Ten-Year Follow-up Data of Diffuse Large B-Cell Lymphoma Patients: Single Center Experience

Abstract Abstract 5223 Background Non-Hodgkin's Lymphoma (NHL) is the most common type of hematopoietic cancers and it constitutes 4% of all cancers. It is the seventh most common type of all cancers in Turkey. The NHL is 1.5 times more common among males and the median age of most subtypes is equal to or more than 50. About 85% of NHL has B cell origin and 5-year overall survival is around 60%. Tumor volume, histology, patient's age and performance, serum lactate dehydrogenase (LDH) and beta-2 microglobulin levels, stage of disease and presence of extranodal disease are related to prognosis of NHL. International Prognostic Index (IPI) includes five of these factors to predict prognosis: patient's age and performance, stage of the disease, serum LDH level, extranodal disease. Methods The aim of this study is to evaluate the responses to actual treatments applied and survival periods of our Diffuse Large B Cell Lymphoma (DLBCL) patients. Non-Burkitt's, aggressive non-Hodgkin's lymphoma records obtained from our hematology department, which belong to the period between January 2000 and May 2011 were retrospectively analyzed. 278 patients diagnosed morphologically/immune-histochemically as CD20 positive DLBCL were included in this study. 153 of 278 paraffin blocks of diagnostic tissue were accessible and two subgroups of DLBCL were determined as Germinal Center B cell (GC) and Activated B cell (AB). From the remaining 125 cases, paraffin blocks of diagnostic tissue could not be accessed 115 cases, so any subgroup could not be determined (ND) and Mediastinal Large Cell Lymphoma (MLCL) were assessed in 10 cases. The subgroups were compared in order to evaluate the survival and also the responses to treatment. In the non-parametric comparison process, we used Mann-Whitney-U test. Results Patient characteristics according to the subgroups are detailed in Table 1. Complete remission was achieved with the first line treatment in 75% of patients and from those, 20% were relapsed at the median of 9 months. Overall Survival (OS) was significantly longer in GC than in AB patients (median OS: 27 vs 24 months, p=0.006). The Time to Relapse (TTR) is two times longer in GC group than in AB group, however this data is not statistically significant (median TTR: 12 vs 5.5 months, p=0.221). Survival curve of ND patients is not significantly different from GC curve (p= 0.436). Nevertheless, AB subgroup survival curve is significantly worse than ND group (p= 0.024, Figure 1). Regarding all patients, IPI predicts the survival of DLBCL independent from subgroups and treatment modalities (p<0.001, Figure 2). The longest survival time is in MLCL patients, nonetheless statistical analysis could not be made because of the small number of patients. Conclusion The data should be analyzed carefully because all data could not be accessed in some patients as this is a retrospective analysis. However, our data is valuable at the point that it reflects “real-life” patient data. Disclosure This study was supported by Istanbul University Research Fund. Disclosures: No relevant conflicts of interest to declare.

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Cell of origin in diffuse large B-cell lymphoma in systemic lupus erythematosus: molecular and clinical factors associated with survival

Lupus Science & Medicine ◽

10.1136/lupus-2019-000324 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000324 ◽

Cited By ~ 6

Author(s):

Basile Tessier-Cloutier ◽

David DW Twa ◽

Eva Baecklund ◽

Randy Gascoyne ◽

Nathalie A Johnson ◽

...

Keyword(s):

Overall Survival ◽

General Population ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Cell Of Origin ◽

