Age as a potential new prognostic indicator in primary cutaneous B-cell lymphoma (PCBCL).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19034-e19034
Author(s):  
Poorvi Kirit Desai ◽  
Magali Van den Bergh ◽  
Xiaohui Zhang ◽  
Hailing Zhang ◽  
Braydon Schaible ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Age Groups ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Prognostic Indicator ◽  
Rank Test ◽  
Cancer Center ◽  
Significant Difference

e19034 Background: PCBCL is a group of rare lymphoproliferative disorders, with an estimated annual incidence of 2.5 per 1,000,000 persons. Indolent subtypes include Primary Cutaneous Marginal Zone Lymphoma (PCMZL) and Primary Cutaneous Follicular Center Lymphoma (PCFCL). Primary Cutaneous Diffuse Large B-cell Lymphoma (PCDLBCL) is an aggressive subtype with a fatality rate of 50%. The Cutaneous Lymphoma International Prognostic Index (CLIPI) can risk-stratify indolent subtypes, but age is not considered. Here we present our single-institutional analysis of clinicopathologic features and outcomes of patients with PCBCL. Methods: This is a retrospective study of patients evaluated at Moffitt Cancer Center between 01/1990 and 12/2016. Patients were identified using our PCBCL database and diagnosis was verified by independent hematopathologists and dermatopathologists. Staging was determined by ISCL/EORTC criteria. Demographics, subtype, stage, disease course, and CLIPI scores were collected. Continuous and categorical values were tested using Kruskal-Wallis ANOVA method and Fisher’s Exact Test, respectively. Kaplan-Meier curves were produced to determine PFS. Results: We identified 37 patients who met diagnostic criteria for PCBCL (35% PCFCL, 40.5% PCMZL, 13.5% PCDLBCL, and 11% indolent, unspecified). Male:female ratio was 2.4:1. 51% of patients were ≥ 60 years old (yo), and 49% were < 60 yo. 54% had stage T1 disease, 27% T2, and 19% T3. Median PFS for patients <60 was 1.1 years, but was not reached for those ≥60. Mean follow-up time was 2.6 years for all patients. Log-rank test showed a statistically significant difference in PFS between the two age groups (p=0.01). PFS for stage of indolent subtypes showed marginal significance (p <0.06). CLIPI for indolent subtypes did not show a significant difference in PFS. Conclusions: We found that age is a highly statistically significant prognostic parameter in PCBCL, as patients ≥ 60 yo had a longer PFS compared to younger patients, even after adjusting for stage and CLIPI. These results are promising for age as a possible prognostic indicator for PCBCL, but validation is needed with a larger sample size.

Survival disparities of diffuse large B-cell lymphoma in a community-based cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 7541-7541
Author(s):  
Vinicius Machado Jorge ◽  
Andrew Chua Tiu ◽  
Peter Moussa ◽  
Sorab Gupta ◽  
Djeneba Audrey Djibo ◽  
...  
Keyword(s):  
African Americans ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Cancer Center ◽  
Community Based ◽  
Large B Cell Lymphoma ◽  
Large B Cell

