Relapse in stage I(E) diffuse large B‐cell lymphoma

Nijland, Marcel; Boslooper, Karin; Imhoff, Gustaaf van; Kibbelaar, Robbie E.; Joosten, Peter; Storm, Huib; Roon, E.N. Van; Diepstra, Arjan; Kluin-Nelemans, Hanneke C.; Hoogendoorn, Mels

doi:10.1002/hon.2487

Cited by 9 publications

(12 citation statements)

References 24 publications

(52 reference statements)

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“…The most common sites as expected were bone, stomach, and testes. 2,3,19 The outcome of the whole series was excellent with an OS at 5 years of 94% similar to other rituximab era studies. 13 The findings that extranodal involvement was associated with worse survival are in agreement with previous reports of stage I DLBCL in the pre-rituximab era.…”

Section: Discussionsupporting

confidence: 78%

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Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era

Bobillo

Joffe

Lavery

et al. 2021

Blood

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This retrospective study aimed to better define the characteristics and outcomes of extranodal stage I DLBCL in the rituximab era. Patients diagnosed with stage I DLBCL from 2001-2015 treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or R-CHOP-like regimens with or without radiation (RT) were included. We identified 1955 patients with newly diagnosed DLBCL, of whom 341 had stage I and were eligible for this analysis. Extranodal presentation was observed in 224 (66%) patients, while 117 (34%) had nodal involvement. The most common extranodal sites were bone 21%; stomach 19%; testis 9%; intestine 8%; breast 8%. Overall, 69% extranodal and 68% nodal patients received RT. Median follow-up was 5.5 years (interquartile range 4.3-8.2). 10-year overall survival (OS) and disease-free survival were 77% (95% CI 67%, 83%) and 77% (95% CI 68%, 85%). In the multivariable analyses, extranodal involvement was associated with worse OS (HR 3.44, 95% CI 1.05, 11.30) and progression-free survival (PFS) (HR 3.25, 95% CI 1.08, 9.72) compared to nodal. Consolidation RT was associated with better OS (HR, 0.26, 95% CI 0.12, 0.49) and PFS (HR, 0.35, 95% CI 0.18, 0.69) in the extranodal population; however, the benefit was no longer observed in patients with PET negative at the end of immunochemotherapy. Relapses occurred usually late (median 37 months) and the most common sites were the lymph nodes (31%) and the central nervous system (27%). Extranodal stage I DLBCL had a worse outcome than nodal. End of immunochemotherapy PET results may help select extranodal patients for consolidation RT.

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Section: Discussionsupporting

confidence: 78%

“…In accordance with previous population-based reports, extranodal DLBCL accounted for 66% of all stage I in our series. 2,3,19 These numbers are higher compared with recent series of limited-stage DLBCL, probably because they also included patients with stage II. The most common sites as expected were bone, stomach, and testes.…”

Section: Discussionmentioning

confidence: 77%

Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era

Bobillo

Joffe

Lavery

et al. 2021

Blood

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“…The current study also showed that disease stage is not a significant predictor for RR‐RCHOP in DLBCL patients [odds ratio = 1.455 (0.442‐4.793), P = .538]. An earlier study reported a drug therapeutic failure of 15% among patients with stage l of DLBCL disease; and one‐third of them had metastasis of disease to central nervous system 35 . Oki et al 2014’s study on double hit lymphoma patients also showed that there was no significant difference in PFS [OR:1.44, 95% CI (0.76‐2.71), P = .262], overall survival [OR = 1.58, 95% CI (0.78‐3.20), P = .201] and failure to achieve CR [OR = 1.27, 95% CI (0.48‐3.36), P = .628] between advanced disease stage group and early disease stage group 36 .…”

Section: Discussionsupporting

confidence: 53%

Extranodal site of diffuse large B‐cell lymphoma and the risk of R‐CHOP chemotherapy resistance and early relapse

Ting

Gan

Ong

et al. 2020

Int. J. Clin. Pract.

