenectomy for massive splenomegaly (>1500 gm) in patients with various histologies of NHL was analyzed. Methods: Data was obtained from clinical records of 90 patients with a diagnosis of NHL who underwent a splenectomy at Mayo Clinic Rochester from January 1998 to December 2007. Demographics, previous treatments, histology, post- surgical complications were collected and analyzed for the entire cohort. Additionally, median overall survival, improvement in symptoms, anemia and thrombocytopenia were analyzed by NHL type. Results: Median age at splenectomy was 67 years (range 42–84 yrs.) and 56 (62%) of patients were male. Average time from diagnosis to splenectomy was 3 months (range 0–217 months). Splenectomy was the first treatment in 56 (62%) patients; the other 34 patients were treated with chemotherapy with an average of two previous regimens. Most patients had involvement outside of the spleen, 65 (72%) with concurrent bone marrow involvement and 35 (50%) with lymph node involvement. Various different NHL histologies were represented: marginal zone (MZ) (34%), mantle cell (MC) (26%), diffuse large B-cell lymphoma (DLBCL) (10%), follicular (FL) (11%), lymphoplasmacytic (LP) (6%) and T cell NOS (4%). With a median follow-up time of 25 months, the median overall survival differed by histology type of NHL (Table 1). Indolent lymphomas such as FL, LP and MZ had more favorable survival compared with more aggressive lymphomas such as DLBCL and T cell NOS. Splenectomy was safe and well tolerated with only one treatment related death. There were no reported post-splenectomy septic events. Two patients did develop a portal vein thrombosis. 95% of patients had relief in pressure and abdominal symptoms post-splenectomy. With the exception of patients with DLBCL and T-cell NHL, a majority of patients had improvement in anemia and thrombocytopenia related to splenomegaly (Table 2). Conclusions: This represents the largest reported series of patients with lymphoma treated with splenectomy. Our results indicate that median overall survival after splenectomy is determined by the underlying type of NHL. Patients with LP, FL, MZ and MCL have a favorable outcomes following splenectomy. Splenectomy remains a safe and effective treatment option for massive splenomegaly in selected patients during the course of their disease management. Disclosures: No relevant conflicts of interest to declare.

CD4+ T-Cell Immune Response to Large B-Cell Non-Hodgkin’s Lymphoma Predicts Patient Outcome

2001 ◽  
Vol 19 (3) ◽  
pp. 720-726 ◽  
Author(s):  
Stephen M. Ansell ◽  
Mary Stenson ◽  
Thomas M. Habermann ◽  
Diane F. Jelinek ◽  
Thomas E. Witzig
Keyword(s):  
Patient Outcome ◽  
Overall Survival ◽  
T Cells ◽  
B Cell ◽  
Cd4 T Cells ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Hla Dr ◽  
Non Hodgkin's Lymphoma ◽  
Large B Cell

PURPOSE: Previous studies in patients with non-Hodgkin’s lymphoma (NHL) and other malignancies have suggested that the presence of host infiltrates in the tumors of these patients may predict a better outcome. This study was undertaken to determine the prognostic importance of the presence of T cells in the biopsy specimens of patients with B-cell NHL. PATIENTS AND METHODS: Seventy-two patients with diffuse large B-cell NHL were prospectively evaluated at a single institution between 1987 and 1994. The percentage of CD3+, CD3+/HLA-DR+, CD4+, CD8+, and natural killer cells was determined by flow cytometry in the pretreatment diagnostic biopsy specimen and correlated with patient outcome. RESULTS: An increase in the percentage CD4+ T cells in the pretreatment tumor biopsies significantly correlated with patient outcome. The percent of CD4+ T cells was also highly correlated with CD3+/HLA-DR+, CD45RO+, and low l-selectin (CD62L) expression, indicating that the CD4+ T cells are activated memory T-helper cells. Those patients with increased numbers of CD4+ T cells, compared with other patients, had a significantly longer 5-year failure-free survival (72% v 43%, respectively; P = .04), as well as a significantly longer 5-year overall survival (65% v 38%, respectively; P = .05). When evaluated in a multivariate model, the International Prognostic Index and more than 20% infiltrating CD4+ T cells in the pretreatment biopsy were significant independent predictors of relapse-free and overall survival. CONCLUSION: The presence of increased numbers of activated CD4+ cells in the area of B-cell diffuse large-cell NHL predicts a better prognosis. This finding provides a strong rationale for the investigation of cellular immunotherapy in B-cell NHL.

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