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Zheng G, Yang Z, Qian H, Huang H, Gu Z. Conditional survival of patients with primary bone lymphoma of the spine: how survival changes after initial diagnosis. Front Oncol 2024; 14:1356947. [PMID: 38751818 PMCID: PMC11094224 DOI: 10.3389/fonc.2024.1356947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background The current survival prediction methodologies for primary bone lymphoma (PBL) of the spine are deficient. This study represents the inaugural utilization of conditional survival (CS) to assess the outcome of this disease. Moreover, our objective was to devise a CS-based nomogram for predicting overall survival (OS) in real-time for spinal PBL. Methods Patients with PBL of the spine diagnosed between January 2000 and December 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The OS was determined through the Kaplan-Meier method. The CS characteristic of patients with spinal PBL was delineated, with the CS being estimated utilizing the formula: CS(α|β) = OS(α+β)/OS(β). CS(α|β) denotes the probability of additional α-year survivorship, assuming the patient has already survived β years after the time of observation. Three methods including univariate Cox regression, best subset regression (BSR) and the least absolute shrinkage and selection operator (LASSO) regression were used to identify predictors for CS-based nomogram construction. Results Kaplan-Meier analysis was executed to determine the OS rate for these patients, revealing a survival rate of 68% and subsequently 63% at the 3-year and 5-year mark respectively. We then investigated the CS patterning exhibited by these patients and discovered the survival of PBL in the spine progressively improved with time. Meanwhile, through three different prognostic factor selection methods, we identified the best predicter subset including age, tumor histology, tumor stage, chemotherapy and marital status, for survival prediction model construction. Finally, we successfully established and validated a novel CS-based nomogram model for real-time and dynamic survival estimation. Moreover, we further designed a risk stratification system to facilitate the identification of high-risk patients. Conclusions This is the first study to analyze the CS pattern of PBL of the spine. And we have also developed a CS-based nomogram that provide dynamic prognostic data in real-time, thereby aiding in the formulation of personalized treatment strategies in clinical practice.
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Affiliation(s)
| | | | | | | | - Zhiwei Gu
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China
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Adalja D, Tagliaferri A, Rezkalla A, Taha B. Diffuse B-Cell Lymphoma of the Mandible Disguised as Acute Osteomyelitis. Eur J Case Rep Intern Med 2024; 11:004243. [PMID: 38352811 PMCID: PMC10860914 DOI: 10.12890/2024_004243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
Background Primary bone lymphoma (PBL) is a rare form of extra nodal non-Hodgkin's lymphoma (NHL). Case description We describe a 39-year-old-male with no medical history who presented with unilateral facial swelling following a tooth extraction. Initial diagnoses after various presentations over the course of three weeks, based on inflammatory and infectious aetiologies. However, the patient was ultimately diagnosed with diffuse large B-cell lymphoma. Discussion Symptoms of PBL are very similar to inflammatory and infectious diseases of the bone, such as osteomyelitis or osteonecrosis. Clinical features of PBL involving the head and neck include persistent jaw pain, tooth mobility secondary to extensive destruction of bone, and in advanced cases, lip numbness and swelling. On examination it may present as an exposed necrotic bone with surrounding soft tissue oedema. Misdiagnosis of these lesions as an infectious or inflammatory aetiology may lead to an unnecessary delay in lymphoma treatment, and subsequently worsen the prognosis if caught at a later stage. Therefore, any concerning lesion, especially in the oral cavity, must be subjected to early histopathological evaluation to differentiate PBL from osteomyelitis and/or osteonecrosis. Conclusion This case report highlights the importance of an early histopathological evaluation to prevent delay in the diagnosis of primary bone lymphomas. LEARNING POINTS Resemblance in symptoms: Primary bone lymphoma (PBL) symptoms overlap with bone infections, necessitating careful consideration and differential diagnosis to prevent misjudgment.Head and neck manifestations: recognising PBL's signs in the head and neck region, such as jaw pain and bone destruction, aids in timely identification and treatment.Timely biopsy significance: swift histopathological assessment for suspicious lesions is critical to avoid delays in diagnosing primary bone lymphomas.
