R-CHOP21 Vs R-CHOP14 in Diffuse Large B-Cell Lymphoma Patients: Results From a Multicentre Retrospective Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1626-1626
Author(s):  
Luigi Rigacci ◽  
Alberto Fabbri ◽  
Benedetta Puccini ◽  
Enrico Orciuolo ◽  
Alice Pietrini ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Bone Marrow Infiltration ◽  
Advanced Stage ◽  
Symptomatic Disease ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Abstract 1626 Diffuse large B cell lymphoma (DLBCL) is one of the most common types of non-Hodgkin's lymphoma. R-CHOP21 (C21) is considered the standard therapy but a large number of studies tested R-CHOP14 (C14). The aim of our study was to evaluate retrospectively a cohort of patients (pts) treated with C21 or C14. All pts with diagnosis of DLBCL or follicular grade IIIb lymphoma, treated with curative intent were accrued. From January 2002 to December 2010, 123 pts were treated with C21 and 142 were treated with C14. The median age was 63 (range 19–89). The two cohorts of pts were balanced for all clinical characteristics a part for age (<65 or >64 years) with more aged pts in C21 arm (p 0.000), PS with more advanced PS (2–3) in C21 arm (0.000) and LDH value which was more frequently elevated in C14 arm (p: 0.002). After induction therapy 190 pts (71%) obtained a complete remission: 82/123 (67%) after C21 and 108/142 (75%) after C14. After a median period of observation of 31 months 81 pts relapsed, 42 (51%) in the C21 arm and 39 (36%) in the C14 arm. Considering the two therapies, C21 vs C14, no differences were reported in OS, PFS and DFS: 61% vs 68%, 59% vs 58% and 74% vs 61% respectively. In univariate analysis OS was lower in older pts (p: 0.02), advanced stage (p: 0.02), symptomatic disease (p: 0.05), elevated LDH (p: 0.001), bone marrow infiltration (p: 0.02) and intermediate or high risk IPI (p: 0.000); PFS was lower in advanced stage (p: 0.002), symptomatic disease (p: 0.009), elevated LDH (p: 0.001), bone marrow infiltration (p: 0.001) and intermediate high risk IPI (p: 0.000). In multivariate analysis OS was significantly better in low-intermediate IPI risk pts (p: 0.000) and in pts treated with C14 (p: 0.02); the PFS was better in low-intermediate IPI risk pts (p: 0.000). Considering only pts with low or low-intermediate IPI we observed that OS was significantly superior in the group treated with C14 (90% vs 64% p: 0.03), moreover in young pts (< 65 years) OS was better in pts treated with C14 (81% vs 58% p: 0.05). As expected hematological grade III/IV toxicity was more frequent in pts treated with C14, all pts but three (2%) completed the therapy without delay or dose reduction. No differences in extra-hematological toxicity were observed. Conclusions: In conclusion our results confirm that C14 do not improve the results of the standard C21 in the whole lymphoma population but in a subset of pts, young and low/intermediate risk pts, the C14 scheme seems to improve the OS. We will enlarge the cohort of studied patients but further prospective randomized studies are needed to verify this preliminary observations. Disclosures: No relevant conflicts of interest to declare.

Risk and Clinical Implications of Transformation of Follicular Lymphoma to Diffuse Large B-Cell Lymphoma

