Central nervous system involvement in patients with diffuse large B cell lymphoma: analysis of the risk factors and prognostic from a single-center retrospective cohort study

2019 ◽  
Author(s):  
Jingjing Ma ◽  
Qing Li ◽  
Jie Shao ◽  
Yan Ma ◽  
Zhiguang Lin ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Elevated Serum ◽  
B Cell Lymphoma ◽  
Cns Lymphoma ◽  
Absolute Count ◽  
Cns Involvement ◽  
Systemic Involvement ◽  
Large B Cell Lymphoma ◽  
Significant Difference ◽  
Deep Lesion

Abstract Purpose The aim of this study was to identify the risk factors for central nervous system (CNS) involvement in systemic diffuse large B-cell lymphoma (DLBCL) patients and to explore prognostic for DLBCL patients with CNS involvement (relapse or progression). Method This was a retrospective cohort study in our hospital. Data were collected from all DLBCL patients diagnosed in our institutes from January, 2013 to June, 2018. Clinical information was collected from medical records. Result The participants included 138 patients with DLBCL. Among them, 38 patients were diagnosed as CNS lymphoma, including 15 patients exhibited CNS involvement while DLBCL were pathologically confirmed, and 23 patients developed CNS lymphoma during or after initial chemotherapy. The median disease-free interval to CNS involvement was 13 months. Multivariate analysis identified elevated serum lactate dehydrogenase(LDH) level [hazard ratio(HR)=4.035; 95% confidence interval(95%CI):1.147~14.195] was independent predictor of CNS involvement. The median progression-free survival (PFS) and overall survival (OS) time of DLBCL patients with CNS involved were 12.5 months and 22 months, respectively. Multivariate prognostic analysis showed that eastern cooperative oncology group (ECOG) score>2(P=0.018; HR=7.333; 95%CI:1.424~42.002), elevated serum LDH level (P=0.046; HR=6.510; 95%CI:1.035~40.949), deep lesion (P=0.005; HR=10.957; 95%CI:2.050~58.569), and CNS with systemic involvement (P=0.023; HR=2.730; 95%CI:1.151~6.479) were independent poor prognostic factors for the patients. The cases with lymphocyte absolute count >0.75×109/L (HR=0.047; 95%CI:0.003~0.732) had better prognosis. The OS of DLBCL patients with secondary CNS lymphoma was inferior to DLBCL patients without CNS involvement. There was no significant difference between the patients with CNS and extra-CNS involvement. There was no significant difference between the patients with CNS involvement and stage III-IV DLBCL cases without CNS lymphoma. Conclusion In conclusion, elevated serum LDH was independent high-risk factor for secondary CNS lymphoma. For patients DLBCL with CNS involvement, ECOG score>2, elevated serum LDH level, deep lesion, lymphocyte absolute count ≤0.75×109/L and CNS with systemic involvement retained a significant association with outcome.

scholarly journals Central nervous system involvement in patients with diffuse large B cell lymphoma: analysis of the risk factors and prognostic from a single-center retrospective cohort study

2019 ◽  
Author(s):  
Jingjing Ma ◽  
Qing Li ◽  
Jie Shao ◽  
Yan Ma ◽  
Zhiguang Lin ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Elevated Serum ◽  
B Cell Lymphoma ◽  
Cns Lymphoma ◽  
Absolute Count ◽  
Cns Involvement ◽  
Systemic Involvement ◽  
Large B Cell Lymphoma ◽  
Significant Difference ◽  
Deep Lesion

