scholarly journals Lactic acidosis: a unique presentation of diffuse large B-cell lymphoma

2019 ◽  
Vol 12 (10) ◽  
pp. e230277 ◽  
Author(s):  
Turab Jawaid Mohammed ◽  
Rohit Gosain ◽  
Rajeev Sharma ◽  
Pallawi Torka
Keyword(s):  
Lactic Acidosis ◽  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Intrathecal Methotrexate ◽  
Dramatic Improvement ◽  
Metabolic Encephalopathy ◽  
Large B Cell Lymphoma ◽  
Large B Cell

An elderly man in the seventh decade of life was brought to the hospital with worsening mental status. Blood tests revealed anaemia and thrombocytopenia with elevated lactate dehydrogenase and serum lactate levels. CT scan showed bulky thoracic and abdominal lymphadenopathy with splenomegaly. A positron emission tomography scan confirmed the above and in addition, revealed bilateral adrenal involvement. Bone marrow biopsy revealed non-germinal centre B-cell-like (non-GCB)-diffuse large B-cell lymphoma (DLBCL). Prompt treatment with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab with intrathecal methotrexate chemotherapy resulted in a dramatic improvement in the patient’s condition. This vignette serves as a reminder to include aggressive lymphomas like DLBCL in the differential diagnoses of patients presenting with metabolic encephalopathy and lactic acidosis. Our patient was moribund at presentation with poor sensorium and failure to thrive. The dilemma was whether to take an aggressive stand and start chemotherapy urgently or whether to stabilise the patient first and then consider the treatment of DLBCL. We make a case for initiating therapy promptly in such patients irrespective of their performance status.

scholarly journals Poor Prognosis of Diffuse Large B-Cell Lymphoma with Hepatitis C Infection

2021 ◽  
Vol 11 (9) ◽  
pp. 844
Author(s):  
Yu-Fen Tsai ◽  
Yi-Chang Liu ◽  
Ching-I Yang ◽  
Tzer-Ming Chuang ◽  
Ya-Lun Ke ◽  
...  
Keyword(s):  
Hepatitis C ◽  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Liver Involvement ◽  
Poor Performance Status ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Background: Hepatitis C virus (HCV) in diffuse large B-cell lymphoma (DLBCL) is associated with a higher prevalence and distinctive clinical characteristics and outcomes. Methods: A retrospective analysis of adult DLBCL patients from 2011 to 2015 was studied. Results: A total of 206 adult DLBCL were enrolled with 22 (10.7%) HCV-positive patients. Compared to HCV-negative patients, the HCV-positive group had a poor performance status (p = 0.011), lower platelet count (p = 0.029), and higher spleen and liver involvement incidences (liver involvement, p = 0.027, spleen involvement, p = 0.026), and they received fewer cycles of chemotherapy significantly due to morbidity and mortality (p = 0.048). Overall survival was shorter in HCV-positive DLBCL (25.3 months in HCV-positive vs. not reached (NR), p = 0.049). With multivariate analysis, poor performance status (p < 0.001), advanced stage (p < 0.001), less chemotherapy cycles (p < 0.001), and the presence of liver toxicity (p = 0.001) contributed to poor OS in DLBCL. Among HCV-positive DLBCL, the severity of liver fibrosis was the main risk factor related to death. Conclusion: Inferior survival of HCV-positive DLBCL was observed and associated with poor performance status, higher numbers of complications, and intolerance of treatment, leading to fewer therapy. Therefore, anti-HCV therapy, such as direct-acting antiviral agents, might benefit these patients in the future.

