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Yohannan B, Rios A. Primary Diffuse Large B-Cell Lymphoma of the Bone. J Hematol 2023; 12:75-81. [PMID: 37187495 PMCID: PMC10181325 DOI: 10.14740/jh1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/27/2023] [Indexed: 05/17/2023] Open
Abstract
Primary lymphoma of the bone (PLB) is a rare lymphoproliferative neoplasm that can present either as solitary or multiple bone lesions. We report four patients with PLB who were successfully treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by consolidative radiotherapy. All patients achieved a complete remission and had excellent long-term outcomes. PLB has a favorable response to combined modality treatment with chemoimmunotherapy and radiation. Long-term outcomes of PLB tend to be better than those of non-osseous diffuse large B-cell lymphoma.
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Affiliation(s)
- Binoy Yohannan
- Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adan Rios
- Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Corresponding Author: Adan Rios, Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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A Nomogram Predicting Overall and Cancer-Specific Survival of Patients with Primary Bone Lymphoma: A Large Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2021; 2020:4235939. [PMID: 32884939 PMCID: PMC7455811 DOI: 10.1155/2020/4235939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022]
Abstract
We aimed to develop a nomogram for evaluating the overall survival (OS) and cancer-specific survival (CSS) in patients with primary bone lymphoma (PBL). Patients diagnosed with PBL between 2007 and 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were randomly allocated to the training cohort and validation cohort (2 : 1). The nomogram was developed by the training cohort and validated by the validation cohort using the concordance index (C-index), calibration plots, and decision curve analyses (DCAs). The C-index for CSS and OS prediction in the training cohort were 0.76 and 0.77, respectively; in the validation cohort, they were 0.76 and 0.79, respectively. The calibration curve showed good consistency between nomogram prediction and actual survival. The DCA indicated obvious net benefits of the new predictive model. The nomogram showed favorable applicability and accuracy, and it will be a reliable tool for predicting OS and CSS in patients with PBL.
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Liu CX, Xu TQ, Xu L, Wang PP, Cao C, Gao GX, Zheng YH. Primary lymphoma of bone: a population-based study of 2558 patients. Ther Adv Hematol 2020; 11:2040620720958538. [PMID: 32994912 PMCID: PMC7502855 DOI: 10.1177/2040620720958538] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Primary lymphoma of bone (PLB) is an extremely rare malignancy arising in the skeletal system. There is no consensus over the best definition of PLB. Most of the published articles are single-institutional retrospective studies with a limited sample size. The rarity of PLB and discrepancies on diagnostic criteria has resulted in a vague understanding of PLB. Methods We retrospectively analyzed the clinical characteristics and prognostic factors of 2558 PLB patients who were registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2016. Survival rates were calculated using the Kaplan–Meier method. The effects of various factors on survival outcomes were analyzed by using the log-rank test. Univariate and multivariate analyses were conducted by using the Cox proportional hazards model to determine independent prognostic factors. Results: The median follow-up time of all eligible patients was 58 months. There seemed no sex preponderance in PLB incidence. The most involved sites are axial skeletons. The most common histological subtype was diffuse large B-cell lymphoma. The 3-, 5-, 10-, and 20-year overall survival (OS) rates were 70.70%, 65.70%, 54.40% and 39.50%, respectively. PLB patients whose primary tumor sites were appendicular and craniofacial skeletons had a significant survival advantage [hazard ratio (HR) = 0.694, 95% confidence interval (CI) 0.552–0.872; HR = 0.729, 95% CI 0.597–0.889, respectively] over those with axial skeletons as primary tumor sites. Patients with Hodgkin lymphoma, non-Hodgkin lymphoma (NHL)–mature B-cell lymphoma, and NHL-precursor-cell lymphoblastic lymphoma also had a significant OS advantage (HR = 0.392, 95% CI 0.200–0.771; HR = 0.826, 95% CI 0.700–0.973; and HR = 0.453, 95% CI 0.223–0.923, respectively). Patients with Ann Arbor stage III–IV at diagnosis were at higher risk of death than those with stage I–II (HR = 1.348, 95% CI 1.107–1.641). Chemotherapy was an independent favorable prognostic factor (HR = 0.734, 95% CI 0.605–0.890). Conclusions: Primary anatomic site, histology type, higher Ann Arbor stage and chemotherapy were independent prognostic factors. Chemotherapy played a pivotal role in PLB treatment.
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Affiliation(s)
- Chen-Xin Liu
- Institute of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tian-Qi Xu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Li Xu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Pan-Pan Wang
- Institute of Pediatrics, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, China
| | - Chun Cao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guang-Xun Gao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, 127 Chang'le West Road, Xi'an, Shaanxi 710032, PR China
| | - Yan-Hua Zheng
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, 127 Chang'le West Road, Xi'an, Shaanxi 710032, PR China
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Sharma A, Ahmed R, Agrawal N, Kapoor J, Sharma A, Khushoo V, Agrawal P, Bhurani D, Mirgh SP. Primary Bone Lymphoma: A 13 Year Retrospective Institutional Analysis in the Chemo-Immunotherapy Era. Indian J Hematol Blood Transfus 2020; 37:240-248. [PMID: 33867730 DOI: 10.1007/s12288-020-01327-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/03/2020] [Indexed: 01/15/2023] Open
Abstract
Primary Lymphoma of bone (PBL) is an uncommon extranodal tumor accounting for 1% of all malignant lymphomas. The incidence of PBL is so rare that many of its aspects remain unknown. We retrospectively analysed our data in order to know clinical characteristics and treatment outcome in Indian population in chemo-immunotherapy era. We identified 49 patients [2007-2019] (median age 52 years) of which, 35 (71.4%) were males. Nearly one-third patients (n = 18; 36.8%) were elderly (Age > 60). The most common histological subtype was DLBCL. Local pain /swelling (n = 23; 47%) and B symptoms (n = 20; 44.4%) was the most common presentation. Spine was the most frequently involved site (n = 25; 51%) followed by pelvis (n = 17; 34.7%). One third patients had poor ECOG-PS ≥ 2, (n = 16; 32.6). More than 50% of the population presented with IPI score ≥ 2 (n = 25; 55.5%). Majority of the patients presented with Ann-Arbor stage IV disease (n = 31; 63.2%). (n = 32; 71.1%) cases received chemotherapy alone and (n = 13; 28.9%) patients were treated in combination with local radiotherapy. R-CHOP was the most common treatment regimen given to patients (n = 43; 95.5%). Overall, three-fourth patients (n = 36; 80%) achieved a complete response. At a median follow-up of 45 ± 2 (range 3-144) months, 4-year OS (Overall Survival) and PFS (Progression free survival) was 83.1% and 74.5%, respectively, using Kaplan-Meier survival curves. Prognostic factors for OS on multivariate analysis were ECOG-PS 0-1 [p = 0.05], age < 60 [p = 0.03] and achievement of CR [p = 0.001]. PBL in India is usually of DLBCL subtype, with spine as the most common site. It has an excellent prognosis in the R-CHOP era. Chemo-immunotherapy with 6 R-CHOP followed by addition of Radiotherapy if partial response appears to provide good outcomes. However, the exact role of radiation still needs to be confirmed.
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Affiliation(s)
- Archana Sharma
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Rayaz Ahmed
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narendra Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Jyotsna Kapoor
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Anurag Sharma
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vishvdeep Khushoo
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Pragya Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Sumeet P Mirgh
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
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Abdullah HMA, Ellithi M, Waqas Q, Cunningham A, Oliver T. Hypercalcaemia, renal dysfunction, anaemia and bone lesions (CRAB) do not always represent multiple myeloma: diffuse large B cell lymphoma presenting with CRAB symptoms in a 69-year-old man. BMJ Case Rep 2019; 12:e229070. [PMID: 31383675 PMCID: PMC6685385 DOI: 10.1136/bcr-2018-229070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/22/2022] Open
Abstract
Hypercalcaemia, renal dysfunction, anaemia and bone lesions (CRAB) are a constellation of signs and symptoms that are collectively referred to as the CRAB features. When present together, multiple myeloma (MM) should be at the top of the differential diagnosis. We present a 69-year-old man who presented with severe body aches and bone pain in his ribs and pelvis, associated with fatigue and constipation. He was found to have hypercalcaemia, acute kidney injury, anaemia and numerous lytic lesion on chest imaging. Physical examination and imaging were unremarkable for any enlarged lymph nodes. The patient was initially suspected to have multiple myeloma, however, serum and urine protein electrophoresis, and serum free light chain assays were negative. The patient was ultimately diagnosed with diffuse large B cell lymphoma based on a bone marrow biopsy. This case highlights the fact that presence of hypercalcaemia, renal dysfunction, anaemia and bone lesions are not usually specific for MM.