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Affiliation(s)
- Devina Adalja
- Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, USA
| | - Ariana Tagliaferri
- Department of Gastroenterology and Transplant Hepatology, Creighton University, Phoenix, USA
| | - Abraam Rezkalla
- Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, USA
| | - Basil Taha
- Department of Infectious Diseases, St Joseph’s University Medical Center, Paterson, USA
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Cao S, Fan B, Sun Q, Chen J, Song X, Yin W. Comparison of the Effect of Chemoradiotherapy and Chemotherapy on the Survival of Patients with Primary Diffuse Large B-Cell Lymphoma of the Spine: A SEER-Based Study. World Neurosurg 2023; 175:e940-e949. [PMID: 37075894 DOI: 10.1016/j.wneu.2023.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The role of radiotherapy in primary spinal diffuse large B-cell lymphoma (PB-DLBCL) remains controversial. This study explored the effects of chemoradiotherapy and chemotherapy alone on the survival of patients with PB-DLBCL and established an instructive nomogram. METHODS Survival analysis using the Kaplan-Meier method and log-rank test was performed for patients diagnosed with PB-DLBCL from 1983 to 2016, identified in the Surveillance Epidemiology and End Results database. The Cox regression model was used to analyze the effects of each variable on the overall survival (OS) and construct a nomogram for predicting OS in patients. RESULTS Overall, 873 patients with PB-DLBCL were included. The patients were divided into the 1983-2001 (227 [26%]) and 2002-2016 (646 [74%]) groups. The 5-and 10-year OS rates of patients with PB-DLBCL in the 2002-2016 group were 62.8% and 49.9%, respectively. The results of the multivariate Cox regression analysis in the 2002-2016 group showed that age, stage, marriage, and treatment strategy were independent prognostic factors. Kaplan-Meier analysis showed that the OS of patients who underwent chemoradiotherapy from 2002 to 2016 was significantly better than that of patients treated with chemotherapy alone. Further subgroup analysis of patients with different stages of DLBCL and at different ages showed that chemoradiotherapy had a better prognosis than chemotherapy alone in stages I-II and age >60 years, whereas the advantages of chemoradiotherapy were not reflected in stages III-IV and age <60 years. CONCLUSIONS Chemoradiotherapy improves the OS of patients with PB-DLBCL who are aged >60 years or have stage I-II disease. The nomograms established in this study can help clinicians determine prognosis and select treatment strategies.
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Affiliation(s)
- Shuyan Cao
- Department of Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bingjie Fan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qifeng Sun
- Department of Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jianxing Chen
- Department of Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Song
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenzhe Yin
- Department of Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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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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Safaei S, Azimi P, Yazdanian T, Molanaei S. Primary lymphoma of the lumbar vertebrae: a case report and review of the literature. J Med Case Rep 2023; 17:45. [PMID: 36774514 PMCID: PMC9922445 DOI: 10.1186/s13256-022-03725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Primary lymphoma of the spinal vertebrae (PLSV) is an exceedingly rare disease with an unclear optimal treatment plan. We analyzed the clinical features of PLSV in the patient to strengthen our understanding of the disease and to review the literature. CASE PRESENTATION A 65-year-old Persian man was admitted to our hospital with severe low back pain. The patient underwent radiological examinations including computed tomography (CT) scan, magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT). These examinations revealed a lesion in the L3 vertebra. Histological analysis showed a high-grade lymphoma. The patient underwent an L3 corpectomy with expandable cage placement, followed by an L2-L4 lateral screw placement with rod fixation. Also, facetectomy, laminectomy, and total spondylectomy were performed. Pedicle screws were inserted from L1 to L5. Titanium mesh was placed on the post-laminectomy defect. The treatment continued with local radiotherapy and chemotherapy. Post-treatment, the patient showed no new neurological deficit, and in the final follow-up, the patient had achieved a good recovery. CONCLUSION To our knowledge, no prior published literature has revealed a primary lymphoma of the lumbar vertebrae. Here, we report this case of PLSV for the first time and provide a brief review of the literature.