565: INTRAVASCULAR LARGE B CELL LYMPHOMA PRESENTING AS HEMOPHAGOCYTIC SYNDROME AND TYPE B LACTIC ACIDOSIS

2018 ◽  
Vol 46 (1) ◽  
pp. 267-267
Author(s):  
Gautam Phadke ◽  
Dubert Guerrero ◽  
Avish Nagpal ◽  
Hasrat Khan ◽  
Mazen Kherallah ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
B Cell ◽  
Hemophagocytic Syndrome ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Type B ◽  
Large B Cell Lymphoma ◽  
Large B Cell

scholarly journals Intravascular Large B-Cell Lymphoma Presenting as Acute Axonal Polyneuropathy: A Case Report and Literature Review

2020 ◽  
Vol 8 ◽  
pp. 232470962095999
Author(s):  
Jordan M. Minish ◽  
Amar H. Kelkar ◽  
Amol R. Mehta ◽  
Maira Gaffar ◽  
Nam H. Dang
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Disease Process ◽  
B Cell Lymphoma ◽  
Intrathecal Methotrexate ◽  
Common Disease ◽  
Success Rates ◽  
Large B Cell Lymphoma ◽  
Axonal Polyneuropathy ◽  
Large B Cell

Intravascular large B-cell lymphoma (ILBL) is a rare and difficult to diagnose subtype of large B-cell lymphoma. The most common locations of presentation are in the central nervous system and the skin, but there are reports of other organ involvement. Due to the indolence, nonspecific symptoms, and rarity of the disease, this form of lymphoma is most often diagnosed postmortem. In this article, we describe a case of ILBL that presented as a rapidly progressive acute axonal polyneuropathy. Acute axonal polyneuropathy is a common disease process with a wide differential diagnosis, but there is limited literature on its prevalence as the presenting symptom of ILBL. This patient was treated with R-EPOCH and intrathecal methotrexate with significant improvement in his polyneuropathy after 1 cycle, and complete remission after 6 cycles. Data on chemotherapy regimens and their success rates for this disease are lacking.

Treatment of Diffuse Large B-Cell Lymphoma with Rituximab, Intensive Induction and High-Dose Consolidation: The Final Analysis of the Czech Lymphoma Study Group (CLSG) R-MegaCHOP-ESHAP-BEAM (R-MEB) Trial.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 21-21
Author(s):  
Marek Trneny ◽  
Robert Pytlik ◽  
David Belada ◽  
Katerina Kubackova ◽  
Ingrid Vasova ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Cell Transplant ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background. Combined immunochemotherapy with CHOP and rituximab have improved the outcome of patients with diffuse large B-cell lymphoma (DLBCL). and related diseases. However, the cure rate of patients with IPI 3–5 or aaIPI 3 is still only about 50% with this regimen. Given the feasibility of previous CLSG regimens based on high-dose CHOP-ESHAP induction and BEAM consolidation, we have conducted a phase II trial combining this approach with rituximab immunotherapy. Patients and methods. Patients aged 18–65 years with DLBCL and age-adjusted IPI (aaIPI) 2–3 were treated with three cycles of high-dose CHOP (MegaCHOP - cyclophosphamide, 3 g/m2, vincristine 2 mg, adriamycin, 75 mg/m2, and prednisone, 300 mg/m2) with G-CSF every 3 weeks, followed by three cycles of ESHAP (etoposide, 240 mg/m2, cisplatin, 100 mg/m2, methylprednisolone, 2000 mg and Ara-C 2000 mg/m2) every 3 weeks. Four to six doses of rituximab 375 mg/m2 were administered on day 1 of each cycle of induction therapy. High-dose therapy (BEAM) followed by autologous stem cell transplant (ASCT) was used as consolidation. Radiotherapy was given to residual masses or sites of bulky disease. Primary endpoint was progression-free survival (PFS), while secondary endpoints were overall survival (OS) and feasibility of the treatment. Results. From April 2002 to October 2006, 105 consecutive patients from 10 centers were recruited. 58% were men and 42% women with median age 46 years (19–63 years). 74% of patients had stage IV disease, 92% had elevated LDH, 53% had performance status &gt;1, 55% had B symptoms and 19% had bone marrow involvement. aaIPI was 2 in 62% of patients and 3 in 38% of patients. 68% of patients received the whole treatment according to the protocol, including ASCT and radiotherapy. Stem cells mobilization according to the protocol was performed in 90% of patients and was successful in 86% of mobilized patients (77% of all patients). 73% of patients ultimately received ASCT (including 3 patients transplanted after ammended treatment) and 51% of patients received planned radiotherapy. Complete remission (CR) was achieved in 83% of all patients and partial remission (PR) in 2%. Early toxic death rate was 6% and 9% patients had primary refractory disease. Of patients who achieved CR or PR, only 6 subsequently relapsed (7%) and two suffered late toxic death (2%). With a median follow-up of 32 months for living patients, the estimated 2-year PFS is 77% and 2-year OS is 81%. Age less than median (46 years) was strongest predictor of favorable outcome (p = 0,00006 for PFS and p = 0,00013 for OS), while there was no effect of stage, LDH, performance status or aaIPI (2-year PFS 79% for aaIPI 2 and 77% for aaIPI 3, 2-year OS 81% for aaIPI 2 and 80% for aaIPI 3). Delivery of ASCT or radiotherapy did not significantly affected PFS in patients who did not suffered early progression or early toxic death, but radiotherapy modestly improved OS of these patients (p = 0,03). Conclusion. R-MEB has proved to be an effective treatment strategy for younger patients with high-risk aggressive B-cell lymphoma. Currently, CLSG is testing whether utilization of early PET scan may decrease toxicity and improve treatment tolerance while maintaining the efficacy of this regimen.