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Affiliation(s)
| | - Moataz Ellithi
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Qazi Waqas
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Arwyn Cunningham
- Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Tony Oliver
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Tsuchiya H. Primary Lymphoma of the Pelvis: A Case Report. J Orthop Case Rep 2018; 7:6-9. [PMID: 29600200 PMCID: PMC5868887 DOI: 10.13107/jocr.2250-0685.924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Primary lymphoma of the bone (PLB) is uncommon clinical entity with the vast majority of the cases are non-Hodgkin’s lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of PLB. Case Report: We report a case of 60-year-old female presented with pain in the right hip that persisted for 2 months. Plain X-ray, computed tomography, and magnetic resonance imaging of the right hip showed a lytic lesion involving the right acetabulum and adjoining iliac bone with extraosseous mass. The histopathological and immunohistochemical examination confirmed a diagnosis of DLBCL. Treatment with cyclophosphamide, epirubicin, vincristine, and prednisone plus rituximabestablished a complete response (CR) with remodeling of the acetabulum. At the last follow-up, the patient had the ability to walk without any support which obviates the need of primary surgical interference for the tumor. Conclusion: The PLB must be considered in the differential diagnosis of lytic lesions involving the pelvic bones in older adults, especially when accompanied by extraosseous soft tissue mass. Our patient of PLB showed goodremodeling of the acetabular area after CR to chemotherapy without primary surgical interference for the tumor with the limitation of weight-bearing during chemotherapy treatment to prevent fracture.
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Affiliation(s)
- Karem M Zekry
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minia, Egypt
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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SANTOS TELMAMURIASDOS, ZUMÁRRAGA JUANPABLO, REAES FÁBIOMAZETTI, MAÇANEIRO JUNIOR CARLOSHENRIQUE, BAPTISTA ANDRÉMATHIAS, CAMARGO OLAVOPIRESDE. PRIMARY BONE LYMPHOMAS: RETROSPECTIVE ANALYSIS OF 42 CONSECUTIVE CASES. ACTA ORTOPEDICA BRASILEIRA 2018; 26:103-107. [PMID: 29983626 PMCID: PMC6032620 DOI: 10.1590/1413-785220182602185549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: It is difficult to define parameters for management and factors associated with primary bone lymphoma (PBL). This article presents the experience in a single institution with 42 patients with PBL over a 16-year period (2000-2016). Methods: Fifty-five patients were retrospectively evaluated, and forty-two were included (76.3%). Results: Median age at diagnosis was 51.5 years, and median follow-up was 102.7 months. One patient had HIV. Pain in the affected site was the most prevalent symptom. The average time between symptom onset and diagnosis was 5.4 months. The vertebrae were most affected (n=16, 33.3%). According to the International Prognostic Index Score (IPI), 64.3% of the patients were classified as having low-grade lymphoma and 25.7% as low-intermediate. The most common histology was diffuse large B cell lymphoma (DLBCL) (85.7%). Immunophenotyping was CD20 positive in 93.5% of patients, and 11 patients had pathological fracture. All patients received chemotherapy and 30% of the regimens included rituximab. Thirty-eight percent of patients received radiation therapy. Overall survival was 50%, and survival median time was 80 months. Age and chemotherapy regimen influenced patient survival. Younger patients and patients who received RCHOP had better prognoses. Conclusions: The choice of chemotherapy regimen associated with age influenced survival for patients with PBL. Level of Evidence IV; Case series.
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Zhang X, Zhu J, Song Y, Ping L, Zheng W. Clinical characterization and outcome of primary bone lymphoma: a retrospective study of 61 Chinese patients. Sci Rep 2016; 6:28834. [PMID: 27357354 PMCID: PMC4928085 DOI: 10.1038/srep28834] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/31/2016] [Indexed: 11/11/2022] Open
Abstract
Primary bone lymphoma(PBL) is a rare disease. To assess the clinical characteristics, outcome, and prognostic factors of this entity in Chinese population, we retrospectively analyzed 61 PBL patients initially treated in our institution between 1997 and 2014. The median age was 45 years. The most common histological subtype was diffuse large B-cell lymphoma (DLBCL) (55.7%), followed by T-cell lymphoma (18.0%). All patients underwent systemic chemotherapy as initial treatment while 24 patients (39.3%) were additionally treated with radiotherapy. The 5-year overall survival (OS) and the 5-year progression-free survival (PFS) rates of 57 cases with completed follow-up were 52.3% and 40.1%, respectively. In further analysis of the primary bone DLBCL (PB-DLBCL) subgroup, the 5-year OS and PFS rates were 53.0% and 47.0%, and a multivariable analysis revealed that baseline Eastern Cooperative Oncology Group (ECOG) score and response to initial treatment (complete remission versus no complete remission) were independent prognostic factors for both OS and PFS. The proportion of T-cell lymphoma is higher in China than in western populations. High baseline ECOG scores (≥2) and unachieved CR in initial therapy were factors for poor PB-DLBCL prognosis. The role of radiotherapy and rituximab in PLB therapy remains to be confirmed in further investigation.
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Affiliation(s)
- XuanYe Zhang
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Jun Zhu
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - YuQin Song
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - LingYan Ping
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - Wen Zheng
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
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Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy. Clin Orthop Relat Res 2016; 474:719-30. [PMID: 25896135 PMCID: PMC4746160 DOI: 10.1007/s11999-015-4292-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Non-Hodgkin's lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy. QUESTIONS/PURPOSES The objective of this study was to compare patients treated for NHL of bone with and without radiation in terms of (1) overall survival; (2) pretreatment complications; (3) posttreatment complications; and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. METHODS A retrospective analysis of all patients with biopsy-proven NHL of bone diagnosed at our institution between 1985 and 2013 was undertaken; 70 patients met our criteria for inclusion with minimum followup of 6 months (median, 55 months; range, 10-219 months). Overall survival at 5 and 10 years was estimated and compared between two groups of patients: one group treated with systemic therapy alone (chemotherapy, rituximab; 46 patients [66%]) and the other with combined modality therapy (systemic therapy and radiotherapy; 24 patients [34%]). During the period in question, indications for radiotherapy included bulky disease, an abbreviated course of systemic therapy, and an incomplete response to systemic therapy. Patients not meeting these criteria generally received systemic therapy alone. With the available sample size, it was estimated that a difference in survival of approximately 30% would have to be present for detection with 80% power (α = 0.05, β = 0.2, n = 70, Δ = 30%). Pretreatment and posttreatment complications occurring in both patient groups were retrospectively reviewed with special emphasis on fracture healing after treatment. MSTS scores were obtained for 45 patients with appendicular tumors at a median followup of 42 months (range, 10-215 months). RESULTS With the data available, no difference in Kaplan-Meier survivorship was observed between patients treated with and without radiation at 5 years (98%; 95% confidence interval [CI], 93%-100% versus 95%; 95% CI, 85%-100%; p = 0.281). Patients who were treated with radiation were more likely to experience problems with fracture healing (relative risk [RR], 12.8; 95% CI, 1.8-89.8; p = 0.01). Similarly, patients treated with radiation were at a higher risk for fracture in the posttreatment period (five of 24 versus no radiation zero of 46; RR, 20.7; 95% CI, 1.2-359.0; p = 0.0375). MSTS scores were poorer in patients treated with radiation (75% versus 91%; p = 0.034) attributable in part to a higher incidence of bony complications in this group after treatment. CONCLUSIONS Based on the numbers of patients in our study, we could not demonstrate a survival advantage with radiation use. Rather, radiotherapy may be associated with orthopaedic complications occurring during and after treatment. Larger, prospective studies are necessary to definitively establish whether radiation is necessary for the treatment of patients with lymphoma of bone. LEVEL OF EVIDENCE Level III, therapeutic study.
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Wang LJ, Wu HB, Wang M, Han YJ, Li HS, Zhou WL, Wang QS. Utility of F-18 FDG PET/CT on the evaluation of primary bone lymphoma. Eur J Radiol 2015; 84:2275-9. [PMID: 26388466 DOI: 10.1016/j.ejrad.2015.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Primary bone lymphoma (PBL) is a rare type of malignant lymphoma. Few data have been reported regarding the utility of F-18 FDG PET/CT in this disease. The aim of this study was to assess the role of F-18 FDG PET/CT in the diagnosis and therapeutic effect evaluation of PBL. MATERIALS AND METHODS A total of 19 consecutive patients with PBL were enrolled. Whole-body PET/CT scan was performed for all patients. The diagnosis of PBL was established by histopathology and immunohistochemistry. RESULTS F-18 FDG PET/CT was positive in 94.7% (18/19) of patients. Uptake of FDG in lesions was intense with SUVmax of 15.14 ± 11.82. Multiple involved lesions were found in 47.4% (9/19) patients, while 52.6% presented with a single involved lesion. Based on the lesions, PET detected 98.9% (87/88) lesions. Among them, 71.6% (63/88) lesions were found to be located in axial skeleton and 28.4% (25/88) in the extremity skeleton. FDG PET/CT also found the lesions infiltrate to the surrounding soft tissue in 84.2% (16/19) patients. On the syn-modality CT, the bone destruction was noted in 43.2% (38/88) of the lesions, of which 50.0% lesions presented as slight change in bone density and 50.0% as severe change. The diagnostic sensitivity of PET was much higher than that of CT (98.9% vs. 43.2%, P=0.000). PET/CT was performed for evaluation of treatment response in 13 patients. In 12 patients with complete response(CR), PET/CT found the 25 lesions were F-18 FDG fully resoluted after treatment, however, bone destruction was still presented in 72.0% (18/25) lesions. CONCLUSIONS The present study suggests that F-18 FDG PET/CT was a sensitive imaging modality for diagnosis and treatment response evaluation of PBL.