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Affiliation(s)
- Saeid Safaei
- Knee and Sport Medicine Research Center, Milad General Hospital, Tehran, Iran
| | - Parisa Azimi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, 19839-63113, Tehran, Iran.
| | - Taravat Yazdanian
- grid.24696.3f0000 0004 0369 153XSchool of Medicine, Capital Medical University, Beijing, China
| | - Saadat Molanaei
- Department of Pathology, Milad General Hospital, Tehran, Iran
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Wu Z, Teng Y, Wu J, Zhang H, Peng W, Meng C, Tang W, Feng J. Clinical use of HD-MTX monotherapy in a rare case of refractory primary bone diffuse large B-cell lymphoma with long-term survival after local radiotherapy: A case report. Front Med (Lausanne) 2022; 9:989590. [PMID: 36619626 PMCID: PMC9810803 DOI: 10.3389/fmed.2022.989590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) has been rarely reported because of its low incidence. The optimal treatment plan for patients with relapsed/refractory PB-DLBCL remains controversial. In this study, we present a case of a 57-year-old patient with refractory PB-DLBCL to better understand this disease. The patient developed lumbosacral/low extremity pain. A lumbar magnetic resonance imaging (MRI) revealed skeletal lesions with osteolysis in L4-L5 and S1. With the failure of multi-line chemotherapy, the patient developed paralysis of both lower limbs. 18-Fluorinefluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and MRI showed new lesions in the femoral head, cervical and thoracic vertebrae. We tried to treat the patient with adjuvant radiotherapy and 10 courses of high-dose methotrexate (HD-MTX)-based monotherapy, after which the patient was able to walk and achieved complete remission (CR). To the best of our knowledge, this is the first attempt to use local radiotherapy combined with an HD-MTX regimen successfully for the treatment of refractory PB-DLBCL.
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Affiliation(s)
- Zhiya Wu
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Teng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jianqiu Wu
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Honglu Zhang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Weiwei Peng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Meng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Weiyan Tang
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Weiyan Tang,
| | - Jifeng Feng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,Jifeng Feng,
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7
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Yang XY, He X, Zhao Y. Nomogram-Based Prediction of Overall and Cancer-Specific Survival in Patients with Primary Bone Diffuse Large B-Cell Lymphoma: A Population-Based Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1566441. [PMID: 35571733 PMCID: PMC9098304 DOI: 10.1155/2022/1566441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 01/13/2023]
Abstract
Background Primary bone diffuse large B-cell lymphoma (PD-DLBCL) accounts for more than 80% of primary bone lymphoma. We created two nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in patients with PD-DLBCL for this rare disease. Methods In total, 891 patients diagnosed with PB-DLBCL between 2007 and 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox analyses were performed to explore independent prognostic factors and create nomograms for OS and CSS. The area under the curve (AUC), the calibration curve, decision curve analysis (DCA), and Kaplan-Meier (K-M) curve analysis were used to evaluate the nomograms. Results Four variables were identified as independent prognostic factors for OS, and three variables were identified as independent prognostic factors for CSS. The receiver operating characteristic (ROC) curves demonstrated the strong discriminatory power of the nomograms. The calibration and DCA curves showed that the nomograms had a satisfactory ability to predict OS and CSS. The K-M curves showed that age, gender, primary site, chemotherapy, and tumor stage affected patient survival. Conclusions In patients with PD-DLBCL, age, race, primary site, and chemotherapy affected OS, while age, race, and chemotherapy affected CSS. The two nomograms created based on the aforementioned variables provided more accurate individual survival predictions for PD-DLBCL patients and can help physicians make appropriate clinical decisions.
