Primary Breast Diffuse Large B Cell Lymphoma in the Rituximab Era: Outcomes of a Multicenter Retrospective Study By the Lymphoma and Leukemia Committee of Chinese Geriatric Oncology Society(LLC-CGOS)

Abstract Introduction: Primary breast diffuse large B cell lymphoma(PB-DLBCL) is a rare subtype of DLBCL with limited data on treatment outcome. The impact of rituximab on survival and the role of central nervous system(CNS) prophylaxis in patients(pts) with PB-DLBCL remain controversial. The aim of this study was to define the clinical features, treatment outcome and patterns of relapse of Chinese pts with PB-DLBCL. Methods: Data on pts with PB-DLBCL was retrospectively collected from 20 main Chinese medical centers. Between 2000 and 2015, 110 pts were included. Eligibility criteria required confirmed pathological diagnosis of DLBCL and disease localized to one or both breasts±ipsilateral regional lymph nodes. Patients with systemic disease with breast involvement or transformed DLBCL from low-grade lymphoma were excluded. PFS and OS were estimated using the Kaplan-Meier method, and prognostic factors were analyzed using the log-rank test and Cox proportional hazards model. Results: All of 110 pts were female, with a median age of 47years(yrs)(range 16-85yrs). 4.5% presented with B-symptoms; 94.5% presented with unilateral disease (right 58.7%; left 36.7%), and 6 pts(5.5%) presented with bilateral breast involvement. The median tumor size was 4cm(range 1.2-12.8cm); 56.4% had stage IE and 38.2% had stage IIE disease; pts with bilateral breast disease(5.5%) were classified as stage IV. Among the 72 pts in whom immunohistochemistry was available, 68.1% were classified as non-germinal center B-cell like(GCB) immunophenotype and 31.9% as GCB type based on the algorithms of Hans and Visco-Young. The median Ki-67 expression was 80%(range 20-98%). Among the 86 pts with available international prognostic index (IPI), the score was 0 in 51.2% of pts, 1 in 32.6%, 2 in 12.8%, and 3-4 in 3.5%. Most pts(98%) received anthracycline-containing chemotherapy, and 60% received rituximab; 44% received CNS prophylaxis with intrathecal chemotherapy(IT); 36% received radiotherapy (RT); 19% underwent mastectomy. At a median follow-up of 3.2 yrs (range 0.1 - 11.5 yrs), the Kaplan-Meier estimated median PFS was 6.3 yrs (95% CI 4.2 - 8.4 yrs) and the median OS was not reached. The 5-yr PFS and 5-yr OS were 61.2% (95% CI 49.0-73.4%) and 77.3% (95% CI 66.1-88.5%) respectively. In univariate analysis, rituximab was associated with improved PFS(5yrPFS 75.8% vs 38.4%, P=0.03) but not an advantage in OS. RT was associated with a significant benefit in PFS(P=0.02) and a borderline significant advantage in OS(p=0.052). In multivariate analysis, IPI was the only significant prognostic factor for OS(HR=5.16, P=0.01). The 5-yr OS was 94.7% in pts with a IPI score of 0, 76.0% in pts with a score of 1, and 54.3% in those with a score of 2-4. There was no difference in OS in pts with tumors less than versus more than 5cm, or between pts with non-GCB versus GCB subtype. 3 pts with bilateral disease had early progression within 1 yr from diagnsosis, and all died within 4yrs. A total of 35 (31.8%) pts had relapsed, with the breast(16 cases, 14.5%) and CNS(11 cases, 10%) as the most common sites of extra-nodal relapse. Although 71.4% of first relapses occurred within the first 3 yrs, late relapse was frequently observed in the contralateral breast and CNS, with 57% of contralateral breast relapses and 55% of CNS relapses occurring beyond 3 yrs from diagnosis. Among the 11 pts with CNS relapse, 3 pts received prophylactic IT during first-line therapy. There was a continuous risk of CNS relapse up to 8.2 yrs from initiation of treatment(median time to relapse: 3.1yrs), with 72% of relapses occurring in the brain parenchyma. In univariate analysis, elevated LDH(P<0.001) and bilateral breast involvement(P=0.014) were associated with a higher risk of CNS relapse. Neither prophylactic IT nor rituximab was associated with a significant reduction in the cumulative risk of CNS relapse. Conclusions: PB-DLBCL is a very rare subtype of DLBCL among Chinese lymphoma pts. Among the 110 pts collected from 20 main medical centers, PB-DLBCL appears to have worse PFS with distinct patterns of extra-nodal relapse. Rituximab and RT were both associated with improved PFS, but no significant beneficial effect on OS was observed. A continuous pattern of CNS relapse was often, especially in pts with bilateral breast involvement or elevated LDH. Prophylactic IT had limited value in preventing CNS relapses in these PB-DLBCL pts. Disclosures No relevant conflicts of interest to declare.