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Affiliation(s)
- Li-Juan Wang
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Hu-Bing Wu
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Meng Wang
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Yan-Jiang Han
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Hong-Sheng Li
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Wen-Lan Zhou
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Quan-Shi Wang
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
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Benefit of Consolidative Radiation Therapy for Primary Bone Diffuse Large B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2015; 92:122-9. [DOI: 10.1016/j.ijrobp.2015.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/02/2015] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
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Tong MY, Zhang X, Yu Z, Sun XH, Li S, Zhang Y. Primary sternum diffuse large B-cell lymphoma: A case report and review of the literature. Oncol Lett 2015; 9:2623-2628. [PMID: 26137117 DOI: 10.3892/ol.2015.3122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 02/25/2015] [Indexed: 01/30/2023] Open
Abstract
Primary bone lymphoma (PBL) is a rare disease, accounting for >1% of all cases of malignant lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type of PBL. The present study reported the case of a 68-year-old male with primary bone DLBCL, originally occurred in the sternum, which is a rare form of presentation. Computed tomography (CT), magnetic resonance imaging and bone emission CT were performed, followed by immunohistochemical analysis of a biopsy specimen, and the results were used to establish the diagnosis. At the time of diagnosis, no osseous involvement was observed. The clinical, radiological and histological features of PBL can mimic other medical conditions, thereby making the diagnosis difficult, and frequently leading to delays in treatment. The present study investigated the clinical features, management and prognosis of PBL, and reviewed previous relevant cases.
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Affiliation(s)
- Meng-Ying Tong
- Graduate Institute of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Xian Zhang
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Zhe Yu
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Xiu-Hua Sun
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Shuang Li
- Graduate Institute of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Yang Zhang
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
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Messina C, Christie D, Zucca E, Gospodarowicz M, Ferreri AJM. Primary and secondary bone lymphomas. Cancer Treat Rev 2015; 41:235-46. [PMID: 25698636 DOI: 10.1016/j.ctrv.2015.02.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 12/24/2022]
Abstract
Recent studies have contributed to the enhancement of clinical and molecular knowledge on bone lymphomas, a group of rare malignancies with particular characteristics. Nevertheless, several questions remain unanswered and the level of evidence supporting some diagnostic and therapeutic decisions remains low. Currently, three different forms of bone lymphomas can be distinguished: the primary bone lymphoma, consisting of a single bone lesion with or without regional lymphadenopathies; the polyostotic lymphoma, consisting of multifocal disease exclusively involving the skeleton; and the disseminated lymphoma with secondary infiltration of the skeleton. The first two forms exhibit a good prognosis, requiring treatments similar to those commonly used for nodal lymphomas of the same category, but several issues regarding the role of surgery and local control of the disease, the sequence of treatment, radiation volumes and doses, management of pathological fractures and prevention of late sequelae deserve particular attention. Due to its rarity, prospective trials exclusively focused on bone lymphomas appear unrealistic, thus, critical revision of our own experience and analyses of large cumulative series as well as molecular studies on archival cases remain valid alternatives to improve our knowledge on this obscure lymphoproliferative malignancy. The present review is based on the analysis of the largest available database of bone lymphomas established under the sponsorship of the International Extranodal Lymphoma Study Group (IELSG) as well as on the critical revision of related literature. We provide recommendations for diagnosis, staging, treatment, and response assessment of these patients in everyday practice as well as for the management of special conditions like pathological fractures, indolent forms and central nervous system prophylaxis.
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Affiliation(s)
- Carlo Messina
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy
| | - David Christie
- Genesiscare and Bond University, Inland Dr., Tugun, QLD, Australia
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mary Gospodarowicz
- Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, ON, Canada
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy.
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Zhou HY, Gao F, Bu B, Fu Z, Sun XJ, Huang CS, Zhou DG, Zhang S, Xiao J. Primary bone lymphoma: A case report and review of the literature. Oncol Lett 2014; 8:1551-1556. [PMID: 25202366 PMCID: PMC4156201 DOI: 10.3892/ol.2014.2327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 06/12/2014] [Indexed: 01/29/2023] Open
Abstract
Primary lymphoma of the bone (PLB) primarily arising from the medullary cavity is an extremely rare entity, with only retrospective studies and sporadic cases reported in the literature. The current study presents one case of PLB treated with chemotherapy and radiotherapy, and a review of the literature to elucidate the optimal treatment of PLB. A 73-year-old female presented with pain in the left hip that had persisted for two months. Plain X-ray and magnetic resonance imaging of the left hip showed lytic areas involving the left innominatum. Technetium-99m radionuclide imaging showed increased tracer uptake in the ilium, acetabulum and ischium. An 18F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) scan showed high FDG uptake. A fine-needle aspiration biopsy of the lesion was performed, and histopathological and immunohistochemical examination confirmed a diagnosis of B-cell lymphoma. The patient received radiation therapy followed by six cycles of CHOP regimen (1,000 mg cyclophosphamide, 80 mg epirubicine and 2 mg vincristine on day one, and 100 mg prednisone on days one to five, every three weeks) and achieved a complete response, as confirmed by FDG-PET-CT. At present, the patient is in a good condition. This case is noteworthy, as it is a well-documented case in which the patient received successful treatment. This case demonstrates that PLB has an improved prognosis compared with primary lymphoma of other sites; however, combined therapy may further improve the patient outcome.
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Affiliation(s)
- Hai-Yan Zhou
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Fang Gao
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Bing Bu
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Zheng Fu
- Positron Emission Tomography-Computed Tomography Center, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Xu-Jie Sun
- Department of Pathology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Cheng-Suo Huang
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Deng-Guang Zhou
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Shu Zhang
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Jun Xiao
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
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Results of a Prospective Study of High-Dose or Conventional Anthracycline-Cyclophosphamide Regimen Plus Radiotherapy for Localized Adult Non-Hodgkin's Primary Bone Lymphoma. Adv Hematol 2014; 2014:512508. [PMID: 24723955 PMCID: PMC3958647 DOI: 10.1155/2014/512508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/20/2014] [Accepted: 01/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Primary bone lymphoma (PBL) is a rare entity that has only been reviewed in one prospective and small retrospective studies, from which it is difficult to establish treatment guidelines. We prospectively evaluated high-dose or conventional anthracycline-cyclophosphamide dose and radiotherapy for PBL. Patients and Methods. The GOELAMS prospective multicenter study (1986-1998) enrolled adults with localized high-grade PBL according to age and performance status (PS). Patients <60 years received a high-dose CHOP regimen (VCAP) and those ≥60 years a conventional anthracycline-cyclophosphamide regimen (VCEP-bleomycin); all received intrathecal chemotherapy and local radiotherapy. Results. Among the 26 patients included (VCAP: 19; VCEP-bleomycin: 7), 39% had poor PS ≥2. With a median follow-up of 8 years, overall survival, event-free survival, and relapse-free survival were 64%, 62%, and 65%, respectively, with no significant difference between treatment groups. Poor PS was significantly associated with shorter OS and EFS. Conclusions. Our results confirm the efficacy of our age-based therapeutic strategy. High-doses anthracycline-cyclophosphamide did not improve the outcome. VCEP-bleomycin is effective and well tolerated for old patients. The intensification must be considered for patients with PS ≥2, a poor prognostic factor.