Large B Cell Lymphoma ◽

Extranodal Disease ◽

Bcl2 Protein ◽

Large B Cell

BackgroundSLE is associated with increased risk of diffuse large B-cell lymphoma (DLBCL). DLBCL is routinely classified by cell of origin (COO), with germinal centre B-cell (GCB) being more common and indicating better prognosis in the general population. We studied COO subtyping in patients with SLE diagnosed with DLBCL and their survival.Patients and methodsWe evaluated 20 cases of SLE with DLBCL. Immunohistochemistry analysis was performed (BCL2, MYC, BCL6, CD10, CD20, FOXP1, GCET1, MUM1) in tissue microarrays. We examined associations between molecular and clinical features, including overall survival.ResultsOf the 20 DLBCL SLE cases, 12/20 cases (60%) were classified as non-GCB using Hans or Choi algorithms. MYC and BCL2 protein expression was positive in 6/20 (30%) and 8/20 (40%) SLE cases, respectively, with 2/20 (10%) co-expressing both markers. Seven (7/20) had only extranodal involvement at DLBCL diagnosis. As expected, non-GCB cases had worse survival. Cases presenting exclusively with extranodal disease were associated with shorter SLE duration and better survival despite higher BCL2 protein expression.ConclusionsWe present novel data characterising DLBCL in SLE. Sixty per cent of the DLBCL in patients with SLE were non-GCB. The nodal and extranodal distribution in SLE was similar to what is known in the general population, but extranodal disease occurred more often with short SLE duration and was associated with longer overall survival. More research on cancer in SLE is the key to further understanding the complex interplay between cancer and the immune system.

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Survival and Clinicopathological Characteristics of EBV-Positive Diffuse Large B-Cell Lymphoma

Blood ◽

10.1182/blood.v120.21.1588.1588 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1588-1588

Author(s):

Brady E Beltran ◽

Erick Cotacallapa ◽

Jorge J Castillo

Keyword(s):

Overall Survival ◽

Prognostic Factor ◽

B Cell ◽

Lymphocyte Count ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Conventional Chemotherapy ◽

Large B Cell Lymphoma ◽

Extranodal Disease ◽

Large B Cell

Abstract Abstract 1588 Background: EBV-positive diffuse large B-cell lymphoma (EBV+ DLBCL) of the elderly is a provisional entity included in the 2008 WHO Classification of Lymphomas. Diagnostic criteria include age >50 years, DLBCL morphology and EBV expression in lymphomatous cells. However, these criteria are evolving as several patients are <50 years and a specific cut-off for the percentage of EBV expression has not been defined. The goal of this retrospective study is to evaluate clinical and pathological characteristics of EBV+ DLBCL from Peruvian patients. Methods: Between January 2002 and January 2012, all patients meeting criteria for EBV+ DLBCL were included in the analysis. Patients with evidence of immunosuppression were excluded. All cases re positive for the presence of EBV-encoded RNA (EBER) by in situ hybridization, and CD20 and/or PAX-5 expression by immuno-histochemistry. Clinical data were reviewed retrospectively and patient's biopsies were analyzed for the expression of BCL6, CD10, CD30 and MUM-1/IRF4 using a tissue microarray (TMA) technique. The overall survival (OS) curves were calculated using the Kaplan-Meier method, and compared using the log-rank test. Results: A total of 43 EBV+ DLBCL patients are included in this study. The median age was 73 years (range 25–95 years). Four patients (9% ) were <50 years. The male:female ratio was 2.2:1. B symptoms occurred in 59%, ECOG >21 in 60%, advanced stage (III/IV) in 58%, elevated LDH levels in 44%, and lymphocyte count <1000/uL in 35%. The International Prognostic Index (IPI) score was 0–2 in 39% and 3–5 in 61% of the patients. Extranodal disease occurred in 20 patients (46%): stomach (n=3), tonsil (n=3), pleura (n=2), palate (n=2), cecum (n=2), bone marrow (n=2), ileum (n=1), bone (n=1), skin (n=1), lung (n=1), meninges (n=1), breast (n=1) and peritoneum (n=1). Three patients had central nervous system involvement (7%), one at presentation and two at relapse. Based on the Hans classification, 76% had non-germinal center profile. Ki67 expression was >80% in 53% of the patients. Eleven evaluated patients had a c-myc-negative status. Chemotherapy was received in 75% of the cases due to poor performance status. The overall response rate with conventional chemotherapy was 46%, with complete response in 39%, partial response in 7%, and no response in 54%. The median survival was 7.5 months. The Oyama score was: 0 factors (13%), 1 factor (47%), and 2 factors (40%) with median OS of 41, 11 and 1.5 months respectively (p=0.07). A lymphocyte count <1000/uL was a prognostic factor for OS (p=0.001). Conclusions: Based on our study, which is the largest cohort in Latin-America, EBV+ DLBCL is an aggressive entity with frequent extranodal disease and poor response to conventional chemotherapy. The overall survival remains poor. Lymphopenia, as defined as lymphocyte count <1000/uL, appears as a prognostic factor for OS. Disclosures: No relevant conflicts of interest to declare.

