Incidence and outcome of patients with diffuse large B cell lymphoma with marrow involvement and preliminary experience of an adult acute lymphoblastic leukemia protocol (NEALL VI) in cyclophosphamide, doxorubicin, vincristine, and prednisolone – rituximab refractory patients

Sieniawski, Michal; Bhartia, Shilpa; Wilkinson, Jennifer; Proctor, Stephen J.

doi:10.1080/10428190903144667

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…This finding suggests that treatment approach to DLBCL with BM involvement should be considered separately from those for DLBCL with normal BM. Some data support the use of intensive multiagent chemotherapy in eradication of neoplastic cells in BM [19]. In addition, more intensive regimens have been used in lymphoblastic lymphoma, which typically presents as a widely disseminated disease with frequent BM involvement [20].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement

et al. 2013

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PurposeWe investigated the clinical outcome of bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL) who received rituximab-based therapy.Materials and MethodsA total of 567 consecutive patients with newly diagnosed DLBCL treated with rituximab-CHOP (RCHOP) between November 2001 and March 2010 were included in the current study. All of the patients underwent a BM study at the initial staging and the clinical characteristics and prognosis of these patients with or without BM involvement were analyzed retrospectively.ResultsThe total cohort included 567 patients. The overall incidence of BM involvement was 8.5%. With a median follow-up duration of 33.2 months (range, 0.1 to 80.7 months) for patients who were alive at the last follow-up, the five-year overall survival (OS) and event-free survival (EFS) rate in patients without BM involvement (76.3% and 67.5%, p<0.001) was statistically higher than that in patients with BM involvement (44.3% and 40.1%, p<0.001). In multivariate analysis, among total patients, BM involvement showed a significant association with OS and EFS. In univariate and multivariate analyses, even among stage IV patients, a significant association with worse EFS was observed in the BM involvement group.ConclusionBM involvement at diagnosis affected the survival of patients with DLBCL who received RCHOP. Although use of RCHOP can result in significant improvement of the therapeutic effect of DLBCL, BM involvement is still a negative prognostic factor of DLBCL patients in the era of rituximab.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement

et al. 2013

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“…Strong prognostic indicators of outcomes include the International Prognostic Index (IPI) and molecular and genomic markers (Rosenwald et al , ; Shipp et al , ; Gascoyne et al , ; Hong et al , ). Although marrow involvement by lymphoma is common in advanced stage DLBCL (Morra et al , ; Sieniawski et al , ), presentation with circulating lymphoma cells is relatively rare (Come et al , ; Morra et al , ; Bain & Catovsky, ). The presence of circulating malignant lymphoma cells in the blood is well‐recognized in mantle cell lymphoma, follicular lymphoma, anaplastic large cell lymphoma, and in terminal phases of all refractory lymphomas (Morra et al , ; Berinstein et al , ; Criel et al , ; Villamor et al , ).…”

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confidence: 99%

“…Although marrow involvement by lymphoma is common in advanced stage DLBCL (Morra et al, 1989;Sieniawski et al, 2009), presentation with circulating lymphoma cells is relatively rare (Come et al, 1980;Morra et al, 1989;Bain & Catovsky, 1995). The presence of circulating malignant lymphoma cells in the blood is well-recognized in mantle cell lymphoma, follicular lymphoma, anaplastic large cell lymphoma, and in terminal phases of all refractory lymphomas (Morra et al, 1984;Berinstein et al, 1993;Criel et al, 1996;Villamor et al, 1999).…”

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confidence: 99%

Characteristics and outcomes of diffuse large B‐cell lymphoma presenting in leukaemic phase

et al. 2012

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Summary Diffuse large B‐cell lymphoma (DLBCL) occasionally presents with circulating malignant cells. The clinical characteristics and long‐term outcomes of these patients have not been described. Twenty‐nine newly diagnosed DLBCL presenting in leukaemic phase were identified between 1996 and 2010, at two institutions. Median age was 48 years, and patients presented with leucocytosis, high lactate dehydrogenase levels, B symptoms, and high International Prognostic Index score. Extra nodal site involvement was observed in all patients and affected the bone marrow (100%), spleen (62%), pleura/lung (41%), liver (21%), bone (17%), bowels (7%) and cerebrospinal fluid (14%). Blood lymphomatous cells co‐expressed CD19, CD20, CD22, CD38, CD45, HLA‐DR and FMC7 in >90%, and kappa or lambda light chain restriction in >50%. Ninety per cent received rituximab and anthracycline‐based chemotherapy. Overall, remission was complete in 54% and partial in 31%; 15% had resistant disease. Median follow‐up was 47 months; 13 (45%) patients remain alive in complete remission. Median progression‐free and overall survivals were 11·5 and 46·7 months, respectively. In summary, patients with DLBCL in leukaemic phase present with high tumour burden and frequent involvement of extra nodal sites. In this uncommon DLBCL subgroup, anthracycline‐based regimens with rituximab are associated with early morbidity and mortality, but yield approximately 50% 4‐year survival.

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“…Typically a nodal disease, DLBCL can also frequently present with extranodal disease in up to 40% of cases with clinical and prognostic implications. 6 In advanced stages of disease, the bone marrow is frequently involved by DLBCL, and has been reported in up to 17% of patients at the time of original diagnosis, 7 but leukemic involvement (LI) in the peripheral blood is rather rare with a purported incidence ranging between 1.3% and 5%. [8][9][10] It is well established that low grade forms of NHL, such as mantle cell lymphoma, marginal zone B cell lymphoma, and small lymphocytic lymphoma/chronic lymphocytic leukemia can have a leukemic presentation with circulating lymphoma cells, 1 , 11-16 but HGBL with leukemic involvement (L-HGBL) has been sparsely reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience

Kuhlman

Moustafa

Jiang

et al. 2022

Clinical Lymphoma Myeloma and Leukemia

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Incidence and outcome of patients with diffuse large B cell lymphoma with marrow involvement and preliminary experience of an adult acute lymphoblastic leukemia protocol (NEALL VI) in cyclophosphamide, doxorubicin, vincristine, and prednisolone – rituximab refractory patients

Cited by 4 publications

References 13 publications

Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement

Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement

Characteristics and outcomes of diffuse large B‐cell lymphoma presenting in leukaemic phase

Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience

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