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16
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Bruno Ventre M, Ferreri AJM, Gospodarowicz M, Govi S, Messina C, Porter D, Radford J, Heo DS, Park Y, Martinelli G, Taylor E, Lucraft H, Hong A, Scarfò L, Zucca E, Christie D. Clinical features, management, and prognosis of an international series of 161 patients with limited-stage diffuse large B-cell lymphoma of the bone (the IELSG-14 study). Oncologist 2014; 19:291-8. [PMID: 24567283 DOI: 10.1634/theoncologist.2013-0249] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The clinical features, management, and prognosis of stage I-II diffuse large B-cell lymphoma of the bone (PB-DLBCL) included in an international database of 499 lymphoma patients with skeletal involvement were reviewed. METHODS HIV-negative patients (n = 161) with diffuse large B-cell lymphoma of the bone (PB-DLBCL) after complete staging workup were considered. The primary objective of this study was to identify the most effective treatment modality; the secondary objectives were to define the contribution of irradiation fields and doses and the pattern of relapse. RESULTS Median age was 55 years (range, 18-99 years), with a male/female ratio of 1:2; 141 (87%) patients had stage I, 14 (9%) had B symptoms, 37 (23%) had bulky lesion, 54 (33%) showed elevated lactate dehydrogenase serum levels, and 25 (15%) had fracture. Thirteen (8%) patients received chemotherapy alone, 23 (14%) received radiotherapy alone, and 125 (78%) received both treatments. The response to the first-line treatment was complete in 131 of 152 assessed patients (complete response rate, 86%; 95% confidence interval [CI], 81%-91%) and partial in 7, with an overall response rate of 91% (95% CI, 87%-95%). At a median follow-up of 54 months (range, 3-218), 107 (67%) patients remained relapse-free, with a 5-year progression-free survival of 68% (SE: 4). Four (2.5%) patients had meningeal relapse; 119 patients were alive (113 disease-free), with a 5-year overall survival of 75% (SE: 4). Patients managed with primary chemotherapy, whether followed by radiotherapy or not, had a significantly better outcome than patients treated with primary radiotherapy, whether followed by chemotherapy or not. The addition of consolidative radiotherapy after primary chemotherapy was not associated with improved outcome; doses >36 Gy and the irradiation of the whole affected bone were not associated with better outcome. CONCLUSION Patients with PB-DLBCL exhibit a favorable prognosis when treated with primary anthracycline-based chemotherapy whether followed by radiotherapy or not. In patients treated with chemoradiotherapy, the use of larger radiation fields and doses is not associated with better outcome. Central nervous system dissemination is a rare event in PB-DLBCL patients.
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Affiliation(s)
- Marta Bruno Ventre
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy; Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, Canada; Auckland Hospital, Auckland, New Zealand; Christie Hospital, Manchester, United Kingdom; Seoul National University Hospital, Seoul, Korea; Korea Cancer Center Hospital, Seoul, Korea; Division of Hematology, European Institute of Oncology, Milan, Italy, Wesley Research Institute, Brisbane, Australia; Northern Centre for Cancer, New Castle, United Kingdom; Royal Prince Alfred Hospital, Sydney, Australia; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Premion and Bond University, Tugun, Australia
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17
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Lymphome osseux primitif localisé : à propos de quatre cas. Cancer Radiother 2014; 18:23-7. [DOI: 10.1016/j.canrad.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 11/22/2022]
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18
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Traitement des lymphomes osseux primitifs. Cancer Radiother 2013; 17:774-7; quiz 785, 788. [DOI: 10.1016/j.canrad.2013.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/22/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022]
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19
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Held G, Zeynalova S, Murawski N, Ziepert M, Kempf B, Viardot A, Dreyling M, Hallek M, Witzens-Harig M, Fleckenstein J, Rübe C, Zwick C, Glass B, Schmitz N, Pfreundschuh M. Impact of Rituximab and Radiotherapy on Outcome of Patients With Aggressive B-Cell Lymphoma and Skeletal Involvement. J Clin Oncol 2013; 31:4115-22. [DOI: 10.1200/jco.2012.48.0467] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To study clinical presentation, outcome, and the role of radiotherapy in patients with aggressive B-cell lymphoma and skeletal involvement treated with and without rituximab. Patients and Methods Outcome of patients with skeletal involvement was analyzed in a retrospective study of nine consecutive prospective trials of the German High-Grade Non-Hodgkin lymphoma Study Group. Results Of 3,840 patients, 292 (7.6%) had skeletal involvement. In the MabThera International Trial (MInT) for young good-prognosis patients and the Rituximab With CHOP Over 60 Years (RICOVER-60) study for elderly patients, the randomized addition of rituximab improved event-free survival (EFS; hazard ratio for MInT [HRMInT] = 0.4, P > 001; hazard ratio for RICOVER-60 [HRRICOVER-60] = 0.6, P > .001) and overall survival (OS; HRMInT = 0.4, P < .001; HRRICOVER-60 = 0.7, P = .002) in patients without skeletal involvement, but failed to improve the outcome of patients with skeletal involvement (EFS: HRMInT = 1.4, P = .444; HRRICOVER-60 = 0.8, P = .449; OS: HRMInT = 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935). Skeletal involvement was associated with a worse outcome after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab (HREFS = 1.5, P = .048; HROS = 1.1; P = .828), but not after CHOP without rituximab (HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In contrast to rituximab, additive radiotherapy to sites of skeletal involvement was associated with a decreased risk (HREFS = 0.3, P = .001; HROS = 0.5; P = .111). Conclusion Rituximab failed to improve the outcome of patients with diffuse large B-cell lymphoma with skeletal involvement, although our data suggest a beneficial effect of radiotherapy to sites of skeletal involvement. Whether radiotherapy to sites of skeletal involvement can be spared in cases with a negative positron emission tomography after immunochemotherapy should be addressed in appropriately designed prospective trials.
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Affiliation(s)
- Gerhard Held
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Samira Zeynalova
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Niels Murawski
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Marita Ziepert
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Barbara Kempf
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Andreas Viardot
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Martin Dreyling
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Michael Hallek
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Mathias Witzens-Harig
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Jochen Fleckenstein
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Christian Rübe
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Carsten Zwick
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Bertram Glass
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Norbert Schmitz
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Michael Pfreundschuh
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
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Matikas A, Briasoulis A, Tzannou I, Oikonomopoulou D, Bakiri M, Karmiris T, Harhalakis N. Primary bone lymphoma: a retrospective analysis of 22 patients treated in a single tertiary center. Acta Haematol 2013; 130:291-6. [PMID: 24008727 DOI: 10.1159/000351051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/06/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary bone lymphoma is a rare disease, representing less than 5% of all extra-nodal non-Hodgkin lymphomas. MATERIALS AND METHODS We retrospectively searched the database of the lymphoma unit, Hematology/Lymphoma Department, Athens General Hospital 'Evangelismos' for primary bone lymphoma patients. Demographic and clinicopathologic data were collected and overall survival was analyzed. A log-rank test was used in a univariate analysis to identify factors affecting overall survival. RESULTS We identified 24 and analyzed data from 22 patients. 12 were male (54.5%) and 10 female (45.4%) and their median age was 55 years (range: 19-83). Most patients had localized disease at the time of diagnosis (n = 19, 86.3%), the most common site was the spine (n = 11, 50%) and the most common histology was diffuse large B-cell lymphoma. 21 patients received chemotherapy as initial therapy and 16 received combined chemoradiation. 81.8% of the patients (n = 18) achieved complete remission. 5-year survival rate was 86.3% and overall survival was found to be affected by the patients' initial response to treatment. CONCLUSIONS Primary bone lymphoma is usually associated with a good prognosis. Prospective studies are needed in order to clarify the effect of immunochemotherapy in overall survival.
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Affiliation(s)
- Alexios Matikas
- Lymphoma, Hematology and Bone Marrow Transplant Department, Evangelismos General Hospital, Athens, Greece
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21
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Scoccianti G, Rigacci L, Puccini B, Campanacci DA, Simontacchi G, Bosi A, Capanna R. Primary lymphoma of bone: outcome and role of surgery. INTERNATIONAL ORTHOPAEDICS 2013; 37:2437-42. [PMID: 23974836 DOI: 10.1007/s00264-013-2055-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary bone lymphoma is a rare disease. Little is reported about surgical procedures in these patients. We evaluated a single-centre consecutive series of 21 patients for results, prognostic factors and surgical treatment. METHODS Patient ages ranged from 19 to 82 years. The most frequently affected site was the spine (six cases), followed by the ileum, femur and mandible (three cases each). Four patients were treated with chemotherapy and 17 with chemotherapy and radiation therapy. Six patients were affected by a pathological fracture. Surgery was performed in four patients (19%), in two cases before chemotherapy, in one case during chemotherapy and in one case after chemotherapy and radiotherapy. Five patients died within the range of three to 36 months after diagnosis. Average follow-up of the remaining patients was 62.8 (19-145) months. RESULTS Overall survival was 74.2% at five years. The only positive prognostic factor was complete remission after chemotherapy. A trend for better survival was present for International Prognostic Index (IPI) score (P = 0.051), under 40 years of age (P = 0.10) and abnormal lactate dehydrogenase (LDH) values (P = 0.10), but it did not reach statistical significance. CONCLUSIONS Surgical treatment should be aimed at restoring function and eliminating pain while minimising delays in the chemotherapy schedule. When feasible, postponing surgery until after chemotherapy is advisable.