Excellent Outcomes For Limited-Stage Diffuse Large B-Cell Lymphoma In The Rituximab Era: A Retrospective Analysis From Memorial Sloan-Kettering Cancer Center

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3030-3030
Author(s):  
Anita Kumar ◽  
Jocelyn C Maragulia ◽  
Matthew A Lunning ◽  
Craig H. Moskowitz ◽  
Andrew D. Zelenetz
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Stage Ii ◽  
Treatment Programs ◽  
Limited Stage ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background Therapeutic options for limited-stage diffuse large B cell lymphoma (DLBCL) include short-course R-CHOP +/- IFRT and full-course R-CHOP +/- IFRT. In the rituximab-era, few randomized prospective studies exist to compare these treatment approaches in limited-stage DLBCL. In this retrospective analysis of limited-stage DLBCL, we report 1) prognostic factors associated with outcome and treatment and 2) outcomes associated with different treatment programs including 3-4 cycles of R-CHOP +/- IFRT and 6 cycles of R-CHOP +/- IFRT. Methods Patients with newly diagnosed limited-stage DLBCL treated at Memorial Sloan-Kettering Cancer Center with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy with or without involved-field radiotherapy from 1999 – 2012 were included. Limited-stage DLBCL was defined as Ann Arbor stage I or stage II, non-bulky (any mass < 10 cm). Patients with primary mediastinal large B-cell lymphoma were excluded. Treatment programs included: A) R-CHOP x3-4 cycles, B) R-CHOP x3-4 cycles + IFRT, C) R-CHOP x6 cycles, and D) R-CHOP x6 cycles +IFRT. Results 262 pts were identified with median age 58 years (range 18-85), 55% female (N=145), and 30% stage I (N=82), 37% Stage IE (N=96), <1% stage IXEE (N=1), 18% stage II (N=46), and 14% Stage IIE (N=37). The factors associated with inferior progression-free survival (PFS) were age > 60 (p=0.039), elevated LDH (p=0.014), and stage II disease (p=0.015). In contrast, female sex (p=0.54), B-symptoms (0.74), presence of extranodal “E” lesion (p=0.12), and poor performance status (0.35) were not significantly associated with PFS. The stage-modified IPI (SM-IPI, including the factors: stage II (vs. I), age>60, elevated LDH, and ECOG performance status ≥2) stratified patients into prognostically relevant groups, see Figure 1. In the rituximab era, the poorest outcomes were observed in patients with SM-IPI=3 (n=21). Interim PET imaging after 3-4 cycles (interpreted with International Harmonization Project criteria) was available in 198 patients. The majority of patients achieved a negative interim PET scan, see Table 1. Positive interim PET imaging was not associated with inferior PFS, p=0.45. Among the 4 treatment programs, 17 patients received R-CHOP x3-4 cycles (A), 147 received R-CHOP x3-4 cycles + IFRT (B), 48 received R-CHOP x6 cycles (C), and 50 received R-CHOP x6 cycles +IFRT (D). Physician treatment choice appeared to be associated with clinical characteristics at presentation. To assess the clinical and demographic features associated with receipt of arm B versus C (analogous to the treatment arms in the historical study of chemotherapy versus combined modality therapy in the pre-rituximab era, SWOG 8736 (Miller, NEJM, 1998)), Chi-Square or Fisher exact tests were performed. Patients with stage II vs. I (p<0.001), B-symptoms (p<0.001), elevated LDH (p=0.03), and poor performance status (p=0.013) were significantly more likely to receive R-CHOP x6cycles versus R-CHOP x3-4cycles + IFRT. Therefore, patients with more advanced stage, systemic symptoms related to lymphoma, and elevated LDH were significantly more likely to receive full-course chemotherapy. At median follow up of 4.7 years, the outcomes were excellent with 89% PFS and 94% OS for the entire cohort. There were 30 patients who progressed or died. Of the total 19 deaths, 7 were attributable to progressive lymphoma. The outcomes were similar for the 4 treatment groups, see Table 1. Among elderly patients, either ≥ 70 years (n=65) or ≥ 60 years (n=125), there were no differences in outcomes between treatment arms. Conclusion In the rituximab-era, short-course immunochemotherapy followed by radiation appears to have equivalent efficacy when compared to long-course immunochemotherapy in this selected population of limited-stage DLBCL patients. Prospective randomized studies are needed to define the optimal treatment for limited-stage DLBCL in the rituximab era. Disclosures: No relevant conflicts of interest to declare.

