Malignant Lymphomatosis of the Kidneys

Wentzell, Robert A.; Berkheiser, S. W.

doi:10.1016/s0022-5347(17)67262-8

Cited by 32 publications

(7 citation statements)

References 10 publications

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“…[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. 1,6,11 Consistent with prior reports, we observed that renal involvement occurred in the setting of extensive nodal 11 and extranodal 9 disease.…”

Section: Clinical Factor Chop (N=12) R-chop (N=8)mentioning

confidence: 99%

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

Villa¹,

Connors²,

Sehn³

et al. 2011

Haematologica

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BackgroundRenal involvement is uncommon in diffuse large B-cell lymphoma. Recent data suggest that it is an independent risk factor for central nervous system relapse. We reviewed the clinical features, risk of central nervous system involvement, and survival of patients with diffuse large Bcell lymphoma with involvement of the kidney at diagnosis. Design and MethodsAll patients with diffuse large B-cell lymphoma and renal involvement diagnosed from January 1, 1982 to December 31, 2008 at the British Columbia Cancer Agency were retrospectively identified in the Lymphoid Cancer Database. Patients were included if they were 16 years old or over, had advanced stage disease [stage III /IV, or stage I/II with B symptoms or bulky mass (>10 cm)] and were treated with curative intent. Central nervous system involvement was diagnosed by cerebrospinal fluid cytology, radiology or clinically. ResultsWe identified 55/2656 (2%) patients with diffuse large B-cell lymphoma and renal involvement at diagnosis. The male to female ratio was 2:1. The patients' median age was 58 years. Bilateral renal involvement was present in 24 (44%) and stage IV disease in 50 (91%). The International Prognostic Index score was 3, 4 or 5 in 52 (95%), the glomerular filtration rate was less than 30 mL/min/m 2 in 9 (16%) and elevated lactate dehydrogenase was recorded in 46 (84%). Twentyfive (46%) patients received CHOP plus rituximab and 30 (54%) received CHOP-like regimens without rituximab. In total, 20 (36%) patients had central nervous system involvement: four at the time of diagnosis and 16 at relapse. The median time to central nervous system relapse was 5.6 months (range, 1.2 months-4.6 years), and was not affected by the addition of rituximab (P=0.547). The 5-year overall and progression-free survival rates for the whole cohort were 29% and 25%, respectively. In patients who received rituximab, there were trends towards improved 5-year overall survival (43% versus 18%, P=0.071) and progression-free survival (40% versus 13%, P=0.057). ConclusionsThere is an exceptionally high incidence of central nervous system relapse in patients with diffuse large B-cell lymphoma and kidney involvement at diagnosis. The addition of rituximab may improve overall survival in this poor-risk population, likely through improved control of systemic disease.

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Section: Clinical Factor Chop (N=12) R-chop (N=8)mentioning

confidence: 99%

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

Villa¹,

Connors²,

Sehn³

et al. 2011

Haematologica

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“…This low incidence contrasts with the high prevalence (nearly 50%) of renal involvement found at autopsy (Wentzell & Berkheise, 1955;Martinez-Maldonado & Ramirez de Arellano, 1966;Lalli, 1969;Kandel et al, 1987;Richards et al, 1990). Until the introduction of computerised tomography (CT), renal involvement was often found late in the clinical course of NHL patients.…”

mentioning

confidence: 96%

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

Morel

Dupriez²,

Herbrecht³

et al. 1994

Br J Cancer

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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.

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“…Autopsy series of patients dying from lymphoma show microscopic renal involvement in 32-52% [4,5], although by CT or ultrasonography it is detected in only 5% of patients with a clinical diagnosis of malignant lymphoma. Non-Hodgkin's type malignant lymphoma affects the kidney more frequently than Hodg kin's lymphoma, and bilateral renal involvement exceeds unilateral involvement by a factor of 3:1 [7], Lymphomas usually spread to the kidney hematogenously, initially producing multiple small tumor nodules in the renal cortex.…”

Section: Discussionmentioning

confidence: 99%