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Affiliation(s)
- Guido Scoccianti
- Orthopaedic Oncology Department, Careggi University Hospital, Largo Palagi 1, Firenze, Italy,
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22
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Jain A, Alam K, Maheshwari V, Khan R, Nobin H, Narula V. Primary bone lymphomas-Clinical cases and review of literature. J Bone Oncol 2013; 2:132-6. [PMID: 26909283 PMCID: PMC4723388 DOI: 10.1016/j.jbo.2013.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/19/2013] [Accepted: 07/24/2013] [Indexed: 11/05/2022] Open
Abstract
Primary bone lymphoma (PBL) is an uncommon clinical entity and a rare presentation of non-Hodgkin's lymphoma. PBL accounts for less than 5% of malignant bone tumors, 4–5% of extra nodal lymphoma and less than 1% of all non-Hodgkin's lymphoma. Diffuse large-B-cell lymphoma (DLBCL) accounts for the majority of cases of PBL. The incidence of PBL is so rare that many of its aspects remain unknown. A number of studies have been reported from western countries but only a few reports are available from Asia. Out of 20,000 bone lesions received in our department over 5 years, only 5 cases were primary bone lymphoma; all of which were DLBCL. We report our experience on PBLs with main emphasis on two unusual presentations of this rare tumor.
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Affiliation(s)
- Anshu Jain
- Department of Pathology, Jawahar Lal Nehru Medical College, AMU, Aligarh, Uttar Pradesh 202002, India
| | - Kiran Alam
- Department of Pathology, Jawahar Lal Nehru Medical College, AMU, Aligarh, Uttar Pradesh 202002, India
| | - Veena Maheshwari
- Department of Pathology, Jawahar Lal Nehru Medical College, AMU, Aligarh, Uttar Pradesh 202002, India
| | - Roobina Khan
- Department of Pathology, Jawahar Lal Nehru Medical College, AMU, Aligarh, Uttar Pradesh 202002, India
| | - Hage Nobin
- Department of Pathology, Jawahar Lal Nehru Medical College, AMU, Aligarh, Uttar Pradesh 202002, India
| | - Varsha Narula
- Department of Pathology, Jawahar Lal Nehru Medical College, AMU, Aligarh, Uttar Pradesh 202002, India
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23
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Blume P, Charlot-Hicks F, Mohammed S. Case report and review of primary bone diffuse large B-cell lymphoma involving the calcaneus. J Foot Ankle Surg 2013; 52:666-72. [PMID: 23628193 DOI: 10.1053/j.jfas.2013.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Indexed: 02/03/2023]
Abstract
Primary bone lymphoma from diffuse large B-cell lymphoma is a very rare condition, especially in the foot. In the present case report, a 23-year-old female patient presented with long-term pain along the lateral aspect of her right calcaneus. Ancillary magnetic resonance imaging revealed a radiolucent bone tumor in the calcaneus. Computed tomography-guided biopsy of the bone was completed and revealed chronic inflammation with hematopoietic elements. The patient continued to have pain and limitation in her daily activities after the biopsy. The patient underwent surgical excision and curettage by the senior author. Pathologic examination revealed that the lesion was consistent with diffuse, large, B-cell lymphoma, stage IAE. The lesion appeared to have been completely excised at surgery, and the patient underwent 3 cycles of chemotherapy and 15 radiotherapy sessions to the calcaneus. At the last follow-up visit, the patient had been disease free for 5 years. To our knowledge, this is the first case report of primary bone, diffuse, large B-cell lymphoma of the calcaneus to be treated with a combination of surgical excision, chemotherapy, and radiotherapy.
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Affiliation(s)
- Peter Blume
- Section of Podiatric Surgery, Department of Orthopedics, Yale University School of Medicine, New Haven, CT 06511, USA.
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24
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Kim SY, Shin DY, Lee SS, Suh C, Kwak JY, Kim HG, Lee JH, Lee SI, Lee YR, Kang SH, Mun SK, Lee MJ, Lee HR, Yang SH, Kang HJ. Clinical characteristics and outcomes of primary bone lymphoma in Korea. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:213-8. [PMID: 23071477 PMCID: PMC3464339 DOI: 10.5045/kjh.2012.47.3.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/08/2012] [Accepted: 09/10/2012] [Indexed: 11/17/2022]
Abstract
Background This study evaluates the effectiveness of immunochemotherapy and radiation therapy in the treatment of patients with primary bone lymphoma (PBL). Methods We retrospectively reviewed the medical records of 33 patients with PBL who were treated at 6 medical centers in Korea from 1992 to 2010. Clinicopathological features and treatment outcomes were analyzed. Results The median age of the patients participating in our study was 40 years. The most common sites of involvement were the pelvis (12.36%) and femur (11.33%). CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like regimens were administered to 20 patients (61%), and R-CHOP (rituximab plus CHOP) was administered to the remaining 13 patients (39%). The overall response rate was 89% (complete response, 76%; partial response, 12%). The overall survival (OS) of patients with solitary bone lesions was longer than that of patients with multiple bone lesions (median OS: not reached vs. 166 months, respectively; P=0.089). Addition of rituximab to CHOP did not significantly affect either OS or progression-free survival (P=0.53 and P=0.23, respectively). Combining radiation therapy with chemotherapy also did not improve the OS or progression-free survival of patients with solitary bone lesions. Conclusion Conventional cytotoxic chemotherapy remains an effective treatment option for patients with PBL. Additional benefits of supplementing chemotherapy with either rituximab or radiation therapy were not observed in this study. Further investigation is needed to characterize the role of immunochemotherapy in treating patients with PBL.
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Affiliation(s)
- So Yeon Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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25
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Abstract
Primary bone lymphoma is a distinct clinical entity that accounts for 5% of extra-nodal lymphoma. Most patients have diffuse large B-cell lymphoma and present with bone pain, a mass or both. The involvement could be in a single focus or disseminated. There are no prospective clinical studies in this disease. Patients have been treated with radiotherapy, chemotherapy or a combination. There is a trend towards improved outcome with combined modality treatment and further improvement with the addition of rituximab. Assessment of response may be difficult with current imaging techniques. The prognosis of primary bone lymphoma is generally good. Here, the current evidence for the optimal treatment of primary bone lymphoma is reviewed and questions for future investigation are addressed.
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Affiliation(s)
- N G Mikhaeel
- Guy's & St. Thomas' NHS Foundation Trust, London, UK.
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26
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Abstract
Diagnosing small round cell tumors (SCRTs) can be a difficult task for pathologists due to overlapping clinicopathologic features. This review highlights the clinical, radiographic, histologic, immunohistochemical, and genetic features of the most common SRCTs involving bone with an emphasis on differential diagnosis. SRCTs are a heterogeneous group of neoplasms characterized by poorly differentiated cells with small, blue, round nuclei and scant cytoplasm. They can occur as primary tumors in bone or soft tissue.
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Affiliation(s)
- Justin L Seningen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Carrie Y Inwards
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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27
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Cai L, Stauder MC, Zhang YJ, Poortmans P, Li YX, Constantinou N, Thariat J, Kadish SP, Nguyen TD, Kirova YM, Ghadjar P, Weber DC, Bertran VT, Ozsahin M, Mirimanoff RO. Early-stage primary bone lymphoma: a retrospective, multicenter Rare Cancer Network (RCN) Study. Int J Radiat Oncol Biol Phys 2011; 83:284-91. [PMID: 22079728 DOI: 10.1016/j.ijrobp.2011.06.1976] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 06/08/2011] [Accepted: 06/15/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE Primary bone lymphoma (PBL) represents less than 1% of all malignant lymphomas. In this study, we assessed the disease profile, outcome, and prognostic factors in patients with Stages I and II PBL. PATIENTS AND METHODS Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Eighty-seven patients underwent chemoradiotherapy (CXRT) without (78) or with (9) surgery, 15 radiotherapy (RT) without (13) or with (2) surgery, and 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range, 4-60). The median number of CXT cycles was six (range, 2-8). Median follow-up was 41 months (range, 6-242). RESULTS The overall response rate at the end of treatment was 91% (complete response [CR] 74%, partial response [PR] 17%). Local recurrence or progression was observed in 12 (10%) patients and systemic recurrence in 17 (15%). The 5-year overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78%, and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS and LSS were International Prognostic Index (IPI) score ≤1 (p = 0.009), high-grade histology (p = 0.04), CXRT (p = 0.05), CXT (p = 0.0004), CR (p < 0.0001), and RT dose >40 Gy (p = 0.005). For LC, only CR and Stage I were favorable factors. In multivariate analysis, IPI score, RT dose, CR, and CXT were independently influencing the outcome (OS and LSS). CR was the only predicting factor for LC. CONCLUSION This large multicenter retrospective study confirms the good prognosis of early-stage PBL treated with combined CXRT. An adequate dose of RT and complete CXT regime were associated with better outcome.