7541 Background: Non-Hodgkin’s Lymphoma (NHL) is a heterogeneous group of hematologic malignancy from immature or mature lymphocytes or natural killer cells. It is the 9th leading cause of death for both sexes. Diffuse Large B Cell Lymphoma (DLBCL), a subset of NHL, comprises 30 – 40% of all NHL. The etiology for the racial disparities in survival among patients with DLBCL is still unknown. The Revised International Prognostic Index (R-IPI), a tool which predicts the outcome of DLBCL patients, has not yet been fully validated in African Americans (AA). Methods: We conducted a single cohort study of patients diagnosed with DLBCL from January 1, 2007 to December 31, 2017 from our tumor registry in a single community-based cancer center. We abstracted demographic, clinical, histopathologic, treatment, and R-IPI variables. Our primary endpoint was overall survival (OS). Our secondary endpoints were factors that determine mortality through Cox multivariate analysis. Results: Among 381 patients with NHL, 181 (47.5%) patients had biopsy-proven DLBCL. Median age was 65 years old, 47% were males, 41% were AA, 44% were Caucasians, 46% were stage IV by Ann-Arbor staging. African-Americans (AA) had a median OS of 15.7 months (95% CI, 10.31 to 23.90) compared to non-AA 93.6 months (95% CI, 61.48 to 142.57). Even after adjusting for race, R-IPI was correlated with mortality on all patients. Lactate dehydrogenase levels were significantly higher in AA (P<0.001) but there was no difference in the interval from diagnosis to initiation of treatment in all groups. The presence of B symptoms HR 1.80 (95% CI, 1.17 to 2.77), African-American race HR 2.19 (95% CI, 1.38 to 3.52), positive HIV HR 2.16 (95% CI, 1.15 to 4.05), chronic liver disease HR 1.87 (95% CI, 1.09 to 3.23), and malnutrition HR 2.46 (95% CI, 1.30 to 4.65) were all independently associated with increased mortality. Histopathologic features such as the cell of origin, BCL6, and BCL2 rearrangements were not independently associated with increased mortality. Conclusions: There is an overwhelming disparity in survival among AA with DLBCL. The R-IPI is a reliable tool for predicting mortality in AA with DLBCL.

Phase II/III Study of Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone with Rituximab (R-CHOP) Versus Biweekly CHOP with Rituximab (R-Bi-CHOP) In Untreated Advanced-Stage Indolent B-Cell Lymphoma: Japan Clinical Oncology Group (JCOG) 0203 Trial

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 431-431
Author(s):  
Takashi Watanabe ◽  
Yasuo Morishima ◽  
Taro Shibata ◽  
Nobuo Maseki ◽  
Tomohiro Kinoshita ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Phase Ii ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Phase Iii ◽  
Advanced Stage ◽  
Significant Difference

Abstract Abstract 431 Introduction: There has been no standard treatment for untreated advanced-stage indolent B-cell lymphoma, including follicular lymphoma (FL). However, cyclophosphamide, doxorubicin, vincristine, and prednisolone with rituximab (R-CHOP) is regarded as one of the most effective frontline therapies. Granulocyte colony-stimulating factor (G-CSF) has been often used to shorten CHOP intervals, and it potentiates the antibody-dependent cell-mediated cytotoxicity of rituximab. Methods: To improve the outcome of R-CHOP, we conducted a phase II/III trial comparing R-CHOP with biweekly CHOP with rituximab (R-Bi-CHOP). Patients with previously untreated stage III/IV indolent B-cell lymphoma were randomized to receive 6 cycles of R-CHOP or R-Bi-CHOP. All patients received a total of 6 doses of rituximab, 2 