Efficacy Of Rituximab To Chemotherapy In The Treatment Of EBV-Positive Diffuse Large B-Cell Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5120-5120
Author(s):  
Brady E Beltran ◽  
Julio C Chavez ◽  
Jorge J Castillo
Keyword(s):  
Retrospective Study ◽  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Response Rates ◽  
The Elderly ◽  
Female Ratio ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background EBV-positive diffuse large B-cell lymphoma (EBV+ DLBCL) of the elderly is a provisional entity included in the 2008 WHO Classification. EBV+ DLBCL of the elderly is characterized by an aggressive clinical course and a poor outcome. Furthermore, it is unclear if patients with EBV+ DLBCL of the elderly benefit from the addition of rituximab to chemotherapy. The goal of this retrospective study is to evaluate the clinical relevance of rituximab in this entity in a cohort of Peruvian patients. Methods Between January 2002 and December 2012, all patients meeting criteria for EBV+ DLBCL were included in the analysis. Patients with evidence of immunosuppression were excluded. All cases were positive for the presence of EBV-encoded RNA (EBER) by in situ hybridization, and CD20 and/or PAX-5 expression by immunohistochemistry. Clinical data were reviewed retrospectively and patients’ biopsies were evaluated for the immunohistochemical expression of BCL6, CD10, and MUM-1/IRF4. Overall survival (OS) was defined as the time between diagnosis and death or last follow-up. The Kaplan-Meiermethod was used to estimate OS curves, which were then comparedusing the log-rank test. P-values <0.05 were considered statistically significant. Results A total of 42 EBV+ DLBCL patients are included in this study. The median age at diagnosis was 73 years (range 25-95 years). The male-to-female ratio was 2.2:1.  B symptoms were observed in 59%, a performance status ECOG >1 in 60%, advanced stage (III/IV) in 58%, and elevated LDH levels in 44% of the patients. Based on the Hans classification, 81% had a non-germinal center profile. The median Ki67 expression was 80% (range 50-90%). The Oyama score distribution, which uses age >70 and presence of B symptoms, was 0 factors 14%, 1 factor 45% and 2 factors in 40% of the patients. Based on the International Prognostic Index (IPI) score, 0-2 factors were seen in 39% and 3-5 in 61% of the patients. Chemotherapy was not administered in 9 patients due to poor performance status. R-chemotherapy was administered in 17 patients (52%) and chemotherapy without rituximab in 16 patients (48%). The overall response rate (ORR) was 52%, with complete response (CR) in 42%, partial response (PR) in 9% and no response (NR) in 48%. The response rates in patients who received chemotherapy without rituximab were: CR 37.5%, PR 0%, and NR 62.5%. Response rates in patients who received R-chemotherapy were: CR 47%, PR 17%, and NR 35%. The odds ratio for a CR was 2.48 (95% CI 0.49-13.2; p=0.21) for patients receiving R-chemotherapy when compared with patients who received chemotherapy alone. The median OS for treated patients was 8 months with a 3-year OS of 40%. For patients receiving R-chemotherapy, the median OS was 20 months with a 3-year OS of 47% and for patients receiving chemotherapy without rituximab, the median OS was 5 months with a 3-year OS of 37.5% (log-rank p=0.12). The median OS in patients 60 and older was significantly superior with R-chemotherapy in comparison with chemotherapy alone (20 vs. 1.5 months, log-rank p=0.02) Conclusions Based on the results of our retrospective study, the addition of rituximab to chemotherapy show a statistical trend towards improved survival rates versus chemotherapy alone in our cohort of patients with EBV+ DLBCL. In a subset analysis, the addition of rituximab to chemotherapy showed a survival benefit in our cohort of EBV+ DLBCL patients 60 years of age and older . Disclosures: No relevant conflicts of interest to declare.

