Primary bone diffuse large B-cell lymphoma: a retrospective evaluation on 76 cases from French institutional and LYSA studies

Abstract

Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare DLBCL location variant. We treated 76 PB-DLBCL patients by immuno-chemotherapy, resulting in an 84% sustained complete remission rate and a 78.9% survival over a 4.7-year median follow-up period. Ann Arbor stage IV and high age-adjusted international prognostic index were predictive of adverse outcome in univariate analysis. In multivariate analysis using a Cox model, only aa-IPI predicted long-term survival. While based on a limited number of cases, we suggested that radiotherapy may be useful as a consolidation modality in PB-DLBCL. We also suggested that positron emission tomography/ CT scan should be interpreted with caution due to a persistent [18F]fluorodeoxyglucose [18FDG] uptake of bone lesions even after remission in some in PB-DLBCL patients. Our study based on a homogeneous cohort of PB-DLBCL patients confirmed the favorable outcome of this DLBCL variant and support the implementation of prospective clinical trials in this disease. ARTICLE HISTORY

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

“…Of note, MYD88 mutations are absent in primary bone lymphoma [127]. French investigators reported 80% OS at 4 years in bone lymphoma, classifying 65% of cases as GCB [128]. In contrast, a series from the Moffitt Cancer Center reported 5-year PFS of 75% for unifocal, but only 14% for multifocal bone DLBCL ( P =.002), with OS of 92% and 47% ( P <.001), respectively [45].…”

Aggressive B‐cell lymphomas with a primary bone marrow presentation

“…25 Morphologically, PB-DLBCL frequently shows a predominance of large cells with multilobulated nuclei. 31 The distinction of PB-DLBCL from other entities seems reasonable in consideration of its good prognosis when it is treated with combination chemoradiotherapy or immunochemotherapy, [32][33][34] its typical presentation with bone pain (with a low incidence of systemic symptoms), its low International Prognostic Index score, its high prevalence of the GCB phenotype, 32,33 and its GCB signature determined with gene-expression profiling. 33 Two of the submitted cases presented with lytic bone lesions without lymphadenopathy or other organ involvement, and could therefore be classified as primary bone lymphomas.…”

The role of radiotherapy as salvage and/or consolidation treatment in relapsed/refractory and high‐risk diffuse large B‐cell lymphoma

“…These relatively rare patients (<1.5-4% of NHLs) appear to particularly benefit from consolidation radiotherapy, resulting in improvement of PFS and OS. [16][17][18] One retrospective study demonstrated that RT had an independent prognostic impact on PFS (HR = 0.14; P = .014) and a tendency for improving OS (HR = 0.30; P = .053). 18 In the subgroup analysis of 161 patients with skeletal involvement who participated in 9 prospective trials, the German group found a significantly higher 3-year EFS rate in patients who received RT (75% vs 36%; P < .001) with a trend toward improved OS (86% vs 71%; P = .064).…”