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Intrathecal (IT) Chemotherapy for Central Nervous System (CNS) Prophylaxis in Diffuse Large B-Cell Lymphoma (DLBCL): A Single Centre Retrospective Observational Study

Blood ◽

10.1182/blood-2020-140797 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 18-19

Author(s):

Luke Attwell ◽

Benjamin Gray ◽

Rachel Hall ◽

Sally Killick ◽

Helen McCarthy ◽

...

Keyword(s):

B Cell ◽

Board Of Directors ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Advisory Committees ◽

Cns Prophylaxis ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Educational Meetings ◽

Large B Cell

Introduction: CNS relapse of DLBCL is associated with poor prognosis. Estimated incidence varies between 1.9 and 8.4%1. The CNS-International prognostic index (IPI)2 help risk stratify and estimate the 2-year risk of CNS relapse in DLBCL patients treated with R-CHOP chemotherapy. CNS prophylaxis is indicated in patients with a high risk of CNS relapse (a score of ≥4 equated to a 10.2% risk). High-risk DLBCL patients outside the CNS-IPI system include double/triple-hit (MYC/BCL-2/BCL-6 translocations) lymphoma, HIV lymphoma, testicular lymphoma, primary cutaneous lymphoma-leg type, stage IE breast lymphoma3. IT methotrexate or cytarabine administered during the course of systemic chemotherapy has been the most widely employed method of CNS prophylaxis but there is paucity of data validating its efficacy. Aim: The primary aim of the study was to evaluate the CNS relapse rates in DLBCL patients who received CNS prophylaxis. Patients and Methods: This was a single-centre retrospective observational study conducted in a district general hospital. Data was extracted from the regional (Dorset Cancer Network) DLBCL database and laboratory reports for CSF analysis at the time of the first intrathecal chemotherapy. Medical records of patients with DLBCL who received CNS prophylaxis were evaluated for the following patient-related and disease-related demographics: age at diagnosis, gender, stage, systemic treatment, CNS prophylaxis, treatment response, remission duration, systemic relapse rates, CNS relapse rates and survival. CNS-IPI scores were retrospectively calculated and additional indications evaluated for patients who received CNS prophylaxis. Results: Between 2013 and 2018, 178 patients were diagnosed with DLBCL. All patients were treated with RCHOP chemo-immunotherapy. CNS prophylaxis was administered in 47 (26%) patients. Median age was 69 years (range 20-86 years) and 62% were males. All 47 patients (100%) received IT methotrexate as CNS prophylaxis, with 43 (91%) receiving all of the planned 4 doses of IT methotrexate 12.5 mg each. A CNS-IPI score of ³4 was present in 31 (66%) patients, and a score of 2-3 in 9 (19%) patients. Additional risk factors identified included testicular lymphoma in 3 patients, breast lymphoma in 2 patients and oropharyngeal lymphoma in 2 patients. Ten (21%) patients received their treatment at the outset with courses 1-4 of R-CHOP. Of the 47 patients who received CNS prophylaxis, 5 (10%) relapsed; all had isolated CNS lymphoma at relapse. Median time to CNS relapse was 25 months (range 12-36 months) from initial diagnosis of DLBCL. Median survival after CNS relapse was 5 months (range 2-9 months). Of the remaining 141 patients, 2 patients relapsed with isolated CNS lymphoma. Conclusion: Although the overall incidence was low (4%), CNS relapse was observed in 10% of high-risk patients all of whom received CNS prophylaxis with IT methotrexate. The efficacy of CNS prophylaxis with IT chemotherapy remains unproven. There is no randomised study to show that IT prophylaxis alone is effective. Current British guidelines recommend high-dose intravenous methotrexate over IT methotrexate if patient's physiological fitness and renal function are acceptable4. The median age in our cohort was 69 years which makes it challenging to deliver dose-intensive systemic therapy concurrently with intravenous high-dose methotrexate. The role of CNS prophylaxis in high-risk patients including its efficacy and safety in older patients need further evaluation in prospective randomised studies. References Eyre T et al.Efficacy of central nervous system prophylaxis with stand-alone intrathecal chemotherapy in diffuse large B-cell lymphoma patients treated with anthracycline-based chemotherapy in the rituximab era: a systematic review. Hematologica. 2019;105(7):1914-1924.Norbert Schmitz et al.CNS International prognostic Index: A risk model for CNS relapse in patients with diffuse large B-cell lymphoma treated with R-CHOPJ Clin Oncol 2016; 34:3150-3156.Andrew D Zelenetz et al.National Comprehensive Cancer Network (NCCN) Guidelines: B-Cell Lymphomas.Version 2.2020.Pamela McKay et al.The prevention of central nervous system relapse in diffuse large B-cell lymphoma: a British Society for Haematology good practice paper. Onlinelibrary.wiley.com. 2020. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjh.16866 Disclosures Hall: Janssen:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings;Karyopharm:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings;Takeda:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings;Celgene:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings.Killick:Celgene:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending educational meetings;Jazz Pharmaceuticals:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending educational meetings;Novartis:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending educational meetings;Gilead:Honoraria, Other: Support for attending education meetings.McCarthy:Janssen:Honoraria;Abbvie:Membership on an entity's Board of Directors or advisory committees.Walewska:AbbVie:Other: sponsored for educational meetings, Speakers Bureau;Janssen:Other: sponsored for educational meetings, Speakers Bureau;Gilead:Speakers Bureau;Astra Zeneca:Membership on an entity's Board of Directors or advisory committees.Chacko:Astellas:Honoraria;Daiichi-Sankyo:Honoraria;Novartis:Honoraria, Other: Travel Grants;Gilead:Other: Travel grants;Jazz Pharmaceuticals:Other: Travel grants;Celgene:Other: Travel grants.