2007 ◽  
Vol 25 (17) ◽  
pp. 2426-2433 ◽  
Author(s):  
Silvia Montoto ◽  
Andrew John Davies ◽  
Janet Matthews ◽  
Maria Calaminici ◽  
Andrew J. Norton ◽  
...  
Keyword(s):  
High Risk ◽  
Follicular Lymphoma ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Advanced Stage ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Purpose To study the clinical significance of transformation to diffuse large B-cell lymphoma (DLBCL) in patients with follicular lymphoma (FL). Patients and Methods From 1972 to 1999, 325 patients were diagnosed with FL at St Bartholomew's Hospital (London, United Kingdom). With a median follow-up of 15 years, progression occurred in 186 patients and biopsy-proven transformation in 88 of the 325. The overall repeat biopsy rate was 70%. Results The risk of histologic transformation (HT) by 10 years was 28%, HT not yet having been observed after 16.2 years. The risk was higher in patients with advanced stage (P = .02), high-risk Follicular Lymphoma International Prognostic Index (FLIPI; P = .01), and International Prognostic Index (IPI; P = .04) scores at diagnosis. Expectant management (as opposed to treatment being initiated at diagnosis) also predicted for a higher risk of HT (P = .008). Older age (P = .005), low hemoglobin level (P = .03), high lactate dehydrogenase (P < .0001), and high-risk FLIPI (P = .01) or IPI (P = .003) score at the time of first recurrence were associated with the diagnosis of HT in a biopsy performed at that time. The median survival from transformation was 1.2 years. Patients with HT had a shorter overall survival (P < .0001) and a shorter survival from progression (P < .0001) than did those in whom it was not diagnosed. Conclusion Advanced stage and high-risk FLIPI and IPI scores at diagnosis correlate with an increased risk of HT. This event strongly influences the outcome of patients with FL by shortening their survival. There may be a subgroup of patients in whom HT does not occur.

scholarly journals Prognostic significance of bone marrow infiltration detected by PET-CT in newly diagnosed diffuse large B cell lymphoma

Oncotarget ◽  
2016 ◽  
Vol 7 (14) ◽  
pp. 19072-19080 ◽  
Author(s):  
Jin-Hua Liang ◽  
Jin Sun ◽  
Li Wang ◽  
Lei Fan ◽  
Yao-Yu Chen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
Bone Marrow Infiltration ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

scholarly journals Bone marrow infiltration by flow cytometry at diffuse large B‐cell lymphoma NOS diagnosis implies worse prognosis without considering bone marrow histology

2019 ◽  
Vol 98 (6) ◽  
pp. 525-528 ◽  
Author(s):  
Fernando Martín‐Moro ◽  
Miguel Piris‐Villaespesa ◽  
Juan Marquet‐Palomanes ◽  
Mónica García‐Cosío ◽  
Jesús Villarrubia ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Flow Cytometry ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Bone Marrow Infiltration ◽  
Bone Marrow Histology ◽  
Large B Cell Lymphoma ◽  
Worse Prognosis ◽  
Large B Cell

The Secretion of Paraprotein Is Associated with Bone Marrow Involvement in Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2646-2646
Author(s):  
Olga A. Gavrilina ◽  
Eugene E. Zvonkov ◽  
Elena N. Parovichnikova ◽  
Valeri G. Savchenko
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
B Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
M Protein ◽  
Fish Analysis ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background: Except multiple myeloma secretion of monoclonal paraprotein may be associated with several malignant conditions (lymphomas), they are produced by abnormally expanded single clone of plasma cells in an amount that can be detected in serum, urine, or rarely in other body fluids. A secretion of monoclonal paraprotein related to the neoplastic clone, was detected in more than 10% of newly diagnosed diffuse large B-cell lymphoma (DLBCL). M-protein in DLBCL might be easily missed, the rarity of associated clinical signs and the rapid fading during treatment. This group of DLBCL showed homogeneous morphologic and immunohistochemical features consistent with the non GCB-type. FISH analysis was negative for c-MYC gene rearrangements. M-protein in DLBCL patients, might be related to a very poor non GCB-type subset who should be given upfront intensified therapies [ASH 2012, abstract 2659]. The role and biological relevance of monoclonal paraprotein in diffuse large B-cell lymphoma is unknown. Aims: to compare the clinical and biological features of DLBCL patients with and without secretion of paraprotein. Patients and methods: We included in the study 86 high-risk DLBCL patients, diagnosed between July 2007 and September 2014. All patients were treated with intensified therapy (mNHL-BFM-90 or R-DA-EPOCH/R-HMA). 14 cases (16%) with monoclonal secretion paraprotein was identified. The Hans algorithm was used in order to classify cases of DLBCL as GCB-type and non GCB-type at the moment of diagnosis. Bone marrow involvement was identified by histological and B-cell clonality study. Results: We detected different types of protein in DLBCL: Mk (in 5 patients), Bence-Jones k (3 pts), Gk (2 pts), Ak (1 pts), Mλ (2 pts), Bence-Jones λ (2 pts), Gλ (2 pts), Aλ (1 pts). Four cases have shown 2 different clones simultaneously. Secretion ranged from trace to 27,1 g/l. 12 of 14 cases with monoclonal secretion were classified as non-GCB-type DLBCL. Characteristic of patients with monoclonal secretion were: stage III-IV; ECOG 2-3; median age 57 years (28-71); age ≥60y/<60y 43%/47%; M/F 71%/29%; IPI: 21% high-intermediate and 79% high risk; 93% with bone marrow involvement. We grouped the patients depending of bone marrow involvement, and according to the long-rank analysis only detection of monoclonal secretion of immunoglobulins was associated with bone marrow involvement in patients with diffuse large B-cell lymphoma (Table 1). Conclusions: Our study has shown that monoclonal secretion of paraprotein was associated with bone marrow involvement in patients with diffuse large B-cell lymphoma. Detection of secretion of paraprotein could help to suspect the cases with bone marrow involvement before the results of histology and when histology not informative. Diffuse large B-cell lymphoma with bone marrow involvement is characterized by aggressive course and poor response to standard chemotherapy. Disclosures No relevant conflicts of interest to declare.