IPI In Selecting Patients With Diffuse Large B Cell Lymphoma in Rituximab Era

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5063-5063
Author(s):  
Sonja Genadieva-Stavrik ◽  
Alexandra Pivkova ◽  
Zlate Stojanoski ◽  
Borce Georgievski
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Extranodal Involvement ◽  
Large B Cell Lymphoma ◽  
Risk Patients ◽  
Large B Cell

Abstract Nowadays, goal of treatment approach in diffuse large B cell lymphoma is cure and first step towards it is to achieve complete remission. DLBCL is a potentially curable disease, with curability highly dependent on clinical and biological features. According to the WHO classification of Hematological Malignancies, the entity of DLBCL is characterized by rapidly growing mature B cell tumors with large or relatively large cells and /includes a number of disease variants/entities / encompassing several distinct clinopathologic diseases, several different histologic variants and clinical subtypes. There is no unique treatment for all patients with diffuse large B cell lymphoma. Different subgroup of patients with DLBCL needs different treatment. In the pre-rutuximab era International Prognostic Index (IPI) was considered to be the most important prognostic factor for survival and the strongest indicator for identification of high-risk patients, who are unlikely to be cured with standard chemotherapy. Having in mind that IPI is based on 5 clinical characteristics (age, performance status, stage, extranodal involvement, LDH level) and it is constructed in the pre-rituximab is clear that R-IPI should be tested in rituximab era to provide any information of its validity. We retrospectively analyzed unselected population of 80 patients with confirmed diagnose of diffuse large B cell lymphoma treated at University hematology department in the period of 2005-2010. All patients were uniformly treated with R-CHOP regiment as initial treatment with curative intent. There were 80 patients with mean age 54, 5 years (15-84), male 35 and female 45. Older than 60 years were 29 patients (36, 25%). More than half of the patients (42) were diagnosed in advanced stage of the disease. We analyzed five prognostic factors: age, performance status, stage, extranodal involvement, LDH level and through the multifactorial analyses we selected two groups of patients. One with 0 to 2 factors as patients with low risk. Patients with more than 3 factors are considered as high risk. There is statistically significant difference in overall survival between two groups with five –years overall survival 70% for low risk patients and 47% for high risk. High-risk patients may be candidates for autologous transplantation as initial treatment, having in mind that in the rituximab era relapses occur very early in the first year and are difficult to be treated. R-IPI score is significant predictor and should be used for risk stratification of patients with aggressive B-cell lymphoma. However, these findings should be validated prospectively in an independent population of patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Aggressive CD5-Positive Primary Bone Marrow Diffuse Large B-Cell Lymphoma with Leukemic Presentation