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Rituximab Based Regimen May Decrease the Incidence of CNS Relapse in Patients with Diffuse Large B-Cell Lymphoma.

Blood ◽

10.1182/blood.v114.22.4770.4770 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4770-4770

Author(s):

Mervat Mahrous Mohamed ◽

Rena Buckstein ◽

Eugenia Piliotis ◽

Matthew C Cheung ◽

Neil Berinstein

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage Iii ◽

Cns Involvement ◽

Cns Prophylaxis ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

The Impact ◽

Large B Cell

Abstract Abstract 4770 BACKGROUND Relapse in the central nervous system (CNS) following initial treatment of diffuse large B-cell lymphoma (DLBCL) is an uncommon but fatal complication. However, the addition of rituximab improves the clinical outcome dramatically in DLBCL patients; its influence on CNS relapse is unproven. Aim This single centre retrospective study was conducted to investigate the incidence of CNS relapse, and to evaluate the impact of adding rituximab to standard CHOP (RCHOP) regimen without CNS prophylaxis in patients at risk of CNS relapse. PATIENTS AND METHODS All patients with DLBCL diagnosed from April 2002 to December 2007 at sunnybrook cancer center were retrospectively identified in the Cancer Database. Patients were included if they were >16 years old, had advanced stage (stage III /IV, or stage I /II with B symptoms, elevated LDH or bulky disease, were treated with RCHOP regimen with curative intent and were free of CNS involvement at diagnosis. CNS relapse was diagnosed by CSF cytology, radiology or clinically. Results A total of 155 patients were newly diagnosed with DLBCL and treated with RCHOP only. 22 pts were excluded, 20 had CNS prophylaxis and 2 pts had CNS involvement. 133 pts were eligible (69 male and 64 female) Median age was 64 (Age'60 was 59.4%). Stage III/IV was 69.9%. LDH was elevated in 59.4%. Bone marrow (BM) involvement and Extra nodal “>2 were 18.05% and 25.6% respectively. EN sites were: (liver 4.5%, Bone 6.8%, Pulmonary 4.5%, kidney 3.01%, cardiac 1.5%, intestine 2.3%, testicular 1.5%). The International Prognostic Index was high-intermediate/high in 55.6%. Pathologically transformed was 12.03% and were transformed from indolent histologies. BCL2 was positive in 65.4%, BCL6 was 48.9%, CD10 was positive in 49.6%, Ki-67 was >80% in 25%. All patients received RCHOP (Median 6 cycles, (range 2-8). Overall response (ORR) was 88.6%, CR/CRU 72.7% with a median follow up 24.6 months (range 2.6-75.5). 28 patients (21.05%) relapsed systemically. Two patients (1.5%) had a CNS relapse 1 brain parenchyma and 1 leptomeningeal one month after systemic relapse. The median time to CNS relapse was 10.4 mos (6.24-14.5 mos). In univariate risk factor analysis (LDH (p=0.8), IPI>3 (p=0.9), No of EN (p=0.9). Actuarial 5 y Overall Survival (OS) was 67.3% (95% CI (57-77%) and progression free Survival (PFS) was 65.7% (95% CI (52.3-78.6%). Conclusion Our data suggest that the addition of rituximab may reduce the risk of CNS relapse for poor risk patients likely through systemic control. Future prospective studies of rituximab-containing chemotherapies with CNS prophylaxis are warranted Disclosures: No relevant conflicts of interest to declare.