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Affiliation(s)
- Xing-yao Yang
- Department of Orthopaedics, The Fifth People's Hospital of Chengdu, Sichuan 611130, China
| | - Xin He
- Department of Orthopaedics, The Fifth People's Hospital of Chengdu, Sichuan 611130, China
| | - Yun Zhao
- Department of Orthopaedics, The Fifth People's Hospital of Chengdu, Sichuan 611130, China
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8
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Ayesh Haj Yousef MH, Audat Z, Al-Shorafat DM, Al-Khatib S, Daoud AK. Primary Diffuse Large B Cell Lymphoma of Bone: A Single-Center Experience. J Blood Med 2022; 13:143-149. [PMID: 35330698 PMCID: PMC8939860 DOI: 10.2147/jbm.s350655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Primary diffuse large B-cell lymphoma of the bone (PB-DLBCL) is a rare type of extra-nodal lymphoma. This study aimed to examine the clinical characteristics, outcomes, treatment modalities and risk of central nervous system relapse (CNSR) among adult Jordanian patients with PB-DLBCL. Methods This retrospective study included patients aged >16 years who were diagnosed with PB-DLBCL and treated at our hospital between 2002 and 2021. Clinical characteristics, treatment modalities, outcomes and CNSR events were extracted from the hospital’s data system and analysed. Patients were categorised into unifocal (UF) and multifocal (MF) PB-DLBCL groups according to the number of bone sites involved. The involvement of only one site was defined as UF, whereas the involvement of two or more sites was defined as MF. Results In total, 12 patients were diagnosed with PB-DLBCL. Their median age was 47.5 years (range, 17–80 years). The male:female ratio was 1:1. There were eight patients in the UF PB-DLBCL group and four in the MF PB-DLBCL group. All patients received treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. In the UF PB-DLBCL group, the male:female ratio was 5:3, the median age was 41 years, and the follow-up duration was 9–135 (mean, 83.3) months. In the MF PB-DLBCL group, the male:female ratio was 1:3, the median age was 51.5 years, and the survival time was 3–11 (mean, 7) months. Three patients with vertebral UF PB-DLBCL underwent early vertebroplasty without complications. The most common site involved was the vertebral column. Most patients with UF PB-DLBCL achieved complete remission (CR), whereas no patients with MF PB-DLBCL achieved CR. Conclusion PB-DLBCL is rare in adult Jordanian patients. UF PB-DLBCL is more common than MF PB-DLBCL. Patients with UF PB-DLBCL had a good prognosis. Patients with MF PB-DLBCL had a high international prognostic index score, risk of CNSR and short survival time.
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Affiliation(s)
- Mahmoud H Ayesh Haj Yousef
- Department of Internal Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
- Correspondence: Mahmoud H Ayesh Haj Yousef, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Email
| | - Ziad Audat
- Department of Special Surgery, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Duha M Al-Shorafat
- Department of Neurology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Al-Khatib
- Department of Pathology and Microbiology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Ammar K Daoud
- Department of Internal Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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9
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de Groen RA, van Eijk R, Böhringer S, van Wezel T, Raghoo R, Ruano D, Jansen PM, Briaire-de Bruijn I, de Groot FA, Kleiverda K, te Boome L, Terpstra V, Levenga H, Nicolae A, Posthuma EF, Focke-Snieders I, Hardi L, den Hartog WC, Bohmer LH, Hogendoorn PC, van den Berg A, Diepstra A, Nijland M, Lugtenburg PJ, Kersten MJ, Pals ST, Veelken H, Bovée JV, Cleven AH, Vermaat JS. Frequent mutated B2M, EZH2, IRF8, and TNFRSF14 in primary bone diffuse large B-cell lymphoma reflect a GCB phenotype. Blood Adv 2021; 5:3760-3775. [PMID: 34478526 PMCID: PMC8679674 DOI: 10.1182/bloodadvances.2021005215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Abstract
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare extranodal lymphoma subtype. This retrospective study elucidates the currently unknown genetic background of a large clinically well-annotated cohort of DLBCL with osseous localizations (O-DLBCL), including PB-DLBCL. A total of 103 patients with O-DLBCL were included and compared with 63 (extra)nodal non-osseous (NO)-DLBCLs with germinal center B-cell phenotype (NO-DLBCL-GCB). Cell-of-origin was determined by immunohistochemistry and gene-expression profiling (GEP) using (extended)-NanoString/Lymph2Cx analysis. Mutational profiles were identified with targeted next-generation deep sequencing, including 52 B-cell lymphoma-relevant genes. O-DLBCLs, including 34 PB-DLBCLs, were predominantly classified as GCB phenotype based on immunohistochemistry (74%) and NanoString analysis (88%). Unsupervised hierarchical clustering of an extended-NanoString/Lymph2Cx revealed significantly different GEP clusters for PB-DLBCL as opposed to NO-DLBCL-GCB (P < .001). Expression levels of 23 genes of 2 different targeted GEP panels indicated a centrocyte-like phenotype for PB-DLBCL, whereas NO-DLBCL-GCB exhibited a centroblast-like constitution. PB-DLBCL had significantly more frequent mutations in four GCB-associated genes (ie, B2M, EZH2, IRF8, TNFRSF14) compared with NO-DLBCL-GCB (P = .031, P = .010, P = .047, and P = .003, respectively). PB-DLBCL, with its corresponding specific mutational profile, was significantly associated with a superior survival compared with equivalent Ann Arbor limited-stage I/II NO-DLBCL-GCB (P = .016). This study is the first to show that PB-DLBCL is characterized by a GCB phenotype, with a centrocyte-like GEP pattern and a GCB-associated mutational profile (both involved in immune surveillance) and a favorable prognosis. These novel biology-associated features provide evidence that PB-DLBCL represents a distinct extranodal DLBCL entity, and its specific mutational landscape offers potential for targeted therapies (eg, EZH2 inhibitors).