Abstract Purpose The aim of this study was to identify the risk factors for central nervous system (CNS) involvement in systemic diffuse large B-cell lymphoma (DLBCL) patients and to explore prognostic for DLBCL patients with CNS involvement (relapse or progression). Method This was a retrospective cohort study in our hospital. Data were collected from all DLBCL patients diagnosed in our institutes from January, 2013 to June, 2018. Clinical information was collected from medical records. Result The participants included 138 patients with DLBCL. Among them, 38 patients were diagnosed as CNS lymphoma, including 15 patients exhibited CNS involvement while DLBCL were pathologically confirmed, and 23 patients developed CNS lymphoma during or after initial chemotherapy. The median disease-free interval to CNS involvement was 13 months. Multivariate analysis identified elevated serum lactate dehydrogenase(LDH) level [hazard ratio(HR)=4.035; 95% confidence interval(95%CI):1.147~14.195] was independent predictor of CNS involvement. The median progression-free survival (PFS) and overall survival (OS) time of DLBCL patients with CNS involved were 12.5 months and 22 months, respectively. Multivariate prognostic analysis showed that eastern cooperative oncology group (ECOG) score>2(P=0.018; HR=7.333; 95%CI:1.424~42.002), elevated serum LDH level (P=0.046; HR=6.510; 95%CI:1.035~40.949), deep lesion (P=0.005; HR=10.957; 95%CI:2.050~58.569), and CNS with systemic involvement (P=0.023; HR=2.730; 95%CI:1.151~6.479) were independent poor prognostic factors for the patients. The cases with lymphocyte absolute count >0.75×109/L (HR=0.047; 95%CI:0.003~0.732) had better prognosis. The OS of DLBCL patients with secondary CNS lymphoma was inferior to DLBCL patients without CNS involvement. There was no significant difference between the patients with CNS and extra-CNS involvement. There was no significant difference between the patients with CNS involvement and stage III-IV DLBCL cases without CNS lymphoma. Conclusion In conclusion, elevated serum LDH was independent high-risk factor for secondary CNS lymphoma. For patients DLBCL with CNS involvement, ECOG score>2, elevated serum LDH level, deep lesion, lymphocyte absolute count ≤0.75×109/L and CNS with systemic involvement retained a significant association with outcome.

Retrospective analysis of CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) treated with chemotherapy with or without rituximab

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8551-8551
Author(s):  
K. Miyazaki ◽  
M. Yamaguchi ◽  
R. Suzuki ◽  
N. Niitsu ◽  
D. Ennishi ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
Elevated Serum ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Large B Cell Lymphoma ◽  
Cns Relapse ◽  
Significant Difference ◽  
Large B Cell

8551 Background: CD5+ DLBCL comprises 5–10% of DLBCL, and shows a high incidence of central nervous system (CNS) relapse. It has been included in the 4th WHO classification as an immunohistochemical subgroup. To clarify the prognosis and incidence of CNS relapse of CD5+ DLBCL in the rituximab-era, we conducted a multicenter retrospective study. Methods: We analyzed 313 patients (pts) with CD5+ DLBCL who received chemotherapy with (n=164) or without rituximab (n=149). The current series includes 107 out of 120 pts described in our previous study (Haematologica, 2008). Intravascular large B-cell lymphoma, primary CNS DLBCL, and secondary CD5+ DLBCL were excluded from the study population. Results: 313 pts showed the following clinical features: median age, 67 (range: 15–93); M:F=163:150; elevated serum LDH level, 71%; stage III/IV, 64%; IPI HI/H, 53%. No significant difference in clinical background such as the IPI and its five components, B symptom, male sex, and bone marrow involvement was found between pts who were treated with and without rituximab. Pts treated without rituximab received more dose-intensive chemotherapies (CHOP14, third-generation regimen, and high dose cytarabine-based regimen) than those treated with rituximab (24% vs. 7%, P<0.0001). The CR rate was higher in pts received rituximab than those without (81% vs. 65%; P=0.0014). The median follow-up was 28 months in pts who received rituximab (range: 7–77) and 68 months in those who did not (range: 6–187). Overall survival (OS) was significantly superior for pts with rituximab than for those without (2-yr OS: 68% vs. 54%, P=0.003). Multivariate analysis revealed that the use of rituximab was favorably associated with OS (HR=1.81, 95% CI: 1.26–2.58, P=0.001), but dose-intensive chemotherapies did not affect OS. However, the incidence of CNS relapse was not different between the two groups (2-yr CNS relapse rate: 11.9% vs. 11.4%, P=0.91). 16 of the 20 pts (80%) with CNS relapse in the rituximab group had brain parenchymal disease. Conclusions: Our data show that rituximab improves OS of pts with CD5+ DLBCL, but does not prevent CNS relapse. Future prospective studies to decrease CNS disease for CD5+ DLBCL are warranted. No significant financial relationships to disclose.

