T-cell-rich B-cell lymphomas: diagnosis and response to therapy of 44 patients.

Abstract

TCRBCLs are difficult to recognize without immunoperoxidase studies. Patients with TCRBCL have clinical features similar to patients with other large B-cell lymphomas, except they may have more splenomegaly and advanced-stage disease; they should receive combination chemotherapy directed at large-cell lymphomas.

T-Cell/Histiocyte-Rich B-Cell Lymphoma: Biology, Diagnosis, and Management

“…Bone marrow involvement occurs in approximately one third of patients with T/HRBCL, which is considerably higher than in their traditional DLBCL counterparts [1,5,12,14,17]. T/HRBCL patients also appear more likely to develop "B" symptoms (unexplained fever >38ºC, drenching night sweats, and unexplained weight loss >10% of body weight over a 6-month period), with rates reported as high as 62% [1,12,17]. Clinical differences also exist between T/HRBCL and the Hodgkin's lymphoma entities cHL and NLPHL.…”

“…They also may have included a disproportionate population of high-risk patients, as most were not adjusted for International Prognostic Index (IPI) score. When treated for aggressive NHL with anthracycline-containing chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), however, most series demonstrate similar outcomes for T/HRBCL and traditional DLBCL patients (Table 1) [12,17,18,22,23]. Recent series have shown complete response rates to CHOP-like therapy in the range of 56%-63% [5,12,14], with 3-year and 5-year overall survival rates estimated at 50%-64% [12,14] and 45%-58% [5,14], respectively.…”

“…The detailed treatment of DLBCL has recently been reviewed elsewhere [26,27]. Importantly, several series have shown that T/HRBCL patients misdiagnosed and treated for alternative diagnoses, such as cHL or lowgrade NHL, do quite poorly, highlighting the necessity of accurate initial diagnosis [12,17,18,22].…”

“…T/HRBCL occurs at a younger age than traditional DLBCL, with a median age in the fourth decade of life [5,9,[12][13][14] compared with the sixth decade for DLBCLs as a whole [1]. A male predominance has been noted in most series, in the range of 57%-88% [5,[12][13][14][15][16][17], contrasting with DLBCL, which occurs roughly equally in men and women [1]. Several series have suggested a propensity of T/HRBCL to present with advanced Ann Arbor stage, multiple extranodal sites, and an elevated lactate dehydrogenase level (LDH), though these differences were not significant from traditional DLBCLs in two small case-controlled analyses (Table 1) [ 5,10,12,14,15,17,18].…”

“…A male predominance has been noted in most series, in the range of 57%-88% [5,[12][13][14][15][16][17], contrasting with DLBCL, which occurs roughly equally in men and women [1]. Several series have suggested a propensity of T/HRBCL to present with advanced Ann Arbor stage, multiple extranodal sites, and an elevated lactate dehydrogenase level (LDH), though these differences were not significant from traditional DLBCLs in two small case-controlled analyses (Table 1) [ 5,10,12,14,15,17,18]. Most series suggest, however, that T/HRBCL infiltrates the spleen, liver, and bone marrow with greater frequency than DLBCL (Table 1).…”