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Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1546 patients

Blood ◽

10.1182/blood-2013-04-498964 ◽

2013 ◽

Vol 122 (19) ◽

pp. 3251-3262 ◽

Cited By ~ 90

Author(s):

Stefan K. Barta ◽

Xiaonan Xue ◽

Dan Wang ◽

Roni Tamari ◽

Jeannette Y. Lee ◽

...

Keyword(s):

Overall Survival ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Pooled Analysis ◽

Factors Affecting ◽

Large B Cell Lymphoma ◽

Key Points ◽

Large B Cell

Key Points Rituximab use is associated with significant improvement in all outcomes for patients with HIV-associated CD20-positive lymphomas. Infusional EPOCH chemotherapy is associated with better overall survival in patients with AIDS-related diffuse large B-cell lymphoma (DLBCL).

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Impact of Genetic Polymorphism of Myeloid Differentiation Primary Response Gene 88, Enhancer of Zeste Homolog 2, and B-cell Lymphoma 2 like 11 in Patients with Diffuse Large B Cell Lymphoma Treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristin

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5697 ◽

2021 ◽

Vol 9 (A) ◽

pp. 98-105

Author(s):

Hussam Zawam ◽

Noha E. Ibrahim ◽

Rasha Salama ◽

Mai Samir ◽

Walaa Abdelfattah ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Poor Response ◽

Cell Of Origin ◽

Bulky Disease ◽

Large B Cell Lymphoma ◽

Younger Age ◽

Extranodal Disease ◽

Large B Cell

BACKGROUND: Despite the growing landscape of genetic drivers in Diffuse Large B-cell Lymphoma, yet their clinical implication is still unclear and R-CHOP regimen remains a “one size fits all” therapy. We aimed in this study to examine the prevalence of EZH2, BCL211 and MYD 88 genetic polymorphisms in DLBCL patients and correlate the results with various clinical and survival outcomes. METHODS: Genotyping of MYD88 (rs387907272 T/C), EZH2 (rs3757441 C/T), and BCL2L11 (rs3789068 A/G) polymorphisms were conducted using real time polymerase chain reaction analysis in a total of 75 DLBCL patients. RESULTS: Most of our cases carried the wild TT genotype of MYD88 gene (64%), the mutant TT genotype of EZH2 gene (52%) and the wild AA genotype of BCL2L11 gene (48%). Regarding cell of origin, Germinal Centre (GC) phenotype was present in 56% of cases while 44% expressed the Post-GC (PGC) phenotype. Poor response outcome to first line R-CHOP was significantly correlated with the mutated CC genotype of MYD 88 (p=0.02), while better response to R-CHOP was significantly associated with younger age <50 years (p <0.0001), good PS (p=0.046), normal LDH level (p=0.003), earlier stage (p <0.0001), good IPI score (p=0.009), absence of extranodal disease (p <0.0001) and absence of bulky disease (p=0.004). The median PFS and the 2 year OS were significantly higher in younger age, earlier stage, good IPI score, absence of extranodal disease, absence of bulky disease and in GC phenotype. CONCLUSIONS: Our results emphasized that the mutated genotype of MYD 88 gene polymorphism is significantly associated with poor response to R-CHOP therapy.