days prior to each cycle of CHOP. In the R-Bi-CHOP arm, during each cycle patients received G-CSF for 6 days until the next cycle's rituximab was given. Maintenance use of rituximab was not allowed. The primary endpoint of the phase II portion was complete response rate (%CR). The primary and secondary endpoints of the phase III study were progression-free survival (PFS), and overall survival (OS) and safety, respectively. Age, bulky disease, and institution were used as dynamic allocation adjustment factors. The sample size was determined with a one-sided alpha of 0.05 and beta of 0.2. All the histopathologic specimens were reviewed by 3 hematopathologists. In the phase II portion, the response was judged according to the International Workshop Criteria by the Central CT Review Committee. Results: For the 73 patients enrolled in the phase II portion, the %CR of the R-CHOP and R-Bi-CHOP arms were 60% vs. 72%, both of which were above the threshold value, and consequently this study continued to the phase III portion. Between September 2002 and February 2007, 300 patients were enrolled in the study overall. The median age of all patients was 54 years. Baseline characteristics were well balanced between the 2 arms except for B symptoms and the number of extranodal sites (R-CHOP < R-Bi-CHOP). FL (G1 to G3) was seen in 88%. The delivered doses were exactly the same in both arms except for vincristine (R-CHOP > R-Bi-CHOP). Excluding 1 patient with histologic transformation, 299 patients were eligible for survival analysis. The median follow-up time for all randomly assigned patients was 4.7 years at the planned analysis time point 3 years after the last patient enrollment. Of note, most of the enrolled patients were followed up for more than 3 years. There was no significant difference in PFS between the R-CHOP and R-Bi-CHOP arms: median, 3.6 y [95% confidence interval (CI), 3.0–5.1 y] vs. 4.2 y [95%CI, 3.1–5.4 y]; 40% [95%CI, 31–49%] vs. 40% [95%CI, 30–50%] at 6 y (HR=0.94, stratified log-rank p=0.35). The median survival time was not reached in either arm and there was no significant difference in 6-y OS: 85% [95%CI, 75–92%] vs. 87% [95%CI, 77–92%] (p=0.53). No difference was found in either 6-y PFS or 6-y OS in any of the 3 risk groups defined by the Follicular Lymphoma International Prognostic Index. Moreover, the 2 arms did not differ in PFS or OS in the 2 International Prognostic Index risk categories (low/low-intermediate and high-intermediate/high) or in groups based on patient age (above or below 60 years). As for FL patients, there was no significant difference in PFS between R-CHOP (n=133) and R-Bi-CHOP (n=132): median, 3.7 y vs. 4.2 y; 42% vs. 40% at 6 y (p=0.45). Of 134 patients in the R-CHOP arm, 7 (5.2%) developed interstitial pneumonitis. Pneumocystis jiroveci was the cause in 6 of these. Because the original protocol stipulated prophylaxis against this organism only for patients assigned to the R-Bi-CHOP arm, it was amended to include both arms. The incidence of G4 neutropenia, G3 infection, and G3 peripheral neuropathy in the R-CHOP and R-Bi-CHOP arms were 85% vs. 37%, 34% vs. 15%, and 2.0% vs. 7.3%, respectively. Conclusion: R-Bi-CHOP, a dose-dense approach, has failed to improve the outcome of R-CHOP treatment for untreated patients with advanced-stage indolent B-cell lymphoma. The long-term PFS with R-CHOP treatment is unsatisfactory, warranting further investigations on post-remission therapy after R-CHOP. Disclosures: Kinoshita: Chugai Pharmaceutical Co., Ltd., Zenyaku Kogyo Co., and Kyowa Hakko Kirin Co., Ltd.: Research Funding.