Central Nervous System Lymphoma: Analysis of the Texas Cancer Registry

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 45-46
Author(s):  
Cesar Gentille Sanchez ◽  
Ethan Burns ◽  
Ibrahim Muhsen ◽  
Humaira Sarfraz ◽  
Carlo Guerrero ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
T Cell ◽  
Cancer Registry ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Cns Lymphoma ◽  
Large B Cell Lymphoma ◽  
Significant Difference

Introduction Primary or secondary central nervous system (CNS) lymphoma is a rare and aggressive disease. Prior database analyses have enriched our knowledge of the epidemiology, clinical presentation and prognosis for these patients, although data regarding treatment patterns and long-term survival data is lacking. Ours is the first study investigating epidemiology, clinical characteristics, treatment patterns and potential prognostic factors using the Texas Cancer Registry (TCR). This is a statewide database, population-based registry that serves as the foundation for measuring the cancer burden in Texas and it is one of largest cancer registries in the United States1. Methods We used the TCR database to retrospectively identify patients diagnosed with CNS lymphoma from 1997 to 2017. Data collected included age, race, histology (diffuse large B-cell lymphoma, T-cell lymphoma), location and outcomes (alive/dead). Treatment (chemotherapy, radiation therapy or both) data was collected from 2004 to 2017. Differences in patient-level characteristics between cohorts were compared using a chi-square test and Fisher's exact test as appropriate. Survival was analyzed using the Kaplan-Meier method and log-rank tests were used to compare survival distributions. P &lt; 0.05 was considered statistically significant for all analysis. Results There were 1134 patients with CNS lymphoma identified between 1995 and 2017. Most of them were diffuse large B-cell lymphoma (DLBCL) (97.4%); only 22 patients had T cell lymphoma. The most common locations were brain (73.9%), unspecified (14.1%) and spinal cord (6.7%). Almost 50% of all patients were over 65 years old; male to female ratio was 1.23. Patients were frequently reported to be Caucasian (62.7%) followed by Hispanic (27.0%) and African-american (6.9%). The median follow-up time was 11 months. Treatment data was available for 485 patients. They either received chemotherapy (58.1%), radiation (9.7%) or both (12.8%). Survival was better for patients receiving chemotherapy and radiation than radiation alone (HR 1.8, p=0.02) or no treatment (HR 3.3, p &lt; 0.0001). There was no statistically significant difference when compared with chemotherapy alone (HR 1.4, p= 0.0931) (Figure 1). Overall survival (OS) for patients with DLBCL at 5-years was 27.4 % (95% CI: 24.7%, 30.1%) and 42.0% for T-cell (95% CI: 23.9%, 59.0%). Five-year disease specific survival (DSS) was similar at 39.2% (95% CI: 35.9%, 42.5%) for DLBCL and 51.8% for T-cell lymphoma (95% CI: 30.3%, 69.5%). There was no statistically significant difference between these two cohorts for OS (p = 0.5063) and DSS (p=0.2819). Age over 65 years was associated with poor survival (32 months vs 6 months, p&lt;0.0001). Spinal cord involvement was associated with a better prognosis than other nervous system, cerebellum, or brain (34 months vs 21 months vs 9 months vs 10 months, p &lt; 0.0001) (Figure 2). Conclusion CNS lymphoma is a rare lymphoma presentation. Most of them are DLBCL and commonly found in patients older than 65 years old. Spinal cord disease alone was associated with a better prognosis and age over 65 years old was associated with a worse outcome. Treatment with chemotherapy (either with radiation or alone) is associated with better outcomes. 1. Cancer incidence data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756, https://www.dshs.texas.gov/tcr/. Disclosures No relevant conflicts of interest to declare.

