Patterns of Outcome and Prognostic Factors in Primary Large-Cell Lymphoma of the Testis in a Survey by the International Extranodal Lymphoma Study Group

Zucca, Emanuele; Conconi, Annarita; Mughal, Tariq I.; Sarris, Andreas H.; Seymour, John F.; Vitolo, Umberto; Klasa, Richard; Ozşahin, Mahmut; Mead, GM; Gianni, M.C.; Cortelazzo, Sergio; Ferreri, Andrés J.M.; Ambrosetti, A.; Martelli, Maurizio; Thiéblemont, Catherine; Gómez, Henry L.; Pinotti, Graziella; Martinelli, Giovanni; Mozzana, R; Grisanti, S.; Provencio, Mariano; Balzarotti, Monica; Laveder, Francesco; Oltean, Galafteon; Callea, Vincenzo; Roy, Pascal; Cavalli, Franco; Gospodarowicz, Mary K.

doi:10.1200/jco.2003.11.141

Cited by 378 publications

(405 citation statements)

References 43 publications

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“…The risk of CNS relapses in patients with PBL appears greater than that has been reported for aggressive nodal NHL and approximately estimated to 5% [38]. The situation of PBL could be compared with that of primary testicular lymphoma for which CNS relapses occurred in 15% of cases [39]. Therefore, the twofold increase of the CNS relapse risk raises the question of a specific CNS prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Primary breast non‐Hodgkin's lymphoma: A large single center study of initial characteristics, natural history, and prognostic factors

et al. 2009

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The aims of this study were to define the initial pathological and clinical characteristics, and prognostic factors of patients with primary breast malignant lymphoma (PBL). All patients treated at the Institut Curie for lymphoma with breast involvement were reviewed. A pathological review of all cases was performed. Fortyfive cases were selected in whom 38 cases were of diffuse large B-cell lymphoma. A complete analysis was then performed on these 38 patients. Twenty out of 28 cases (71%) of cases were Bcl-2 positive and four out of 28 (14%) had a CD10 positive staining. Peculiar initial characteristics showed nodal involvement in 58% of the cases and two or more extra-nodal sites in 31% of the cases. Among the 37 patients for whom all data were available, and according to the International Prognostic Index, 19 patients (51%) were classified in the low-risk group, 5 cases (14%) in the low-to intermediate-risk group, 6 patients (16%) in the intermediate-to high-risk group, and 7 (19%) case in the high-risk group. At the end of initial therapy, 34 patients (89%) achieved CR. With a median follow-up of 96 months, 18 patients (47%) relapsed of whom 3 had a relapse in central nervous system site. The 5-year disease-free (DFS) and overall survivals (OS) were 54% and 61%, respectively. In multivariate analysis, the presence of 2 or more extranodal sites was prognostic for lower DFS (P 5 0.0008) and OS (P 5 0.09), and a performance status ‡1 was prognostic for lower OS (P 5 0.005). Finally, when our series was compared with a historical series of 111 patients with aggressive nodal lymphomas, we observed significant lower survival rates in localized PBL (P < 0.03). Initial breast localization has a pejorative impact on the outcome of patients with Non-Hodgkin's Lymphoma (NHL), with an impressive adverse influence of additional extranodal sites. These results suggest a specific management of NHL with breast involvement. Am. J. Hematol. 84:133-139, 2009. V

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Section: Discussionmentioning

confidence: 99%

Primary breast non‐Hodgkin's lymphoma: A large single center study of initial characteristics, natural history, and prognostic factors

et al. 2009

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“…20 Involvement of the bone marrow, testes, and paranasal sinuses as well as the kidneys, adrenal glands, liver, bladder, breasts, mediastinum, bone, epidural space, and peripheral blood have all been associated with an increased risk of CNS recurrence. 1,[4][5][6][7][8][9][10]21 In addition, univariate risk factor analysis of patients who develop CNS recurrence also has identified LDH elevation, the presence of extranodal sites of disease, age, and B symptoms as conferring an increased risk of CNS recurrence. 1,3,18 On multivariate analysis, the presence of an elevated LDH in concert with the involvement of multiple extranodal sites by DLBCL appears to be the most strongly predictive clinical algorithm, predicting a CNS recurrence risk of 17% to 34%.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] These risk factors include the involvement of specific extranodal sites (bone marrow, testes, and paranasal sinuses, as well as perhaps the kidneys, adrenal glands, liver, and breast). 1,[4][5][6][7][8][9][10] Multivariate risk models have further identified the combination of an elevated lactate dehydrogenase (LDH) and involvement of 2 extranodal sites as conferring a risk of CNS recurrence as high as 34%. 1,11 A large Norwegian retrospective analysis identified 5 independent risk factors for CNS recurrence: elevated LDH, age >60 years, involvement of >1 extranodal site, retroperitoneal lymph node involvement, and hypoalbuminemia.…”

