Tumor burden assessment and its implication for a prognostic model in advanced diffuse large-cell lymphoma.

Jagannath, Sundar; Velasquez, W S; Tucker, Susan L.; Fuller, Lillian M.; McLaughlin, Peter; Manning, John T.; North, Luceil B.; Cabanillas, Fernando

doi:10.1200/jco.1986.4.6.859

Cited by 164 publications

(50 citation statements)

References 18 publications

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“…The prognostic value of the Ann Arbor distinction between stage III and IV disease remains uncertain. Several studies have reported similar survival figures for stage III and stage IV patients (Koziner et al, 1982;Jagganath et al, 1985;Todd et al, 1986;Laurence et al, 1982;Sweet et al, 1980), but Nathwani et al (1982) (Bierman et al, 1957;Ferraris et al, 1979;Jagannath et al, 1986;Schneider et al, 1980;Hagberg & Siegbahm, 1983). In this study, although serum LDH was shown to be an independent (Christensson et al, 1986;Morgan et al, 1986;Juneja et al, 1986), but few have investigated the prognostic significance of DNA content within the category of high grade lymphoma.…”

Section: Overall Survivalmentioning

confidence: 86%

Prognostic factors in high and intermediate grade non-Hodgkin's lymphoma

Cowan

Jones²,

Harris³

et al. 1989

Br J Cancer

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Summary An analysis of prognostic factors has been performed on 260 patients with high and intermediate grade non-Hodgkin's lymphoma (NHL) treated over an 11-year period between 1975 and 1986. The overall 5-year survival rate was 50% with a median follow-up of 72 months. Over 20 clinical, radiological and laboratory parameters have been studied, including variables reported to be important indicators of prognosis in previous series, and these variables have been subjected to univariate and multivariate analysis. Attainment of complete remission (CR) was the most important predictor of overall survival, low serum lactate dehydrogenase (LDH), limited stage disease and a high serum albumin were also independently associated with prolonged survival in multivariate analysis. After removing remission status from the model, Ann Arbor clinical stage became the most significant pre-treatment prognostic indicator. Sixty-five per cent of patients achieved CR, and a discriminant analysis showed that failure to attain CR was associated with advanced stage disease, constitutional symptoms, increasing patient age, a lovy serum albumin and the presence of bulk disease. Advanced clinical stage and an elevated serum LDH predicted independently for a poor relapse-free survival, and reduced overall survival following CR. There was no significant correlation between histological subtype in the Kiel classification and prognosis. This study confirms the prognostic significance of remission status and Ann Arbor clinical stage, and illustrates additional factors including serum levels of albumin and LDH, which serve to enhance the pre-treatment prognostic evaluation of patients with unfavourable histology NHL.

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Section: Overall Survivalmentioning

confidence: 86%

Prognostic factors in high and intermediate grade non-Hodgkin's lymphoma

Cowan

Jones²,

Harris³

et al. 1989

Br J Cancer

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“…In these patients, the presence of bulky lesions is associated with an elevated local relapse rate and a poor prognosis [3, 4, 5, 6, 7]due to the persistence of microscopical residual disease even when a clinical complete remission is achieved after chemotherapy. To avoid this, consolidation radiotherapy to bulky lesions has been proposed [8, 9], but the worldwide experience is very limited, no retrospective series have been reported and a single randomized trial has been published [10].…”

Section: Introductionmentioning

confidence: 99%

Consolidation Radiotherapy to Bulky or Semibulky Lesions in the Management of Stage III–IV Diffuse Large B Cell Lymphomas

Ferreri¹,

Dell’Oro²,

Reni³

et al. 2000

Oncology

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Background: To assess the impact on survival of consolidation radiotherapy to bulky or semibulky lesions in patients with advanced diffuse large B cell lymphoma (DLCL) in complete remission after primary chemotherapy. Patients and Methods: Ninety-four patients with stage III–IV DLCL and bulky (≥10 cm) or semibulky lesions (6–9 cm) in complete remission after primary chemotherapy were reviewed. Forty patients received consolidation radiotherapy to bulky (n = 20) or semibulky lesions (n = 20), while 54 (18 with bulky disease) did not. Twenty-eight patients were irradiated to the involved field and 12 to the extended field with a dose of 30–46 Gy. Results: In patients with bulky disease, consolidation radiotherapy prevented relapses involving exclusively the bulky area, prolonged time to relapse (TTR) (median 41+ vs. 18 months; p = 0.05) and improved 5-year overall survival (OS) (73 vs. 57%; p = 0.05). Consolidation radiotherapy reduced relapses within the semibulky area, prolonged TTR (median 26+ vs. 20 months; p = 0.01) and improved 5-year OS (59 vs. 41%; p = 0.09) also in patients with semibulky lesions. Multivariate analyses confirmed the independent association between consolidation radiotherapy and survival, and showed that a dose ≥36 Gy was related to a longer OS, while the extension of the radiotherapy field did not modify outcome. No treatment-related deaths were observed. Four patients developed a second malignancy, none of whom had undergone consolidation radiotherapy. Conclusions: Consolidation radiotherapy to bulky or semibulky lesions significantly improved the outcome in patients with advanced DLCL in complete remission after primary chemotherapy. Involved-field irradiation with 36–45 Gy made a prolonged disease control possible without either lethal toxicity or a higher incidence of second malignancies.

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“…Of all the biochemical indicators investigated in the lymphomas, serum lactic dehydrogenase (LDH) has enjoyed the most universal acceptance. Since the early report of Bierman et al (1957) many investigators have confirmed the value of serum LDH as a prognostic tool, notably Ferraris et al, 1979;Schneider et al, 1980;Fisher et al, 1981;Jagannath et al, 1986 andSwan et al, 1989. In their study of patients with advanced (stage III/IV) diffuse large cell NHL, Jagannath et al (1986) identified serum LDH and tumour burden as independent risk factors for survival and devised a model in which three distinct groups of patients could be identified based on the serum LDH being normal or elevated and tumour burden being low or heavy; the five year follow-up data revealed survival as 87%, 48% and 20% for the high, intermediate and low risk groups, respectively.…”

Section: Biochemical Markersmentioning

confidence: 97%

“…There is clearly a need to move towards systems which take more account of tumour bulk. Categorisations of patients as having low, intermediate or high tumour burden have been put forward as alternatives to the Ann Arbor system, notably a system based on the number of extensively involved nodal areas and the number of extranodal sites (Jagannath et al, 1986). Reappraisal of staging, as has been done for HD, and probably a more radical shift to an international system which grades tumour burden is now needed.…”

Section: Stagingmentioning

confidence: 99%

Prognostic factors in the non-Hodgkin's lymphomas--a time for consensus?

Child¹

1991

Br J Cancer

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Tumor burden assessment and its implication for a prognostic model in advanced diffuse large-cell lymphoma.

Cited by 164 publications

References 18 publications

Prognostic factors in high and intermediate grade non-Hodgkin's lymphoma

Prognostic factors in high and intermediate grade non-Hodgkin's lymphoma

Consolidation Radiotherapy to Bulky or Semibulky Lesions in the Management of Stage III–IV Diffuse Large B Cell Lymphomas

Prognostic factors in the non-Hodgkin's lymphomas--a time for consensus?

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