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Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era

Authors :
Audrey Hamilton
Anita Kumar
Ahmet Dogan
Sabela Bobillo
M. Lia Palomba
Jessica A. Lavery
Anas Younes
Ariela Noy
Philip Caron
David Sermer
Steven M. Horwitz
Andrew D. Zelenetz
Venkatraman E. Seshan
Connie Lee Batlevi
Paul A. Hamlin
Collette N. Owens
Joachim Yahalom
Matthew J. Matasar
Erel Joffe
Gottfried von Keudell
David J. Straus
Paola Ghione
Alison J. Moskowitz
Source :
Blood
Publication Year :
2020

Abstract

This retrospective study aimed to better define the characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma (DLBCL) in the rituximab era. Patients diagnosed with stage I DLBCL from 2001 to 2015 treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or R-CHOP–like regimens with or without radiation (RT) were included. We identified 1955 patients with newly diagnosed DLBCL, of whom 341 had stage I and were eligible for this analysis. Extranodal presentation was observed in 224 (66%) patients, whereas 117 (34%) had nodal involvement. The most common extranodal sites were as follows: bone, 21%; stomach, 19%; testis, 9%; intestine, 8%; breast, 8%. Overall, 69% extranodal patients and 68% nodal patients received RT. Median follow-up was 5.5 years (interquartile range, 4.3-8.2). Ten-year overall survival (OS) and disease-free survival were 77% (95% confidence interval [CI], 67%-83%) and 77% (95% CI, 68%-85%). In the multivariable analyses, extranodal involvement was associated with worse OS (hazard ratio [HR], 3.44; 95% CI, 1.05-11.30) and progression-free survival (PFS; HR, 3.25; 95% CI, 1.08-9.72) compared with nodal involvement. Consolidation RT was associated with better OS (HR, 0.26; 95% CI, 0.12-0.49) and PFS (HR, 0.35; 95% CI, 0.18-0.69) in the extranodal population; however, the benefit was no longer observed in patients that were positron emission tomography (PET) negative at the end of immunochemotherapy. Relapses occurred usually late (median, 37 months), and the most common sites were the lymph nodes (31%) and the central nervous system (27%). Extranodal stage I DLBCL had a worse outcome than nodal stage 1 DLBCL. End of immunochemotherapy PET results may help select extranodal patients for consolidation RT.

Details

ISSN :
15280020
Volume :
137
Issue :
1
Database :
OpenAIRE
Journal :
Blood
Accession number :
edsair.doi.dedup.....ebf881e3d82c1254c75d4c5b7fa1d8e8