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confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

205

158

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BACKGROUND:The outcome of patients with systemic diffuse large B-cell lymphoma (DLBCL) had improved over the past decade with the addition of monoclonal antibody therapy. Unfortunately, approximately 5% of these patients still developed a secondary central nervous system (CNS) recurrence followed invariably by rapid death. This rate is substantially increased in patients with certain high-risk features. Although prophylaxis against CNS recurrence with either intrathecal or intravenous methotrexate is commonly used for such patients, to the authors' knowledge, there is no standard of care. Retrospectively evaluated was the role of high-dose systemic methotrexate combined with standard cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (R-CHOP) chemotherapy to decrease CNS recurrence in high-risk patients. METHODS: A total of 65 patients with DLBCL and CNS risk factors were identified at the study institution between 2000 and 2008 who received intravenous methotrexate as CNS prophylaxis concurrent with standard systemic therapy with curative intent. CNS recurrence rate, progression-free survival, and overall survival were calculated. RESULTS: Patients received a median of 3 cycles of methotrexate at a dose of 3.5 gm/m 2 with leucovorin rescue. The complete response rate was 86%, with 6% partial responses. At a median follow-up of 33 months, there were only 2 CNS recurrences (3%) in this high-risk population. The 3-year progression-free and overall survival rates were 76% and 78%, respectively. Complications associated with methotrexate therapy included transient renal dysfunction in 7 patients and a delay in systemic chemotherapy in 8 patients. CONCLUSIONS: Intravenous methotrexate can be safely administered concurrently with R-CHOP and is associated with a low risk of CNS recurrence in high-risk patients. Cancer 2010;116:4283-90.

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“…We identified 8 extranodal sites that have an impact on prognosis, 7 of which are associated with a poor prognosis. Lymphomas with involvement in these sites reportedly tend toward advanced stages, [5][6][7][8][9][10][11] whether defined as primary sites or not. Patients with extranodal involvement of these sites in our cohort also tended to have disseminated disease.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, DLBCL with testicular involvement tends to extend to and relapse in other extranodal sites, including the CNS and contralateral testis. 10,11 Presence of the blood-brain and blood-testicular barriers blocks the access of chemotherapy to lesions in these areas, reducing its efficacy and leading to a poor prognosis. In our recent study with the same patient cohort, 4 adrenal as well as testicular involvement was extracted as a risk factor for CNS involvement by multivariate analysis, which seemed to be a cause of poorer OS for patients with either of these 2 extranodal involvements.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Takahashi

Tomita

Yokoyama

et al. 2011

Cancer

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BACKGROUND:Extranodal involvement is considered a poor prognostic factor for patients with diffuse large B‐cell lymphoma (DLBCL); however, the prognostic impact of specific sites of involvement has not been fully elucidated.METHODS:The authors retrospectively analyzed 1221 patients treated uniformly with standard R‐CHOP therapy between 2003 and 2006. Patients with distinct forms of DLBCL such as intravascular lymphoma, primary effusion lymphoma, pyothorax‐associated lymphoma, primary central nervous system lymphoma, and intraocular lymphoma were also excluded. The authors evaluated 26 extranodal sites of involvement with respect to prognostic impact. The median age was 64 years (range, 15‐91 years).RESULTS:Univariate analysis revealed that patients with involvement of specific extranodal sites had significantly worse overall survival (OS) than did patients without such involvement; these sites included nasal cavity, paranasal sinus, lung, pleura, small intestine, peritoneum, liver, pancreas, stomach, spleen, adrenal gland, testis, bone, bone marrow, peripheral blood, skin, and subcutaneous tissue. Patients with Waldeyer ring involvement had significantly better OS. Multivariate analysis revealed that patients with the involvement of the pleura (P < .001), small intestine (P = .015), peritoneum (P = .002), adrenal gland (P < .001), testis (P = .005), bone marrow (P < .001), and peripheral blood (P = .002) had significantly worse OS, whereas those with Waldeyer ring involvement had significantly better OS (P = .038). Subgroup analysis with the nodal and/or Waldeyer patient group also showed prognostic impact of Waldeyer ring by multivariate analysis (relative risk, 0.3; P = .04).CONCLUSIONS:Extranodal involvement affects the prognosis of patients undergoing R‐CHOP therapy for DLBCL. Cancer 2012. © 2011 American Cancer Society.

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Patterns of Outcome and Prognostic Factors in Primary Large-Cell Lymphoma of the Testis in a Survey by the International Extranodal Lymphoma Study Group

Cited by 378 publications

References 43 publications

Primary breast non‐Hodgkin's lymphoma: A large single center study of initial characteristics, natural history, and prognostic factors

Primary breast non‐Hodgkin's lymphoma: A large single center study of initial characteristics, natural history, and prognostic factors

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

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