scholarly journals Bone Marrow Molecular Markers Associated with Relapsed/Refractory Activated B-Cell-Like Diffuse Large B-Cell Lymphoma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Di Wang ◽  
Peng Liu ◽  
Yue Zhang ◽  
Hui-Ying Liu ◽  
Di Shen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Molecular Markers ◽  
B Cell ◽  
Bone Marrow Aspirate ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Significant Finding ◽  
Large B Cell Lymphoma ◽  
Significant Difference ◽  
Large B Cell

Activated B-cell-like diffuse large B-cell lymphoma (ABC-DLBCL) is a common subtype of non-Hodgkin’s lymphoma and is very likely to infiltrate the bone marrow. Over 30% of patients are converted to relapsed/refractory DLBCL after first-line rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, with a poor prognosis. Our aim was to identify molecular markers that might be utilized to predict relapsed/refractory ABC-DLBCL patients. Hence, we collected bone marrow aspirate smears from 202 patients with ABC-DLBCL and detected expression of bone marrow molecular marker proteins by immunocytochemistry. Signal transducer and activator of transcription (Stat)3, nuclear factor (NF)-κB p65, Syk, Bruton’s tyrosine kinase (BTK), and Bcl2 proteins were strongly expressed in bone marrow aspirate smears of ABC-DLBCL patients. The same smear could present positive expression of multiple proteins simultaneously. Positive combinations of protein expression were associated with resistance. The most significant finding was that the Stat3+NF-κB+ group developed resistance, which was significantly higher than that of the Stat3-NF-κB-group (80 vs. 14%). There was a significant difference in two-year relapse-free survival between protein-positive and protein-negative combinations of Stat3-NF-κB (P = 0.005), Bcl2-Stat3 (P = 0.009), Bcl2-Pax5 (P = 0.003), and BTK-Syk (P < 0.001). Thus, we detected key molecules in multiple signaling pathways in bone marrow aspirate smears. At the same time, the results provide further clinical evidence of ABC-DLBCL drug-resistant molecules and provide a theoretical basis for rational second-line treatment after drug resistance.

Outcome of Diffuse Large B-Cell Lymphoma with First-line Chemotherapy

2021 ◽  
Vol 5 (01) ◽  
pp. 03-09
Author(s):  
Zulfia Zinat Chowdhury ◽  
Tamanna Bahar ◽  
Shaila Rahman ◽  
Salina Haque ◽  
A K M Mynul Islam ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
First Line ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Retrospective Data Analysis ◽  
Significant Difference ◽  
Line Chemotherapy ◽  
Large B Cell

Background: Diffuse Large B-Cell Lymphoma (DLBCL), most common Non-Hodgkin Lymphoma (NHL) variety, is an aggressive, fast-growing form comprising up to 40% of all cases globally. Objective: To observe the treatment outcome of different subtypes of Diffuse Large B-Cell Lymphoma (DLBCL) after first-line chemotherapy and also the association with IHC, presenting age, sex, and IPI score with outcome. Methodology: This is a retrospective data analysis included all DLBCL patients registered in the department of Haematology of National Institute of Cancer Research and Hospital (NICRH) between July 2016 to June 2019. Results: Total 188 cases were included in this study and mean age was 48 years with a Standard deviation of 15 years with Male (69.1%) predominance. We divide the cases into three different entities of DLBCL [Germinal Centre B-cell like (GCB), Non-GCB and others (NOS) among them Non-GCB variety was the prevalent (47.3%) one. After first line   chemotherapy 52.1% complete remission with 7% death was observed in overall outcome. There was no significant difference in outcome among different types of DLBCL after chemotherapy based on Han’s algorithm. Rituximab with CHOP has significantly better outcome than CHOP alone arm (p: 0.021). Conclusion: This limited database study of NICRH will help to ascertain the outcome of DLBCL after first-line chemotherapy in Bangladesh.