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Primary pituitary diffuse large B-cell lymphoma with somatotroph hyperplasia and acromegaly: case report

Journal of Neurosurgery ◽

10.3171/2016.5.jns16828 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1725-1730 ◽

Cited By ~ 6

Author(s):

Vijay M. Ravindra ◽

Amol Raheja ◽

Heather Corn ◽

Meghan Driscoll ◽

Corrine Welt ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Common Type ◽

Histopathological Diagnosis ◽

Sellar Lesions ◽

Non Hodgkin Lymphoma ◽

Large B Cell Lymphoma ◽

Persistent Elevation ◽

Large B Cell

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma and comprises approximately 30% of all lymphomas. Patients typically present with a nonpainful mass in the neck, groin, or abdomen associated with constitutional symptoms. In this report, however, the authors describe a rare case of a 61-year-old woman with hyperprolactinemia, hypothyroidism, and acromegaly (elevation of insulin-like growth factor-1 [IGF-1]) with elevated growth hormone–releasing hormone (GHRH) in whom an MRI demonstrated diffuse enlargement of the pituitary gland. Despite medical treatment, the patient had persistent elevation of IGF-1. She underwent a transsphenoidal biopsy, which yielded a diagnosis of DLBCL with an activated B-cell immunophenotype with somatotroph hyperplasia. After stereo-tactic radiation therapy in combination with chemotherapy, she is currently in remission from her lymphoma and has normalized IGF-1 levels without medical therapy, 8 months after her histopathological diagnosis. This is the only reported case of its kind and displays the importance of a broad differential diagnosis, multidisciplinary evaluation, and critical intraoperative decision-making when treating atypical sellar lesions.

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miR-199a and miR-497 Are Associated with Better Overall Survival due to Increased Chemosensitivity in Diffuse Large B-Cell Lymphoma Patients

International Journal of Molecular Sciences ◽

10.3390/ijms160818077 ◽

2015 ◽

Vol 16 (8) ◽

pp. 18077-18095 ◽

Cited By ~ 36

Author(s):

Katharina Troppan ◽

Kerstin Wenzl ◽

Martin Pichler ◽

Beata Pursche ◽

Daniela Schwarzenbacher ◽

...

Keyword(s):

Overall Survival ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Real-world practice patterns and outcomes in Veterans with relapsed/refractory diffuse large B-cell lymphoma

Future Oncology ◽

10.2217/fon-2020-0522 ◽

2020 ◽

Author(s):

Hsu-Chih Chien ◽

Deborah Morreall ◽

Vikas Patil ◽

Kelli M Rasmussen ◽

Chunyang Li ◽

...

Keyword(s):

Overall Survival ◽

B Cell ◽

Cell Lymphoma ◽

Progression Free Survival ◽

B Cell Lymphoma ◽

Line Treatment ◽

Electronic Health Record Data ◽

Free Survival ◽

Large B Cell Lymphoma ◽

Large B Cell

Aim: To describe practices and outcomes in veterans with relapsed/refractory diffuse large B-cell lymphoma. Patients & methods: Using Veteran Affairs Cancer Registry System and electronic health record data, we identified relapsed/refractory diffuse large B-cell lymphoma patients completing second-line treatment (2L) in 2000–2016. Treatments were classified as aggressive/nonaggressive. Analyses included descriptive statistics and the Kaplan–Meier estimation of progression-free survival and overall survival. Results: Two hundred and seventy patients received 2L. During median 9.7-month follow-up starting from 2L, 470 regimens were observed, averaging 2.7 regimens/patient: 219 aggressive, 251 nonaggressive. One hundred and twenty-one patients proceeded to third-line, 50 to fourth-line and 18 to fifth-line treatment. Median progression-free survival in 2L was 5.2 months. Median overall survival was 9.5 months. Forty-four patients (16.3%) proceeded to bone marrow transplant. Conclusion: More effective, less toxic treatments are needed and should be initiated earlier in treatment trajectory.

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