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Affiliation(s)
- Ling Cai
- Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland
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28
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Pellegrini C, Gandolfi L, Quirini F, Ruggieri P, Stefoni V, Derenzini E, Broccoli A, Argnani L, Pileri S, Mercuri M, Baccarani M, Zinzani PL. Primary Bone Lymphoma: Evaluation of Chemoimmunotherapy as Front-line Treatment in 21 Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:321-5. [PMID: 21816370 DOI: 10.1016/j.clml.2011.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/04/2011] [Accepted: 03/22/2011] [Indexed: 11/29/2022]
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/mortality
- Bone Neoplasms/therapy
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Immunologic Factors/administration & dosage
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Male
- Middle Aged
- Radiotherapy, Adjuvant/methods
- Remission Induction
- Retrospective Studies
- Rituximab
- Survival Rate
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Affiliation(s)
- Cinzia Pellegrini
- Institute of Hematology and Medical Oncology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
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29
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Senthilvel E, Subbiah S, Jain V, Seidman M. Primary diffuse large B-cell lymphoma of the skull mimicking osteomyelitis. EAR, NOSE & THROAT JOURNAL 2011; 90:E22-5. [PMID: 21229495 DOI: 10.1177/014556131109000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary lymphomas of the skull are extremely rare, as fewer than 20 cases have been reported in the literature. We describe the case of a 51-year-old woman with Huntington chorea who presented with forehead swelling. Imaging studies detected an enhancing mass in the skull with some destruction of the underlying bone. These features were suggestive of osteomyelitis. Surgical excision was performed, and the mass was found to be a primary diffuse large B-cell lymphoma. The patient was administered postoperative chemotherapy, and she was in complete remission at the 1-year follow-up.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Family Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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30
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Chen P, Li B, Zhuang W, Huang H, Zhang H, Fu J. Multiple bone lesions and hypercalcemia presented in diffuse large B cell lymphoma: mimicking multiple myeloma? Int J Hematol 2010; 91:716-22. [PMID: 20379806 DOI: 10.1007/s12185-010-0562-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/07/2010] [Accepted: 03/22/2010] [Indexed: 02/01/2023]
Abstract
We encountered a 58-year-old female patient who developed hypercalcemia and multiple bone lesions. She complained of lumbodorsal pain, nausea and vomiting on admission. Radiographic examination revealed multiple osteolytic lesions. She was diagnosed diffuse large B cell lymphoma (BLBCL) by bone marrow examination and biopsy of cervical lymph node. She underwent eight cycles of chemotherapy and is now in the stable stage. Osteogenic potential of mesenchymal stem cells from bone marrow was found to be correlated with the expression of Dickkopf1 (DKK-1) in the bone marrow plasma and lymphoma cells before and after treatment. PTH-related protein (PTHrP) expression was detectable in the lymphoma cells and was elevated in the serum. The receptor activator of nuclear factor kappaB ligand expression was found to be elevated in the bone marrow plasma and mesenchymal stem cells. These findings suggest that factors affecting the differentiation of both osteoblasts and osteoclasts involved in the pathogenesis of hypercalcemia and bone lesions of lymphoma. This was similar to that of multiple myeloma in which bone lesions and hypercalcemia are frequently observed.
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Affiliation(s)
- Ping Chen
- Haematology Department, No. 2 Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
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31
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Alencar A, Pitcher D, Byrne G, Lossos IS. Primary bone lymphoma--the University of Miami experience. Leuk Lymphoma 2010; 51:39-49. [PMID: 19860629 DOI: 10.3109/10428190903308007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Primary bone lymphoma (PBL) is a rare disease. There has been paucity of studies addressing its therapy and prognosis. We retrospectively examined PBL cases seen at the University of Miami from June 2000 to August 2007 to describe our single institution experience and review the literature. Fifty-three patients were identified with a median age of 52 (18-87) and a median follow-up of 40 months (0-106). The most common histologic type was diffuse large B-cell lymphoma (83%). Forty-one patients (77%) presented with localized disease and 48 were treated at our institution. Forty-six patients underwent chemotherapy (40 patients) and/or radiation (36 patients). Forty-four patients achieved a complete response and all patients were alive at last follow-up. The progression-free survival (PFS) was 83% at 4 years. No difference in PFS was observed between patients treated with chemotherapy or combined chemotherapy plus radiation. There was a trend toward improvement in PFS (p = 0.062) of patients with DLBCL treated with rituximab plus chemotherapy. Our single institutional experience demonstrates that the outcome of patients with PBL is excellent. Although the current data support the use of combined modality treatment for localized PBL, randomized controlled trials are needed especially now, when rituximab is routinely added to chemotherapy regimens.
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Affiliation(s)
- Alvaro Alencar
- Division of Hematology-Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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32
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Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer 2010; 116:871-9. [PMID: 20043324 DOI: 10.1002/cncr.24828] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Muhammad U Jawad
- Department of Orthopedics, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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33
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O'Neill J, Finlay K, Jurriaans E, Friedman L. Radiological manifestations of skeletal lymphoma. Curr Probl Diagn Radiol 2009; 38:228-36. [PMID: 19632500 DOI: 10.1067/j.cpradiol.2008.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lymphoreticular neoplasms primarily arise in extraskeletal locations with skeletal involvement usually secondary to hematogenous spread or by direct invasion from surrounding involved lymph nodes or soft tissues. Primary lymphoma of bone is relatively rare in comparison. Lymphoma encompasses Hodgkin's and non-Hodgkin's disease, Burkitt's lymphoma, and mycosis fungoides. Skeletal disease may present with symptoms localized to the site of bone involvement, as an incidental finding on imaging for other reasons, or as part of the staging of the disease. It is important that the radiologist is cognizant of the many presentations of skeletal lymphoma. We present a review of the radiological imaging of skeletal lymphoma with conventional radiographs, computed tomography, scintigraphic studies, and magnetic resonance imaging.
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Affiliation(s)
- John O'Neill
- Department of Radiology, St. Josephs Healthcare Hamilton, Ontario, Canada.
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34
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Yuste AL, Segura A, López-Tendero P, Gironés R, Montalar J, Gómez-Codina J. Primary Lymphoma of Bone: A Clinico-Pathological Review and Analysis of Prognostic Factors. Leuk Lymphoma 2009; 45:853-5. [PMID: 15160973 DOI: 10.1080/10428190310001615648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Bosch-Barrera J, Arbea L, García-Velloso MJ, Gil-Bazo I, García-Foncillas J, Panizo C. Primary bone lymphoma of the mandible and thyroid incidentaloma identified by FDG PET/CT: a case report. CASES JOURNAL 2009; 2:6384. [PMID: 19829800 PMCID: PMC2740098 DOI: 10.4076/1757-1626-2-6384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 06/12/2009] [Indexed: 11/21/2022]
Abstract
The mandible is a rare site for the occurrence of primary bone lymphoma (PBL), a non-Hodgkin lymphoma. We report herein a case of an incidentally diagnosed thyroid incidentaloma by (18)Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a patient with a previous diagnosis of PBL. Therapeutic options are reviewed and discussed.
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Affiliation(s)
| | - Leire Arbea
- Department of Oncology, Clínica Universidad de NavarraPamplonaSpain
| | | | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de NavarraPamplonaSpain
| | | | - Carlos Panizo
- Department of Hematology, Clínica Universidad de NavarraPamplonaSpain
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36
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Hwang JE, Cho SH, Kim OK, Shim HJ, Lee SR, Ahn JS, Yang DH, Kim YK, Lee JJ, Kim HJ, Chung IJ. Newly developed multiple myeloma in a patient with primary T-cell lymphoma of bone. J Korean Med Sci 2008; 23:544-7. [PMID: 18583898 PMCID: PMC2526528 DOI: 10.3346/jkms.2008.23.3.544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary non-Hodgkin's lymphoma of bone (PLB) is rare, and generally presents as a single extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large B-cell lymphoma, and T-cell lymphoma is rare. By contrast, multiple myeloma is a disease defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. We report a case of multiple myeloma that developed during treatment of PLB in a type of T-cell. A 48-yr-old man was diagnosed as T-cell PLB, stage IE, 18 months ago. The patient received the chemoradiotherapy and salvage chemotherapy for PLB. However, the lymphoma progressed with generalized bone pain, and laboratory findings showed bicytopenia and acute renal failure. On bone marrow biopsy, the patient was diagnosed as having multiple myeloma newly developed with primary T-cell lymphoma of bone. In spite of chemotherapy, the patient died of renal failure.