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The Diving Bell and the Butterfly Revisited: A Fatal Case of Locked-in Syndrome in a Man With Epstein-Barr Virus–Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified

Clinical Medicine Insights: Blood Disorders ◽

10.1177/1179545x18762799 ◽

2018 ◽

Vol 11 ◽

pp. 1179545X1876279

Author(s):

Jacqueline N Poston ◽

Russell Dorer ◽

David M Aboulafia

Keyword(s):

B Cell ◽

Epstein Barr Virus ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Barr Virus ◽

Cns Prophylaxis ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Epstein Barr ◽

Large B Cell

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare variant of DLBCL. The natural history of this subtype is poorly understood. Incomplete literature in the era of rituximab suggests that patients with EBV-positive DLBCL have similar outcomes to patients with EBV-negative DLBCL when treated with rituximab and anthracycline-based chemotherapy regimens; however, there are few prospective studies on this subtype and little is known about the risk of central nervous system (CNS) relapse with EBV-positive DLBCL. Herein, we describe the case of a 64-year-old man who presented with stage IIA EBV-positive DLBCL. His international age-adjusted International Prognostic Index (IPI) was 2. He achieved a complete response to 6 cycles of rituximab combined with chemotherapy consisting of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin. After 10 days of completion of chemotherapy, he had a fulminant neurologic decline manifested by diffuse weakness followed by a locked-in syndrome; he could only communicate by moving his eyes. He had been deemed at low risk for CNS relapse based on the application of the recently developed CNS-IPI score of 2 (1 point for age >60 years and 1 point for lactate dehydrogenase higher than normal) and consequently did not receive therapy for CNS prophylaxis. A limited postmortem autopsy revealed extensive lymphoma throughout the brain, particularly in the deep basal nuclei, midbrain, pons, centrum semiovale, and corpus callosum. This presentation of CNS relapse is rare and has not yet been described in EBV-positive DLBCL. We discuss some of the unique aspects of this case including the clinical manifestations of locked-in syndrome and its differential diagnosis and the uncertain benefits of CNS prophylaxis in this clinical context.

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Primary Breast Diffuse Large B Cell Lymphoma: A Distinct Clinical Entity

Blood ◽

10.1182/blood.v120.21.1618.1618 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1618-1618

Author(s):

Matthew P Salzberg ◽

Jocelyn C Maragulia ◽

Oliver W. Press ◽

Thomas M Habermann ◽

Julie M Vose ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage I ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Kaplan Meier ◽