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Affiliation(s)
| | | | | | | | - Richard Raghoo
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | - Valeska Terpstra
- Department of Pathology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Alina Nicolae
- Department of Pathology, Groene Hart Hospital, Gouda, The Netherlands
| | | | | | | | | | - Lara H. Bohmer
- Department of Hematology, Haga Hospital, The Hague, The Netherlands
| | | | | | | | - Marcel Nijland
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Marie José Kersten
- Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands; and
| | - Steven T. Pals
- Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands; and
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
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10
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Mofidi A, Esfandbod M, Pendar E, Mortezazadeh M, Hadizadeh A. Primary diffuse large B-cell lymphoma of the bone mimicking osteomyelitis. Clin Case Rep 2021; 9:e04724. [PMID: 34484760 PMCID: PMC8405425 DOI: 10.1002/ccr3.4724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022] Open
Abstract
Consider primary bone lymphoma as an important differential diagnosis of osteomyelitis.In patients who are unresponsive to antibiotics and core needle biopsy result is incoherent with clinical symptoms, consider open biopsy for accurate diagnosis.
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Affiliation(s)
- Abbas Mofidi
- School of MedicineIran university of Medical SciencesTehranIran
| | - Mohsen Esfandbod
- Hematology‐Oncology DepartmentSina HospitalTehran University of Medical SciencesTehranIran
| | - Ehsan Pendar
- Orthopedic Surgery DepartmentSina HospitalTehran University of Medical sciencesTehranIran
| | - Masoud Mortezazadeh
- Internal Medicine DepartmentSina HospitalTehran University of Medical SciencesTehranIran
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11
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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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Müller A, Dreyling M, Roeder F, Baur-Melnyk A, Knösel T, Klein A, Birkenmaier C, Jansson V, Dürr HR. Primary bone lymphoma: Clinical presentation and therapeutic considerations. J Bone Oncol 2020; 25:100326. [PMID: 33083218 PMCID: PMC7554647 DOI: 10.1016/j.jbo.2020.100326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
Primary lymphoma of bone is a rare entity with unspecific symptoms. Typical radiology is a large soft-tissue tumor around non-destructed bone. Treatment is based on systemic chemotherapy. Chemotherapy seems to produce a better outcome than radiotherapy alone. Positiv factors: age<60 y, solitary lesion, low LDH, favourable ECOG and IPI scores.
Background Primary lymphoma of bone (PBL) is a rare entity. Due to unspecific clinical signs and equivocal radiographs diagnosis may be delayed. This retrospective report of 109 PBL cases demonstrates typical aspects of the lesion. Treatment and prognostic factors are evaluated. Methods Retrospectively patient records were reviewed. All patients were followed for evidence of local or distant recurrence. Overall survival (OS) was used as clinical outcome. Results The median age of the 109 patients was 62.8 years. The most common symptoms were pain (76%), swelling (29%), neurologic symptoms and pathological fracture (16% each). Mean duration of symptoms was 8 months (0–197 months). 19% of patients had indolent NHL subtypes, 72% aggressive NHL subtypes and 7% cases Hodgkin disease. Cyclophosphamid, doxorubicin, vincristine and prednisone (CHOP) or CHOP plus rituximab (RCHOP) were given in 88 (81%) of patients. Radiotherapy was delivered in 67 (61%) of cases. 51 (47%) patients received both. Surgical interventions were restricted to cases with complications as fractures. The 5-year OS was 66%. The 5-year OS was 66%. In the subgroup of 78 patients with aggressive NHL subtype there was a highly significant benefit for chemotherapy or chemotherapy and radiation in comparison to no treatment or radiation alone. Raised LDH, age, IPI and ECOG performance were prognostic factors. In multivariate analysis, age and raised LDH levels only kept significance. Conclusions In our series of primary bone lymphoma, chemotherapy resulted in a better outcome than Radiotherapy alone. Long-term survival is based on the stage of the disease, favoring younger (<60 years) patients with solitary bone lesions, low level of LDH and favourable ECOG performance status and IPI scores.