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Affiliation(s)
- Jun-Eul Hwang
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Hee Cho
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ok-Ki Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Se-Ryeon Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Sook Ahn
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Duk-Hwan Yang
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeo-Kyeoung Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Je-Jung Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyeoung-Joon Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ik-Joo Chung
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
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37
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Power DG, McVey GP, Korpanty G, Treacy A, Dervan P, O'Keane C, Carney DN. Primary bone lymphoma: single institution case series. Ir J Med Sci 2008; 177:247-51. [PMID: 18516662 DOI: 10.1007/s11845-008-0165-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 04/16/2008] [Indexed: 12/01/2022]
Affiliation(s)
- D G Power
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
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38
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Staub-Zähner T, Garzoni D, Fretz C, Lampert C, Ohlschlegel C, Wüthrich RP, Fehr T. Pseudotumor of gout in the patella of a kidney transplant recipient. ACTA ACUST UNITED AC 2007; 3:345-9. [PMID: 17525717 DOI: 10.1038/ncpneph0494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 02/07/2007] [Indexed: 11/10/2022]
Abstract
BACKGROUND A 33-year-old renal transplant recipient presented with painless swelling of the right knee. Physical examination revealed an impressive knee joint effusion with no signs of inflammation. The patient did not remember a recent trauma, but he mentioned a strain 3 years earlier; radiographic findings had been normal at that time. The patient had suffered from end-stage renal disease due to chronic glomerulonephritis and had previously undergone two transplantations. At presentation, his kidney function was stable under treatment with ciclosporin, azathioprine and steroids. INVESTIGATIONS Conventional radiography revealed a tumor at the superolateral pole of the right patella. Extensive soft tissue invasion and bone destruction was seen on MRI. A knee arthroscopy with biopsy, performed to aid diagnosis, showed extensive chondrocalcinosis macroscopically; histologically, gouty tophi were found. DIAGNOSIS Pseudotumor of gout in the patella. MANAGEMENT Uric-acid-lowering therapy with benzbromarone was started immediately after diagnosis. A local arthroscopic debridement of the right knee joint was performed 4 months later, and the patient remained asymptomatic for the next 3 years.
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39
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Abdelwahab IF, Hoch B, Hermann G, Bianchi S, Klein MJ, Springfield DS. Primary periosteal lymphoma--rare and unusual. Skeletal Radiol 2007; 36:335-9. [PMID: 16534637 DOI: 10.1007/s00256-006-0096-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Accepted: 01/23/2006] [Indexed: 02/02/2023]
Abstract
We describe a primary periosteal lymphoma that involved only the periosteum without affecting the adjacent medulla or the regional lymph nodes. No other lymphomatous foci were found in either the distant lymph nodes or viscera. This unusual presentation simulates the imaging appearance of surface lesions of bone, namely benign and malignant tumors, and departs from the typical appearance of primary lymphoma of bone. Therefore, this rare type of lymphoma should be considered in the differential diagnosis of surface bone lesions.
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Affiliation(s)
- Ibrahim Fikry Abdelwahab
- Department of Radiology, Coney Island Hospital, affiliated with Downstate School of Medicine, CUNY, New York, NY, USA
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40
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Ford DR, Wilson D, Sothi S, Grimer R, Spooner D. Primary Bone Lymphoma — Treatment and Outcome. Clin Oncol (R Coll Radiol) 2007; 19:50-5. [PMID: 17305254 DOI: 10.1016/j.clon.2006.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS A retrospective review of patients with histologically confirmed primary bone lymphoma (PBL) diagnosed and treated at a single tertiary referral centre between 1985 and 2003. MATERIALS AND METHODS The medical records of all patients treated for histologically primary bone lymphoma were identified using the hospital data base. Data was obtained on patient demographics, stage, treatment and outcome. RESULTS Twenty-two patients with PBL were identified. Seventeen had localised disease and five had multifocal bone involvement. The median age was 50 years. Of the patients who could be graded according to the International Prognostic Index (IPI), 12 cases were classified as low risk, seven as intermediate risk and one as high risk. All patients received chemotherapy; 19 with an anthracycline-containing regimen. Eighteen patients were treated with radiotherapy to a median total dose of 40 Gy (range 30-50 Gy). Three patients had surgery instead of radiotherapy as local treatment (one fibulectomy and two endoprosthetic replacements). The median follow-up was 84.5 months (range 3-206 months). The overall 10-year survival was 74%; 92% for low-risk IPI vs 73% for intermediate-risk IPI (P = 0.27). The 10-year relapse-free survival was 85% overall and 83% for both low- and intermediate-risk IPI (P = 0.87). Local relapse was seen in one patient. Orthopaedic complications occurred in two patients--one developed a pathological fracture after biopsy before radiotherapy and the other developed avascular necrosis outside the irradiated area. CONCLUSIONS Combined modality treatment for PBL results in good local control and survival rates with acceptable toxicity.
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Affiliation(s)
- D R Ford
- Oncology Centre, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK.
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41
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Beal K, Allen L, Yahalom J. Primary bone lymphoma: treatment results and prognostic factors with long-term follow-up of 82 patients. Cancer 2006; 106:2652-6. [PMID: 16700039 DOI: 10.1002/cncr.21930] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND To the authors' knowledge, there is limited information on the preferred treatment and long-term prognosis of primary bone lymphomas (PBLs). All PBL cases treated at the study center between 1963 and 2003 were analyzed to determine patient, disease, and treatment factors that could affect outcome measured by overall survival (OS), cause-specific survival (CSS), and freedom-from-treatment failure (FFTF). METHODS A total of 101 patients with PBL diagnosed at the study institution were identified. Nineteen patients were excluded because they transferred their treatment or follow-up to another center. Disease control, survival, and prognostic factors were analyzed for all 82 remaining patients. RESULTS The median age of the patients was 48 years (range, 11-83 years). Approximately 80% presented with diffuse large-cell lymphoma (DLCL), and 81% presented with Ann Arbor Stage I or II disease. Approximately 57% were treated with combined modality therapy, 14% were treated with radiation therapy alone, and 30% were treated with chemotherapy alone. The median follow-up was 67 months (range, 2-280 months). The 5-year OS, CSS, and FFTF were 88%, 96%, and 81%, respectively. The 5-year OS for patients treated with combined modality versus single-modality therapy was 95% versus 78% (P = .013), and the 5-year FFTF for patients treated with combined modality versus single-modality therapy was 90% versus 67% (P = .025). The 5-year CSS for patients treated with combined modality versus single-modality therapy was 95% versus 83% (P = .065). Using a Cox regression for multivariate analysis, age < 40 years and use of combined modality therapy were found to be favorable prognostic factors for OS, CSS, and FFTF. CONCLUSIONS To the authors' knowledge, the current study is the largest series of patients with PBL treated with modern curative modalities. The data demonstrate that primary lymphoma involving the bone has an excellent prognosis. Patients with PBL treated with combined modality versus single modality therapy were found to have a superior outcome, with a significantly better survival.
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Affiliation(s)
- Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Mankin HJ, Hornicek FJ, Harmon DC, Gebhardt MC. Lymphoma of bone: a review of 140 patients. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/14750708.3.4.499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Takasaki H, Kanamori H, Takabayashi M, Yamaji S, Koharazawa H, Taguchi J, Fujimaki K, Ishigatsubo Y. Non-Hodgkin's lymphoma presenting as multiple bone lesions and hypercalcemia. Am J Hematol 2006; 81:439-42. [PMID: 16680736 DOI: 10.1002/ajh.20559] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We report a rare case of a patient with non-Hodgkin's lymphoma who developed multiple bone lesions and hypercalcemia. A 50-year-old woman complained of drowsiness and multiple bone pain on admission. Radiographic examination revealed multiple bone fractures and osteolytic lesions. She was diagnosed with diffuse large B cell lymphoma by biopsy of an inguinal lymph node. Elevation of parathyroid hormone-related protein (PTHrP) and hypercalcemia were confirmed pretreatment, and those serum levels decreased during chemotherapy for lymphoma. However, the disease was resistant to chemotherapy combined with rituximab. These findings suggest that hypercalcemia is associated with PTHrP and the prognosis of patients with bone lymphoma in advanced stage is poor, although it is thought to be a relatively favorable prognosis in localized primary lymphoma of bone.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Bone Neoplasms/blood
- Bone Neoplasms/complications
- Bone Neoplasms/drug therapy
- Bone Neoplasms/pathology
- Drug Resistance, Neoplasm
- Female
- Fractures, Bone/blood
- Fractures, Bone/drug therapy
- Fractures, Bone/etiology
- Fractures, Bone/pathology
- Humans
- Hypercalcemia/blood
- Hypercalcemia/drug therapy
- Hypercalcemia/etiology
- Hypercalcemia/pathology
- Lymph Nodes/pathology
- Lymphoma, B-Cell/blood
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Non-Hodgkin/blood
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Middle Aged
- Osteolysis/blood
- Osteolysis/etiology
- Osteolysis/pathology
- Parathyroid Hormone-Related Protein/blood
- Prognosis
- Rituximab
- Sentinel Lymph Node Biopsy
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Affiliation(s)
- Hirotaka Takasaki
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Míguez Sánchez C, Hebrero ML, Mesa C, Villanego I, Sánchez Calzado JA, Errazquin L. Primary bone lymphoma. Clin Transl Oncol 2006; 8:221-4. [PMID: 16648124 DOI: 10.1007/s12094-006-0015-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary bone lymphoma is a rare condition which represents a low percentage of both the malignant primary bone tumours and the non-Hodgkin extranodal lymphoma. This explains the lack of publications, lines of investigations, and specific diagnostic and treatment protocols. In the following article we will carry out a revision of the existing literature on this rare subject, using as argument a clinical case of left femoral location stage IE treated with CHOP chemotherapy and radiotherapy.