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Background About 20%‐30% of diffuse large B‐cell lymphoma (DLBCL) patients experience early disease progression despite R‐CHOP chemotherapy treatment. Revised international prognostic index (R‐IPI) score could risk stratify DLBCL patients but does not identify exactly which patient will be resistant to R‐CHOP therapy or experience early relapse. Aims of the Study To analyse pre‐treatment clinical features of DLBCL patients that are predictive of R‐CHOP therapy resistance and early disease relapse after R‐CHOP therapy treatment. Methods Used to Conduct the Study A total of 698 lymphoma patients were screened and 134 R‐CHOP‐treated DLBCL patients were included. The Lugano 2014 criteria was applied for assessment of treatment response. DLBCL patients were divided into R‐CHOP resistance/early relapse group and R‐CHOP sensitive/late relapse group. Results of the Study 81 of 134 (60%) were R‐CHOP sensitive/late relapse, while 53 (40%) were R‐CHOP resistance/early relapse. The median follow‐up period was 59 months ± standard error 3.6. Five‐year overall survival rate of R‐CHOP resistance/early relapse group was 2.1%, while it was 89% for RCHOP sensitive/late relapse group. Having more than one extranodal site of DLBCL disease is an independent risk factor for R‐CHOP resistance/early relapse [odds ratio = 5.268 (1.888‐14.702), P = .002]. The commonest extranodal sites were head and neck, gastrointestinal tract, respiratory system, vertebra and bones. Advanced age (>60 years), advanced disease stage (lll‐lV), raised pre‐treatment lactate dehydrogenase level, bone marrow involvement of DLBCL disease high Eastern Cooperative Oncology Group status (2‐4) and high R‐IPI score (3‐5) showed no significant association with R‐CHOP therapy resistance/early disease relapse (multivariate analysis: P > .05). Conclusion and Clinical Implications DLBCL patients with more than one extranodal site are 5.268 times more likely to be R‐CHOP therapy resistance or experience early disease relapse after R‐CHOP therapy. Therefore, correlative studies are warranted in DLBCL patients with more than one extranodal site of disease to explore possible underlying mechanisms of chemoresistance.

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“…Glucocorticoid-induced osteoporosis (GIOP) is a is frequently seen in clinics. Systemic metabolic osteopathy characterized by decreased bone strength, increased risk of fracture and bone brittleness may lead to high incidence of serious bone pain, osteonecrosis, joint surface collapse and arthritis which seriously affect standard of health [2].…”

Section: Introductionmentioning

confidence: 99%

Effects of ginsenoside Rg3 on bone loss, bone mineral density and osteoclast number in glucocorticoid-induced osteoporosis rats, and the likely michanism of action

Peng¹,

Jiang²,

He³

et al. 2020

Trop. J. Pharm Res

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Purpose: To investigate the effect of ginsenoside Rg3 on bone loss, bone mineral density (BMD) and osteoclast number in glucocorticoid-induced osteoporosis (GIOP) rats, and the mechanism of action involved.Methods: Sixty female Wistar rats were assigned to control, model group, ginsenoside Rg3, and alendronate sodium groups, comprised of 15 rats per group. The osteoporosis rat model was established via intramuscular injection of dexamethasone. Changes in bone mineral content (BMC), BMD trabecular thickness and area, osteoblasts and osteoclasts in femurs and lumbar vertebrae were measured after 3 months of treatment.Results: There were significantly higher BMC and BMD levels in ginsenoside Rg3 group than in alendronate rats (p < 0.05). The thickness and trabecular area in femur and lumbar vertebrae in the ginsenoside Rg3 group were significantly higher than those in the model group (p < 0.05), but were comparable with those in the alendronate sodium group (p > 0.05). There were marked increases in osteoblasts, and marked decreases in osteoclasts in the ginsenoside Rg3 group, alendronate sodium and control rats, relative to model rats (p < 0.05).Conclusion: Ginsenoside Rg3 arrests bone loss, and enhances bone density, trabecular thickness and area, bone microstructure, osteoblast activity and population of osteoclasts number in glucocorticoidinduced osteoporotic rats. This provides a new research direction for the clinical treatment ofosteoporosis. Keywords: Ginseng soap, Rg3, Glucocorticoid, Osteoporosis, Bone loss, Bone mineral density, Osteoclast population

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Relapse in stage I(E) diffuse large B‐cell lymphoma

Cited by 9 publications

References 24 publications

Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era

Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era

Extranodal site of diffuse large B‐cell lymphoma and the risk of R‐CHOP chemotherapy resistance and early relapse

Effects of ginsenoside Rg3 on bone loss, bone mineral density and osteoclast number in glucocorticoid-induced osteoporosis rats, and the likely michanism of action

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