Parenchymal Disease ◽

Large B Cell

Abstract Abstract 1618 Introduction: Primary breast lymphoma is a rare type of non-Hodgkin lymphoma (NHL), representing about 1% of breast tumors and 2% of extranodal NHL. Diffuse large B-cell lymphoma (DLBCL) is the most common primary subtype presenting in the breast. Due to the low incidence of primary breast DLBCL, outcome data is limited. The aim of this study was to retrospectively assess the natural history of primary breast DLBCL in the pre and post rituximab eras, with specific emphasis on the incidence of local, systemic and central nervous system (CNS) relapses. Methods: Data was retrospectively collected on patients with primary breast DLBCL from seven USA academic medical centers. Institutional review board approval was obtained at each participating site. Patients were identified through institutional databases and tumor registries at each site. Charts were reviewed to obtain demographic and clinical variables including treatment history and dates of relapse and death when applicable. Only patients with stage I/II disease (involvement of breast and localized lymph nodes) were included. All histologies apart from primary DLBCL were excluded. Overall survival (OS) was calculated from the diagnosis date to the date of death or last follow-up. Time to Progression (TTP) was calculated from diagnosis data until the date of pathological evidence of recurrence or death. Data were summarized using descriptive statistics, and survival was analyzed using the Kaplan-Meier method. Results: Between 1984 and 2012, 75 patients were identified who met the eligibility criteria. The median age was 62 years (range 17–87); 81% presented with a palpable mass; 12% had their disease detected incidentally by mammography; 4% presented with B-symptoms; 59% had right breast involvement; 67% had stage I and 33% had stage II disease. The stage-adjusted international prognostic index (IPI) score was 0 in 28% of patients, 1 in 41%, 2, in 25%, 3 in 4% and 4 in 1%. 91% of patients were treated with chemotherapy; 31% of these were treated in the pre-rituximab era and 69% received rituximab. Radiation therapy (RT) was utilized in 68% of patients and was the only treatment modality in 8% of those receiving RT. 8% of patients received CNS prophylaxis with intrathecal chemotherapy. After a median follow-up of 4.5 years (range 0.6 – 20.6 years), the Kaplan-Meier estimated median TTP was 10.4 years (95% CI 6.2 – 14.6 years) and the median OS was 14.6 years (95% CI 6.5 – 22.6 years). The 5-year TTP and 5-year OS were 65% (95% CI 53–77%) and 75% (95% CI 64–86%) respectively. Among the patients who relapsed, 67% occurred within the first 2 years. A total of 7 relapses in the breast were observed, none in patients treated with combination of chemotherapy and RT. In univariate analysis, rituximab exposure was not associated with any difference in TTP or OS. The stage-adjusted IPI was associated with OS; the 5-year OS was 88% (95% CI 79–98%) in patients with a score of 0–1 versus 48% (95% CI 25–71%) in those with a score of 2–4 (log rank p < 0.001). The very limited-disease group with a stage-adjusted IPI of 0 had a 5-year OS of 94% (95% CI 83–100%) compared to all others who had a 5-year OS of 67% (95% CI 52–81%; log rank p = 0.001). There was no difference in TTP and OS in patients with solitary versus multiple breast masses or between patients with tumors less than versus more than 7cm. Patients receiving RT in addition to chemotherapy had a longer TTP than those who did not (log rank p = 0.03), but RT was not associated with an improved OS. Patients who relapsed and underwent stem cell transplant (SCT) had similar OS to those who never relapsed. Ten patients (13%) had CNS relapse (3 with leptomeningeal disease, 5 with brain parenchymal disease and 2 with both). All CNS relapses occurred within the first 2.8 years from the time of diagnosis. There was no difference in the rate of CNS relapse in the patients who received IT prophylaxis versus those who did not. Conclusions: In this multicenter study, the largest published to date, primary breast DLBCL appears to have a worse prognosis than early-stage DLBCL in nodal or other extranodal sites. RT was associated with improved TTP. Patients who relapsed were successfully salvaged with SCT, and had similar survival times to those who never relapsed. A high CNS relapse rate (∼1 in 8 patients, including parenchymal disease in 70%) was observed. The small numbers preclude definitive conclusions on the value of intrathecal prophylaxis or the utility of rituximab. Disclosures: No relevant conflicts of interest to declare.

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Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse

Blood Cancer Journal ◽

10.1038/s41408-021-00506-3 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Sabela Bobillo ◽

Erel Joffe ◽

David Sermer ◽

Patrizia Mondello ◽

Paola Ghione ◽

...

Keyword(s):

High Risk ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Dose ◽

Relapse Risk ◽

Cns Prophylaxis ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Large B Cell

AbstractAlthough methotrexate (MTX) is the most widely used therapy for central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the optimal regimen remains unclear. We examined the efficacy of different prophylactic regimens in 585 patients with newly diagnosed DLBCL and high-risk for CNS relapse, treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like regimens from 2001 to 2017, of whom 295 (50%) received prophylaxis. Intrathecal (IT) MTX was given to 253 (86%) and high-dose MTX (HD-MTX) to 42 (14%). After a median follow-up of 6.8 years, 36 of 585 patients relapsed in the CNS, of whom 14 had received prophylaxis. The CNS relapse risk at 1 year was lower for patients who received prophylaxis than patients who did not: 2% vs. 7.1%. However, the difference became less significant over time (5-year risk 5.6% vs. 7.5%), indicating prophylaxis tended to delay CNS relapse rather than prevent it. Furthermore, the CNS relapse risk was similar in patients who received IT and HD-MTX (5-year risk 5.6% vs. 5.2%). Collectively, our data indicate the benefit of MTX for CNS prophylaxis is transient, highlighting the need for more effective prophylactic regimens. In addition, our results failed to demonstrate a clinical advantage for the HD-MTX regimen.