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Mark G. Evans ◽  
Sherif A. Rezk ◽  
Lauren C. Pinter-Brown ◽  
Xiaohui Zhao
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Intrathecal Methotrexate ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Primary Bone ◽  
Primary Bone Marrow ◽  
Large B Cell

Primary bone marrow diffuse large B-cell lymphoma is an exceedingly rare form of non-Hodgkin lymphoma. It may demonstrate a leukemic presentation, and a proportion of cases have CD5 expression. The prognostic implications of this CD5-positivity remain unknown. Here, we present a 78-year-old man who presented with circulating peripheral blood lymphoma cells and a hypercellular marrow involved by diffuse large B-cell lymphoma, germinal center B-cell subtype. The patient responded favorably to six cycles of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) and intrathecal methotrexate. He unfortunately relapsed in several enlarged inguinal lymph nodes and succumbed to the lymphoma approximately one year after diagnosis, demonstrating the particularly aggressive clinical course of his disease.

scholarly journals IPI, Comorbidity Index, Hospitalization for Treatment-Related Adverse Events Are Predictors for Outcome in Elderly Diffuse Large B Cell Lymphoma Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1860-1860
Author(s):  
Caner Saygin ◽  
Xuefei Jia ◽  
Brian T. Hill ◽  
Robert M. Dean ◽  
Bhumika Patel ◽  
...  
Keyword(s):  
Adverse Events ◽  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Age Groups ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Comorbidity Index ◽  
Dose Reductions ◽  
Large B Cell