scholarly journals CD30 Expression in Diffuse Large B-Cell Lymphoma (DLBCL) Correlates with Non-GCB Subtype but Does Not Have Prognostic Impact in Patients Treated with First Line R-CHOP/R-CHOP-like

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4209-4209
Author(s):  
Maria Queralt Salas ◽  
Fina Climent ◽  
Eva Domingo Domenech ◽  
Santiago Mercadal ◽  
Viviana Paredes ◽  
...  
Keyword(s):  
B Cell ◽  
Multivariate Analyses ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Biological Characteristics ◽  
Rank Test ◽  
Tumour Necrosis Factor Receptor ◽  
Prognostic Impact

Abstract Background: DLBCL is a heterogeneous disease with 30% of patients presenting as refractory/relapsing disease following R-CHOP treatment. Therefore, new prognostic factors to identify the poor-risk population and alternative therapies for them are needed. CD30 is a member of the tumour necrosis factor receptor (TNFR) super family and is expressed by several types of T- and B-cell non-Hodgkin lymphomas. Brentuximab vedotin, an anti CD30 antibody, is used in clinical practice for Hodgkin lymphoma and systemic anaplastic large cell lymphoma. The significance of CD30 expression in DLBCL remains unknown. We aimed to study the expression of CD30 in a large cohort of the novo DLBCL patients homogeneously treated with R-CHOP or R-CHOP-like protocols to evaluate its correlation with clinical and biological characteristics at diagnosis and its impact in clinical outcome. Methods: we prospectively registered 155 patients diagnosed of DLBCL between January 2012 to December 2015 in our center. Twenty-one patients with primary central nervous system DLBCL, transformed lymphoma or post-transplant DLBCL were excluded from the study. Anatomopathology review was performed in all cases, and 14 cases with not enough histological tissue to perform additional staining were also excluded. Immunohistochemistry was performed in 120 cases on 4 microns' paraffin sections using routine protocols,CD30 expression was analyzed using the antibodyCD30 clone BerH2, dilution 1:30; Dako; staining in more than 10% of the malignant cells was considered positive. Samples were classified as germinal center B-cell-like (GCB) vs. non-GCB subtypes by immunohistochemistry according to Hans algorithm. Univariate analyses were assessed by Chi square test. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses for progression-free survival (PFS) were assessed Cox proportional hazard regression model. Results: among the 120 cases analyzed, CD30 was expressed in 40 (33.3%). Clinical and biological characteristics at disease presentation are shown in Table 1. The expression of CD30 was significantly higher in the non-GCB subtype cases (p=0.0001). One hundred and six patients were homogeneously treated with R-CHOP (100 patients) or R-CHOP-like (1 R-COMP, 2 Burkitt scheme, 1 GA101-CHOP and 2 R-Bortezomib-CAP), and were included in the outcome analyses. Response rates and survival of this subgroup of patients are shown in Table 2. With a median follow-up of 16.4 months, no differences were found neither in PFS or OS between CD30 positive and CD30 negative patients (Table 2). In the multivariate analyses including the following independent variables: gender, B-symptoms, Bulky mass (>5cm), cell of origin (GCB vs non-GCB), International Prognostic Index (IPI) and CD30 expression, IPI 3-5 was de only factor significantly related with poor PFS (HR 2.92, 95% CI:1.18-7.24, p=0.02). Conclusion: CD30 is expressed in one third of DLBCL patients, in whom an anti-CD30 therapy could be used. CD30 expression is significantly higher in patients with non-CGB DLBCL, however and in our experience, its expression does not influence either response to R-CHOP or R-CHOP- like therapy or survival. Disclosures Gonzalez Barca: Gilead: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Speakers Bureau.

scholarly journals Circulating long non-coding RNAs HOTAIR, Linc-p21, GAS5 and XIST expression profiles in diffuse large B-cell lymphoma: association with R-CHOP responsiveness

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mahmoud A. Senousy ◽  
Aya M. El-Abd ◽  
Raafat R. Abdel-Malek ◽  
Sherine M. Rizk
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Expression Profiles ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Diagnostic Tools ◽  
Large B Cell Lymphoma ◽  
Non Coding Rnas ◽  
Large B Cell

AbstractThe reliable identification of diffuse large B-cell lymphoma (DLBCL)-specific targets owns huge implications for its diagnosis and treatment. Long non-coding RNAs (lncRNAs) are implicated in DLBCL pathogenesis; however, circulating DLBCL-related lncRNAs are barely investigated. We investigated plasma lncRNAs; HOTAIR, Linc-p21, GAS5 and XIST as biomarkers for DLBCL diagnosis and responsiveness to R-CHOP therapy. Eighty-four DLBCL patients and thirty-three healthy controls were included. Only plasma HOTAIR, XIST and GAS5 were differentially expressed in DLBCL patients compared to controls. Pretreatment plasma HOTAIR was higher, whereas GAS5 was lower in non-responders than responders to R-CHOP. Plasma GAS5 demonstrated superior diagnostic accuracy (AUC = 0.97) whereas a panel of HOTAIR + GAS5 superiorly discriminated responders from non-responders by ROC analysis. In multivariate analysis, HOTAIR was an independent predictor of non-response. Among patients, plasma HOTAIR, Linc-p21 and XIST were correlated. Plasma GAS5 negatively correlated with International Prognostic Index, whereas HOTAIR positively correlated with performance status, denoting their prognostic potential. We constructed the lncRNAs-related protein–protein interaction networks linked to drug response via bioinformatics analysis. In conclusion, we introduce plasma HOTAIR, GAS5 and XIST as potential non-invasive diagnostic tools for DLBCL, and pretreatment HOTAIR and GAS5 as candidates for evaluating therapy response, with HOTAIR as a predictor of R-CHOP failure. We provide novel surrogates for future predictive studies in personalized medicine.

scholarly journals Concurrent Expression of MYC and BCL2 in Diffuse Large B-Cell Lymphoma Treated With Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone

2012 ◽  
Vol 30 (28) ◽  
pp. 3452-3459 ◽  
Author(s):  
Nathalie A. Johnson ◽  
Graham W. Slack ◽  
Kerry J. Savage ◽  
Joseph M. Connors ◽  
Susana Ben-Neriah ◽  
...  
Keyword(s):  
Protein Expression ◽  
B Cell ◽  
Cell Lymphoma ◽  
Molecular Subtype ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Bcl2 Protein ◽  
Large B Cell

Purpose Diffuse large B-cell lymphoma (DLBCL) is curable in 60% of patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). MYC translocations, with or without BCL2 translocations, have been associated with inferior survival in DLBCL. We investigated whether expression of MYC protein, with or without BCL2 protein expression, could risk-stratify patients at diagnosis. Patients and Methods We determined the correlation between presence of MYC and BCL2 proteins by immunohistochemistry (IHC) with survival in two independent cohorts of patients with DLBCL treated with R-CHOP. We further determined if MYC protein expression correlated with high MYC mRNA and/or presence of MYC translocation. Results In the training cohort (n = 167), MYC and BCL2 proteins were detected in 29% and 44% of patients, respectively. Concurrent expression (MYC positive/BCL2 positive) was present in 21% of patients. MYC protein correlated with presence of high MYC mRNA and MYC translocation (both P < .001), but the latter was less frequent (both 11%). MYC protein expression was only associated with inferior overall and progression-free survival when BCL2 protein was coexpressed (P < .001). Importantly, the poor prognostic effect of MYC positive/BCL2 positive was validated in an independent cohort of 140 patients with DLBCL and remained significant (P < .05) after adjusting for presence of high-risk features in a multivariable model that included elevated international prognostic index score, activated B-cell molecular subtype, and presence of concurrent MYC and BCL2 translocations. Conclusion Assessment of MYC and BCL2 expression by IHC represents a robust, rapid, and inexpensive approach to risk-stratify patients with DLBCL at diagnosis.

scholarly journals Diffuse large B-cell lymphoma: A single-institution experience of patient outcomes.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 271-271
Author(s):  
Ryan James Chan ◽  
Rasna Gupta ◽  
Sindu Mary Kanjeekal ◽  
Mohammed Jarrar ◽  
Amin Kay ◽  
...  
Keyword(s):  
British Columbia ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Canadian Province ◽  
Large B Cell Lymphoma ◽  
Cancer Program ◽  
Large B Cell

271 Background: The Windsor Regional Cancer Program (WRCP) was determined to have consistently been a top performer in time to treatment of diffuse large B cell lymphoma in this Canadian province (http://www.csqi.on.ca/by_type_of_cancer/lymphoma/lymphoma_treatment/). We endeavored to determine whether faster time to diagnosis and treatment for diffuse large B-cell lymphoma (DLBCL) influenced the IPI score (International Prognostic Score), thereby predicting an improved clinical outcome in these presenting patients. Methods: The WRCP services a catchment area of 650,000 people. A retrospective chart review was conducted for patients diagnosed with DLBCL at the Windsor Regional Cancer Program (WRCP) between 2006-2012. Information collected included the five factors for scoring by the International Prognostic Index (IPI) – age, performance status, LDH, stage, and number of extranodal sites – chemotherapy regimen, relapses, existence of second malignancies, cause of death, and dates of diagnosis, last follow-up, and death. We analyzed the relationship between prognostic factors and these clinical outcomes, and also compared the IPI scores for this cohort of patients against a similar population in another Canadian province, British Columbia. Results: It is established that compared to other cancer centres in Ontario, the WRCP is consistently reporting a shorter diagnosis to treatment metric when compared to their counterparts in Ontario, Canada. When compared to historical Canadian data, presenting IPI scores for DLBCL patients were lower on average for patients treated at the WRCP than those reported in British Columbia, Canada by Sehn et al. [Sehn, L. H., et al. (2007). The revised International Prognostic Index is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood, 109(5), 1857-1861.]. Conclusions: A lower presenting IPI score is known to be correlated improved lymphoma related outcome. With attention to the metric of diagnosis to treatment < 30 days for diffuse large B cell lymphoma, we expect an improved lymphoma related outcome for our patients. We recommend ongoing attention to this metric, in order to improve outcomes for our patients.

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