No Benefit from Rituximab Containing Regimens in Patients with Primary Extranodal Diffuse Large B-Cell Lymphoma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3615-3615
Author(s):  
Gonzalo Gutiérrez-García ◽  
Luis Colomo ◽  
Neus Villamor ◽  
Leonor Arenillas ◽  
Antonio Martínez ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Primary Cns Lymphoma ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Cns Lymphoma ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell

Abstract Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous category of lymphoid tumors that comprises different clinical forms not fully recognized in the WHO classification. In this regard, extranodal (EN) DLBCLs have particular clinicobiological features and outcome, sometimes related to the specific site where the lymphoma arises. Nowadays, rituximab plus chemotherapy (CT) is the gold-standard in the treatment of DLBCL. However, the superiority of rituximab-CT (R-CT) over CT alone has not been addressed for all the clinical subsets of the disease and, in fact, the clinical role of the new therapies might be different for primary nodal or EN DLBCLs. The aim of this study was to assess the impact of rituximab in patients suffering from nodal or EN DLBCL. Two-hundred and thirty non-immunocompromised patients (112M/118F; median age, 61 years) diagnosed with CD20+DLBCL in a single institution between 1997 and 2006 (five years before and after establishing R-CT as the standard treatment in DLBCL) and treated with adriamycin-containing regimens were the subject of the present study. The series included 148 primary nodal and 82 EN DLBCL. Patients with primary CNS lymphoma were excluded and lymphomas arising at Waldeyer ring were considered as nodal DLBCL. The main EN sites were GI (n=26), bone (n=13), soft tissue (n=13), lung/pleura (n=9), liver (n=9), and other (n=12). Main clinico-biological and evolutive variables were analyzed. One hundred nineteen patients received only CT and 111 R-CT. Eighty-seven cases with available information were assigned to germinal center B-cell-like (GCB) (41%) or non-GCB (59%) groups according to the Hans method (Blood2004;103:275–82) based on CD10, BCL6 and MUM1 expression. Main initial features, including the primary nodal or EN origin, international prognostic index (IPI), and GCB/non-GCB categories were similar for CT and R-CT groups. No correlation was observed between the GCB/non-GCB groups and the primary site of the tumor, although nodal lymphomas more frequently expressed MUM1 than EN (69% vs. 31%, respectively; p=0.01). CR rate and 5-year overall survival (OS) according to the treatment arm (CT vs. R-CT) is detailed for the whole series and for the nodal and EN groups in the table and OS curves depicted in the figure. In the whole series, variables predicting poor OS in the multivariate analysis were high-risk IPI (RR 2.5; p<0.001), primary nodal involvement (RR 1.6; p=0.04) and no R-CT treatment (RR 1.9; p=0.002). In the nodal group, IPI and no R-CT maintained the prognostic value, whereas in the primary EN only IPI predicted OS. Moreover, no difference in OS was observed according to the nodal or EN origin in those patients receiving R-CT. Biological subtypes GCB vs. non-GCB did not add predictive information neither in the whole series nor in the nodal or EN groups. In conclusion, patients with primary EN DLBCL seem to have little benefit from the use of R-CT. Nevertheless, this intriguing observation should be confirmed in further prospective studies. Complete response CR (%) 5-years OS (%) CT R-CT CT R-CT *p<0.002 R-CT vs. CT All cases (n=230) 59 79* 46 70* Primary nodal (n=148) 54 78* 34 71* Primary extranodal (n=82) 68 78 70 69 Figure Figure

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