The Utility of Positron Emission Tomography (PET) with 18Fluorodeoxyglucose (18F-FDG) Compared to Standard Procedures in Detecting Bone Marrow Infiltration in Diffuse Large B-Cell Lymphoma in Developing Countries.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5015-5015
Author(s):  
Marcelo Bellesso ◽  
Renata Oliveira Costa ◽  
Flavia Dias Xavier ◽  
José Claudio Meneguetti ◽  
Felipe Vieira Rodrigues Maciel ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Developing Countries ◽  
B Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Bone Marrow Infiltration ◽  
Large B Cell Lymphoma ◽  
Initial Staging ◽  
Large B Cell

Abstract Abstract 5015 Background Computed tomography (CT) scanning and bone marrow biopsy (BMB) are the most used methods for initial staging in Diffuse Large B-cell Lymphoma (DLBCL) in developing countries. In the United States and Europe, 18-FDG PET has demonstrated to be an essential imaging modality for initial staging, early response and final therapeutic assessment in DLBCL patients. Afterward BM biopsy (BMB) is the gold standard to detect BM infiltration in lymphoma. However the ability of the FDG-PET to assess bone marrow (BM) positivity in DLBCL has been investigated and remains a controversial issue in the literature. For that reason we retrospectively compared the BM infiltration by bilateral BMB with FDG-PET at diagnosis in DLBCL patients. Methods We evaluated retrospectively 38 patients with DLBCL reporting the number of true-positive, false-positive, true-negative, and false-negative BM positivity by FDG-PET having the bilateral BMB as a reference standard. Results Out of 38, BM(+) was detected in 4 (10.5%) patients by BMB and in 14 (36.8%) patients by FDG-PET. The sensitivity and specificity of FDG-PET to recognize BM infiltration were respectively 100% and 71%. Negative and positive predictive values of the FDG-PET to identify BM(+) were respectively 100% and 28.5%. In negative-BMB patients, a positive FDG-PET BM was found in iliac 1 (10%), vertebra 5 (50%), sternum 2 (20%), scapula 1 (10%) and femur 1 (10%). The 18FDG mean maximum standardized uptake value (SUVmax) was 6.85 ± 3.9 in negative-BMB group and 9.77 ± 3.2 in positive-BMB group, p=0,208. Conclusion These results suggest that FDG-PET has a good sensitivity in detecting bone marrow infiltration in this type of aggressive lymphoma when compared to bilateral BMB to our knowledge the standard procedure to evaluate BM infiltration in lymphoma staging. Even though this study has several limitations such as one single center experience, a small number of patients and the lack of FDG-PET BM(+) confirmation by guided biopsy in previously negative-BMB patients, the majority of publications have been made in developed countries, and moreover we believe many issues still remain to be answered such as data regarding the FDG-PET cost-effectiveness out of clinical trails, specially in developing countries, in order to elucidate whether these results will be translated into a real benefit in overall survival for these patients. Disclosures No relevant conflicts of interest to declare.

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