Diffuse large B‐cell lymphoma with testicular involvement: outcome and risk of CNS relapse in the rituximab era

Abstract

The addition of rituximab has improved outcomes in diffuse large B-cell lymphoma (DLBCL), however, there remains limited information on the impact of rituximab in those with testicular involvement. All patients with diffuse large cell lymphoma and testicular involvement treated with curative intent were identified in the British Columbia Cancer Agency Lymphoid Cancer Database. In total, 134 patients diagnosed between 1982 and 2015 with diffuse large cell lymphoma involving the testis were identified: 61 received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)like chemotherapy and 73 received CHOP plus rituximab (R-CHOP). A greater proportion of R-CHOP treated patients had higher International Prognostic Index (IPI, P = 0Á005). In multivariate analysis, the protective effect of rituximab on progression-free survival (hazard ratio (HR) 0Á42, P < 0Á001), overall survival (HR 0Á39, P < 0Á001) and cumulative incidence of progression (HR 0Á46, P = 0Á014) were independent of the IPI. However, in a competing risk multivariate analysis including central nervous system (CNS) prophylaxis and the CNS-IPI, rituximab was not associated with a decreased risk of CNS relapse. The addition of rituximab has reduced the risk of lymphoma recurrence in testicular DLBCL, presumably through improved eradication of systemic disease. However, CNS relapse risk remains high and further studies evaluating effective prophylactic strategies are needed.

Extranodal Diffuse Large B Cell Lymphoma: Molecular Features, Prognosis, and Risk of Central Nervous System Recurrence

“…Even when studied as an additional factor in otherwise high-risk subtypes, secondary kidney/adrenal involvement conveys a higher rate of CNS recurrence. For example, in a cohort of testicular lymphomas, the HR for CNS relapse was 17.9 (95% confidence interval [CI], 3.8–84.1) when kidney/adrenal spread was present [94]. Primary adrenal lymphomas are mostly described by case reports owing to their exceptional rarity [95].…”

“…Because of the inherent risk of CNS or contralateral testicular (20%) relapse, the current standard of care for testicular DLBCL includes routine CNS prophylaxis and contralateral testicular RT, although only about half of patients receive RT in clinical practice [102, 101, 103, 104]. Rituximab has improved survival, yet it has not reduced the rates of CNS recurrence [94, 10]. A recent international retrospective of 280 primary testicular lymphomas found that 77% were stage IE or IIE [101].…”

“…Only 34% of patients received CNS prophylaxis, which did not decrease the incidence of CNS recurrence (21% at 10 years). A BCCA cohort reported 25% rate of CNS recurrence at median time of 2.3 years, with half of all relapses involving the CNS [94]. This risk appears independent of clinical stage.…”

“…This risk appears independent of clinical stage. Interestingly, patients with early stage were more likely to experience an intra-parenchymal recurrence (90%), whereas those with advanced stage had more leptomeningeal recurrences (83%, of which 42% had concurrent parenchymal involvement) [94]. …”

Adult primary testicular lymphoma: clinical features and survival in a series of patients treated at a high-volume institution in China

“…PTL is an extremely aggressive malignant with poor progression-free survival (PFS) and overall survival (OS). PTL performs an inclination to involves the contralateral testis and the central nervous system (CNS), and disseminate to other extranodal sites such as skin, lung, kidney, adrenal, gastrointestinal, and other soft organs [1,[8][9][10]. A phase 2 study revealed that the 5-year PFS and OS rates were 74 and 85% among limited stage primary testicular DLBCL individuals who received anthracyclinecontaining chemotherapy in combination with rituximab, prophylactic contralateral scrotal radiotherapy and CNS prophylaxis with intrathecal (IT) chemotherapy [11].…”