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Affiliation(s)
- C Míguez Sánchez
- Servicio de Oncología Radioterápica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Abstract
UNLABELLED The treatment of spinal tumors represents a challenge to spine care professionals. Fortunately, the incidence of new cases of primary malignant bone tumors is lower compared with that of other tumors. In the United States approximately 2000 malignant bone tumors of 7000 new sarcomas are diagnosed each year. Of these, 4% to 20% (80-400 tumors) of bone tumors are spinal tumors. Metastatic tumors are the most frequent tumor of bone and the most frequent tumor of the spinal column regardless of the origin of the primary tumor. More than 90% of spinal tumors are metastatic. Thirty to seventy percent of patients who die from cancer have evidence of vertebral metastases visible on careful postmortem examination, with the potential that this number could reach 85% in patients with breast cancer. Less than 10% of patients with spinal tumors present with spinal instability requiring surgical treatment; this accounts for approximately 18,000 new cases yearly. We will focus on the most recent advances in nonsurgical and surgical treatment of vertebral tumors. In surgical treatment, the evaluation and selection of patients, indications and surgical strategies, open and minimally invasive techniques, outcomes and complications will be discussed. LEVEL OF EVIDENCE Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.
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Affiliation(s)
- Edward D Simmons
- Department of Orthopaedic Surgery, State University of New York at Buffalo Buffalo, NY 14201, USA.
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Achemlal L, Mikdame M, Nouijai A, Bezza A, El Maghraoui A. Dramatical improvement of chemoresistant bone lymphoma with rituximab. Clin Rheumatol 2005; 25:394-5. [PMID: 16247586 DOI: 10.1007/s10067-005-0060-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Revised: 06/12/2005] [Accepted: 06/13/2005] [Indexed: 11/26/2022]
Abstract
Non-Hodgkin's lymphoma of the bone is a very rare disease that accounts for approximately 5% of all extranodal non-Hodgkin's lymphomas and for 7-10% of primary bone tumours. We report the case of a 28-year-old man who, in June 2001, presented with a right humerus showing painful destructive lesions with pathological fractures. Biopsy revealed diffuse, large B-cell non-Hodgkin's lymphoma expressing CD20. The patient received six cycles of conventional chemotherapeutic regimen, including cyclophosphamide, doxorubicin, vincristine and prednisone, and VP-16 (etoposide), ifosfamide and mitoxantrone. His arm pain worsened, and x-rays demonstrated progressive disease. He began a trial of rituximab, 750 mg/week, for 4 weeks. There was improvement in pain after the first infusion. Radiographic studies conducted 3 months after rituximab therapy showed marked improvement in his humerus disease. MRI showed a decrease of tumour volume with residual minor signal abnormalities of the bone marrow. He had no evidence of recurrent lymphoma 24 months later.
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Affiliation(s)
- Lahsen Achemlal
- Rheumatology and Physical Rehabilitation Department, Military Hospital Mohammed V, Rabat, Morocco
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Abstract
Primary bone lymphoma is rare. The majority of cases are diffuse large B-cell non-Hodgkin's lymphomas. Classification, staging, and treatment are controversial. The relatively small number of cases has led to many case reports and series describing institutional experiences but precludes the use of randomized clinical trials to address the question of optimal management. This article will review clinical and radiologic presentations, diagnostic techniques, and histologic characteristics. Most important, it will present what limited information we do have regarding effective treatment options for this unusual type of lymphoma.
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Affiliation(s)
- Paula Gill
- Division of Hematology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Barbieri E, Cammelli S, Mauro F, Perini F, Cazzola A, Neri S, Bunkheila F, Ferrari S, Brandoli V, Zinzani P, Mercuri M, Bacci G. Primary non-hodgkin's lymphoma of the bone: treatment and analysis of prognostic factors for Stage I and Stage II. Int J Radiat Oncol Biol Phys 2004; 59:760-4. [PMID: 15183479 DOI: 10.1016/j.ijrobp.2003.11.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2003] [Revised: 09/22/2003] [Accepted: 11/10/2003] [Indexed: 11/20/2022]
Abstract
PURPOSE Primary non-Hodgkin's lymphomas of the bone (PLB) are very rare diseases accounting for 3%-5% of primary bone tumors. The best treatment for PLB has not been found yet. We report on the experience of the Radiation Oncology Department of Bologna University, Italy, relative to the diagnosis and treatment of this disease. METHODS AND MATERIAL Seventy-seven patients with newly diagnosed PLB were treated from June 1983 to October 2001. Fifty-six were male (72.7%) and 21 were female (27.3%); the median age was 41.8 years, with a range of 16-84 years. The majority of patients had B-cell high-grade histology. The median follow-up was 149 months. Forty-four patients had a solitary bone lesion (Stage I); and in 33 patients, the tumor was spread to locoregional lymphatic area (Stage II). All patients were treated with radiotherapy (RT) with a median dose of 40 Gy (range, 36-54 Gy), and 67 received an additional anthracycline-based regimen of chemotherapy (combined modality therapy [CMT]). RESULTS After therapy 73 of 77 patients (94.8%) reached a complete remission. At a median time of 23 months, 14 of 77 patients (18.2%) had a disease relapse. Four of them were treated with RT alone (in these cases tumor lesions were <3 cm and located at sites different from mandible); 10 patients were treated with combined RT and CMT. Actuarial disease-free survival (DFS) and overall survival (OS) at 15 years were, respectively, 76.6% and 88.3%. No local failures were seen. Prognostic factors such as age, sex, stage, and bulky lesions were analyzed. Age (<40 vs. >40 years) was the only significant factor for DFS (85.3% vs. 66.6%, p = 0.03). Bulky lesions apparently did not affect OS (90.9% vs. 72.7%). However, the difference has no statistical significance (p = 0.05). Acute and late toxicity related to the treatment was moderate. CONCLUSIONS In PLB the CMT seems to produce a better outcome than RT alone; that still remains the best treatment for local disease control. Radiation therapy alone should be reserved for mandibular tumors, which are usually very small and earlier diagnosed.
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Affiliation(s)
- Enza Barbieri
- Radiation Oncology Department, University of Bologna, Bologna, Italy
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Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics 2004; 23:1371-83; discussion 1384-7. [PMID: 14615550 DOI: 10.1148/rg.236025056] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary bone lymphoma is an uncommon malignancy that accounts for less than 5% of all primary bone tumors. The radiographic appearances of primary bone lymphoma are variable, and, because the lesion can appear near normal on plain radiographs, a second modality such as bone scintigraphy or magnetic resonance (MR) imaging should be used. Despite this variability, the presence of a solitary, permeative, metadiaphyseal lesion with a layered periosteal reaction on plain radiographs and a soft-tissue mass on MR images, especially in a patient older than 30 years, is highly suggestive of lymphoma. The case for a diagnosis of primary bone lymphoma is further strengthened if the soft-tissue mass and marrow changes are associated with surprisingly little cortical destruction. Primary bone lymphoma has a better prognosis than many other malignant bone tumors; therefore, early identification allows for appropriate treatment. MR imaging not only permits early identification but also depicts the extent of soft-tissue involvement and can be used to assess the outcome of treatment.
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Affiliation(s)
- Anant Krishnan
- Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA.
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Lewis VO, Primus G, Anastasi J, Doherty D, Montag AG, Peabody TD, Simon MA. Oncologic outcomes of primary lymphoma of bone in adults. Clin Orthop Relat Res 2003:90-7. [PMID: 14612634 DOI: 10.1097/01.blo.0000093901.12372.ad] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A retrospective analysis of adult patients who had lymphomatous involvement of bone was done to evaluate the prognostic factors and the oncologic outcome. Between 1984 and 1994, 28 patients (nine women and 19 men) were diagnosed with lymphoma of bone. The median age was 45 years (range, 23-76 years). The median followup was 40.3 months (range, 0.5 months-15.8 years). Eighteen patients (64%) were classified as having Stage IE disease, two patients (36%) were classified as having stage II disease, and eight patients were classified as having Stage IV disease. Twenty-one of the lesions were classified as diffuse large B cell with multilobulated nuclei. Two patients had local recurrence. Three patients had osteonecrosis develop at the site of their radiation therapy. The 5-year Kaplan-Meier survival estimate was 57.8% (95% confidence interval range, 40-33 82.8). Statistically improved survival was seen in patients younger than 40 years and those patients with diffuse large B cell with multilobulated nuclei. Patients with primary lymphoma of bone did not have a statistically improved survival compared with patients with systemic disease. The results of the current study suggest that age at diagnosis and histologic subtypes are important prognostic factors; however, the diagnosis of primary lymphoma of bone does not confer improved prognosis.
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