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Incidence of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) including CNS relapse in a population-based cohort of 4243 patients in Sweden

Blood Cancer Journal ◽

10.1038/s41408-020-00403-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sara Harrysson ◽

Sandra Eloranta ◽

Sara Ekberg ◽

Gunilla Enblad ◽

Mats Jerkeman ◽

...

Keyword(s):

B Cell ◽

Cumulative Incidence ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Population Based ◽

Refractory Disease ◽

Curative Intent ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Large B Cell

AbstractWe performed a national population-based study of all patients diagnosed with diffuse large B-cell lymphoma (DLBCL) in Sweden in 2007–2014 to assess treatment intent and risk of relapsed/refractory disease, including central nervous system (CNS) relapse, in the presence of competing risks. Overall, 84% of patients started treatment with curative intent (anthracycline-based) (n = 3550, median age 69 years), whereas 14% did not (n = 594, median age 84 years) (for 2% the intent was uncertain). Patients treated with curative intent had a 5-year OS of 65.3% (95% CI: 63.7–66.9). The median OS among non-curatively treated patients was 2.9 months. The 5-year cumulative incidence of relapsed/refractory disease in curative patients was 23.1% (95% CI: 21.7–24.6, n = 847). The 2-year cumulative incidence of CNS relapse was 3.0% (95% CI: 2.5–3.6, n = 118) overall, and 8.0% (95% CI: 6.0–10.6, n = 48) among patients with high CNS-IPI (4–6), when considering other relapse locations and death as competing events. The incidence of relapsed/refractory DLBCL overall and in the CNS was lower than in previous reports, still one in seven patients was not considered fit enough to start standard immunochemotherapy at diagnosis. These results are important for quantification of groups of DLBCL patients with poor prognosis requiring completely different types of interventions.

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Ocular involvement as first sign of isolated CNS relapse in diffuse large B-cell lymphoma

The Lancet Oncology ◽

10.1016/s1470-2045(06)70621-0 ◽

2006 ◽

Vol 7 (3) ◽

pp. 274 ◽

Cited By ~ 1

Author(s):

Angela Ferrari ◽

Mario Luppi ◽

Andrea Lazzerini ◽

Leonardo Potenza ◽

Gian Maria Cavallini ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Ocular Involvement ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Large B Cell

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Prognostic Significance of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Patients with Diffuse Large B-Cell Lymphoma

BioMed Research International ◽

10.1155/2018/9651254 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Siqian Wang ◽

Yongyong Ma ◽

Lan Sun ◽

Yifen Shi ◽

Songfu Jiang ◽

...

Keyword(s):

Prognostic Factors ◽

B Cell ◽

Cell Lymphoma ◽

Univariate Analysis ◽

Prognostic Significance ◽

B Cell Lymphoma ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

Large B Cell Lymphoma ◽

Large B Cell

It is generally believed that there is correlation between cancer prognosis and pretreatment PLR and NLR. However, there are limited data about their role in diffuse large B cell lymphoma (DLBCL). This study aims to determine the prognostic value of pretreatment PLR and NLR for patients who have DLBCL. The associations between clinical characteristics and NLR and PLR were evaluated among 182 DLBCL patients from January 2005 to June 2016. The optimal cutoff values for high PLR (⩾150) and NLR (⩾2.32) in prognosis prediction were determined. The effect of NLR and PLR on survival was evaluated through multivariate Cox regression analysis, univariate analysis, and log-rank test. According to the evaluation results, patients with high NLR and PLR had significantly shorter OS (P=0.026 and P=0.035) and PFS (P=0.024 and P=0.022) compared with those who have low PLR and NLR. On multivariate analyses, IPI>2, elevated LDH, and PLR⩾2.32 were prognostic factors for OS and PFS in DLBCL patients. Therefore, we demonstrated that high PLR and NLR predicted adverse prognostic factors in DLBCL patients.

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