Aggressive lymphomas with renal involvement: a study of 48 patients treated with the LNH-84 and LNH-87 regimens

Abstract

S_nmry In order to describe renal involvement in aggressive non-Hodgkin's lymphomas (NHLs) and its prognostic significance, we reviewed the outcome of 48 patients with renal involvement treated with the LNH-84 or LNH-87 regimen. Histology was diffuse large cell in 29 (60%) patients; immmunoblastic, diffuse mixed cell and lymphoblastic in four each; follicular large cell, diffuse small cleaved cell and diffuse small non-cleaved cell in one each; and unclassified in four. Ann Arbor stage was IV in 44 patients, and IE or IIE in four. Tumour mass > 10 cm, performance status (ECOG scale) > 2 and increased LDH level were present in 69%, 20% and 76% of patients respectively. Fifteen patients (31%) had multiple intraparenchymal nodules, 14 (29%) had direct spread into the kidney from a perirenal mass, ten (21%) had a single intraparenchymal nodule and nine (19%) had diffuse infiltration. Twenty-one patients (43%) presented with bilateral lesions. Three patients (6%) presented with acute renal failure. Ten other patients (21%) had serum creatinine >120 zmoll-'. In 12 of these 13 patients renal function was restored with chemotherapy. Twenty-eight patients (57%) achieved complete remission. Estimated 4 year disease-free survival was 39%. Disease-free survival and actuarial survival at 4 years were estimated to be 58% respectively. Two renal parameters had adverse prognostic sig i for survival: renal hilum involvement (P = 0.02) and diffuse renal infiltration (P = 0.01). A Cox model identified only two independent prognostic factors for survival, namely performance status > 2 and tumour size > 10 cm. We conclude that alteration in renal function occurs in 27% of patients with renal involvement. Systemic chemotherapy improves renal function rapidly. Long-term outcome is similar to that expected in NHL patients presenting with the same prognostic factors.

Lymphoproliferative Disorders of the Kidney on Fine-Needle Aspiration: Cytomorphology and Radiographic Correlates in 33 Cases

“…This would be useful information to gauge the value of FNA for excluding renal lymphoma and could guide future studies. Follow-up was only available for 26 patients; mortality was high for this heterogeneous group of patients but appears consistent with the literature [1]. …”

“…However, renal lymphoma presents a unique challenge to this practice, as it typically responds well to chemotherapy [1] which can avert surgery. While extranodal spread of non-Hodgkin lymphoma frequently affects the kidneys, primary renal lymphoma is very rare.…”

Diffuse large B-cell lymphoma with involvement of the kidney: outcome and risk of central nervous system relapse

“…[9][10][11][12][13][14] This may underestimate the true involvement, however, as older autopsy series reveal that the incidence may be as high as 50% in patients who ultimately succumb to their disease. 9,[20][21][22][23] Renal parenchymal involvement does not necessarily result in impaired organ function, suggesting that a number of patients may have microscopic, subclinical kidney involvement at diagnosis.…”

“…Such studies showed rapid improvement in renal function and tumor size, but treatment failure was common. 9,11,12 The addition of rituximab appears to improve both progression-free and overall survival rates. However, it does not appear to reduce rates of CNS relapse, although this conclusion is limited by our small sample size.…”

“…[3][4][5][6][7][8] There are limited data describing the clinical course and outcomes of patients with DLBCL and renal involvement and many prior studies were based on older lymphoma classification systems. [9][10][11][12] Retrospective cohort studies reveal that these patients tend to present with widespread disease and have a poor outcome in part due to a high rate of central nervous system (CNS) relapse. 13,14 A recently published report from the British Columbia Cancer Agency (BCCA) showed that kidney involvement is an independent risk factor for CNS relapse in patients with DLBCL in both the pre-and post-rituximab treatment eras.…”