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Affiliation(s)
- Annika Müller
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Falk Roeder
- Department of Radiation Oncology, Paracelsus Medizinische Privatuniversität, Landeskrankenhaus, Salzburg, Austria.,CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Thomas Knösel
- Institute of Institute of Pathology, University Hospital, LMU Munich, Germany
| | - Alexander Klein
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Christof Birkenmaier
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Volkmar Jansson
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Hans Roland Dürr
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
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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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Affiliation(s)
- Neus Muñoz
- Departamento de Medicina Interna, Corporació Sanitaria Hospital ParcTaulí, Sabadell, Barcelona, España.
| | - Àngel Rivero Calaf
- Departamento de Medicina Interna, Corporació Sanitaria Hospital ParcTaulí, Sabadell, Barcelona, España
| | - Bárbara González Ávila
- Departamento de Geriatría, Corporació Sanitaria Hospital ParcTaulí, Sabadell, Barcelona, España
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Primary Bone Marrow B-Cell Lymphoma Undetected by Multiple Imaging Modalities That Initially Presented with Hypercalcemia. Case Rep Endocrinol 2018; 2018:7676580. [PMID: 30147967 PMCID: PMC6083738 DOI: 10.1155/2018/7676580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose We report a rare case of severe hypercalcemia that was ultimately diagnosed as primary bone marrow diffuse large B-cell lymphoma (BCL). Case Report A 74-year-old male patient visited our hospital complaining of tenderness and swelling of the left knee caused by supracondylar fracture of the left distal femur. His initial blood tests showed a serum calcium level of 13.9 mg/dL, inorganic phosphorus of 4.34 mg/dL, and a serum creatinine level of 1.54 mg/dL. A serum assay of intact parathyroid hormone showed 5.24 pg/mL, and the patient's serum 25(OH)D level was 22.33 ng/mL. To exclude malignancy, we performed imaging studies, including abdomen or chest computed tomography and positron emission tomography-computed tomography; however, no suspicious lesion was found, although the serum PTH-related peptide level was elevated at 4.0 pmol/L. A bone marrow biopsy was performed to identify any hidden hematologic malignancy. As a result, the pathology of bone marrow confirmed the presence of atypical lymphocytes that stained positive for the CD20 marker, which is consistent with BCL involving the bone marrow. Conclusion This case highlights the importance of pursuing a thorough workup for rare underlying causes of hypercalcemia when parathyroid-related etiologies can be excluded.
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Hu JY, Yu D, Wu YH. Primary non-Hodgkin lymphoma of the right femur and subsequent metastasis to the left femur: A case report and literature review. Oncol Lett 2018. [PMID: 29541210 DOI: 10.3892/ol.2018.7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Non-Hodgkin lymphoma of the bone is rare and typically causes an extensive bone lesion. The present study describes a case of diffuse large B-cell primary non-Hodgkin lymphoma of the bone, which occurred in the right femur, and was initially treated with surgery and chemotherapy. Following a 7-year period of complete remission, a new, similar lesion was identified in the left femur. With both lesions, there was no accompanying destruction of any other bones or organ involvement. Metastasis of PLB to the contralateral side is extremely rare and, to the best of our knowledge, this is the first report of this particular presentation in China or worldwide. We hypothesized that the present situation arose due to mechanisms involving the tumor microenvironment, circulating tumor cells, lymphocyte homing and self-seeding. The present report describes the case in detail, and discusses the possible underlying mechanisms and their potential contribution to the treatment of non-Hodgkin lymphoma, as well as the prevention of metastasis and recurrence, which may be of considerable clinical significance.
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Affiliation(s)
- Jing-Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Dan Yu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China.,Department of Hematology, Wuhan First Hospital, Wuhan, Hubei 430030, P.R. China
| | - Yao-Hui Wu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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