Abstract Background: International Prognostic Index (IPI) has been used as the primary prognostic tool in diffuse large B cell lymphoma (DLBCL) for more than 20 years. Even though the disease is more common in older population, the impact of comorbidities, dose reductions, and treatment-related adverse events (AEs) on the outcome in elderly DLBCL patients has not been well established. In this study, we aimed to investigate the effect of IPI, clinicopathological features, Charlson Comorbidity Index (CCI), AEs and dose reductions on survival of DLBCL patients aged 60 years or above. Methods: We identified 910 DLBCL patients (pts) treated at Cleveland Clinic between 2004-2014 and this analysis includes 413 pts aged ≥60 years. Patient and disease characteristics and treatment data of pts who received at least one cycle of treatment were analyzed for prognostic significance. CCI was calculated, excluding lymphoma, and patients were divided into low CCI (CCI score of 0-2) or high CCI (≥3). For regression analysis, patients were grouped into good or poor risk based on IPI ≤ 2 vs 3-5. Results: Median age of our cohort was 69 years (range, 60-100), 55% were male, and 91% Caucasian. Pts were divided into 3 age groups; 60-69 yrs (N=217), 70-79 yrs (N=124) and >80 yrs (N=72). Most pts had advanced stage disease (59%), high IPI ≥3 (58%) good performance status (PS) ≤1 (74%), and no B symptoms (31%). 15% had high CCI (≥3) with a trend towards higher incidence in >80 yrs (p=0.05). Our cohort had predominantly germinal center (GC) DLBCL (60%) with low incidence of MYC translocation (28%) among the 89 pts tested. Only median BMI (28%, p=0.007) and performance status (≥2: 27%, p=<0.001) was statistically significant among the age grps. 85% were treated with R-CHOP, 2% received CHOP, and 3% received R-EPOCH. 70% experienced at least one clinically significant AE with infection (34%) and febrile neutropenia (31%) being common. 78% had dose reduced chemo with higher frequency seen in older pts (59% in >80 yrs) (p=<0.001). Overall response rate was 92% with 78% achieving CR and no difference among the groups. Median OS and PFS were 9.6 and 3.8 years respectively with an estimated 10 year OS and PFS of 50% and 30%. In the univariable analysis, IPI (OS: HR 1.7, p=<0.001; PFS: HR 1.39, p=<0.001), ECOG PS (OS: HR 2.94 p=<0.001; PFS: 2.29, p=<0.001), CCI (OS: HR 2.1, p=<0.001; PFS: HR 1.59, p=0.015), LDH ratio (OS:HR 1.53, p=0.008; PFS: HR 1.58, p=<0.001), chemotherapy dose reduction (OS: HR 1.64, p=0.016; PFS: HR 1.45, p=0.029), AE (OS: HR 1.78, p=0.17; PFS: 1.56 p=0.017), and hospitalization (OS: HR 4.01, p-=<0.001; PFS: HR 1.56, p=0.017) predicted inferior OS and PFS. On multivariable analysis, only IPI (HR 1.5, p<0.001), CCI (HR 2.1, p=<0.006) and hospitalization (HR 2.4, p=<0.004) were significant predictors of OS. In addition to CCI (HR 2.0 p=0.013) and hospitalization (HR 2.45 p=<0.001), B symptoms (HR 0.62, p=0.038) was also prognostic for PFS. Among the age groups, adverse risk factors for OS were IPI (HR 1.47, p=0.006) and CCI (HR 1.47, p=0.006) in 60-69 yrs, and hospitalization in 70-79 years (HR 3.42, p=0.009). None of these factors predicted survival in >80 yrs, although there was trend observed with IPI (p=0.058) and PS (0.052). Conclusion: In this single center large cohort of DLBCL pts, higher CCI and hospitalization for AE were significant predictors of decreased OS and PFS, especially in pts aged 60-69 years. Although IPI is predictive, a better prognostic model incorporating comorbidities and treatment toxicities may help to better risk stratify older DLBCL patients. Figure Figure. Disclosures Smith: Spectrum: Honoraria; Abbvie: Research Funding; Genentech: Honoraria; Celgene: Honoraria.

Intravascular Large B-Cell Lymphoma and Renal Clear Cell Carcinoma as Collision Tumor: A Case Report and Review of the Literature

2020 ◽  
pp. 106689692098163
Author(s):  
Alejandra Griselda Serrano ◽  
Boris Elsner ◽  
Maria Cecilia Cabral Lorenzo ◽  
Fabio Andres Morales Clavijo
Keyword(s):  
B Cell ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Cell Lymphoma ◽  
Systemic Disease ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Collision Tumor ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumina of vessels. The patient usually presents with nonspecific symptoms and a remarkable deterioration in performance status. The occurrence of synchronous IVLBCL and renal cell carcinoma (RCC) is extremely rare. A right kidney tumor was found in a 72-year-old man with a history of low back pain. The kidney was enlarged, with a tumor mass measuring 4.5 × 4 × 4 cm. Sections exhibited a RCC (clear cell type, nuclear grade I). Also an extensive tumor affecting capillaries and small veins was present, positive for CD45, CD20, BCL-2, and MUM1/IRF-4, consistent with IVLBCL. The lymphoma was circumscribed to the RCC. The final diagnosis was IVLBCL with a RCC as collision tumor. After that, with neurological findings, central nervous system compromise by lymphoma was made. The patient started a first cycle of chemotherapy, progressive deterioration of the sensorium, and positive blood cultures for Klebsiella pneumoniae and Escherichia coli. The patient died 8 days later of acute respiratory failure. No autopsy was done. IVLBCL is an aggressive and systemic disease characterized by massive proliferation of tumor cells without a known primary site. Clinical identification and histopathologic diagnosis are relevant issues in the therapeutic management of these lymphomas. Until now, only one case of IVLBCL coexisting with RCC has been reported. In this article, we report a second case of IVLBCL with RCC simultaneous, as an unusual collision tumor.

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