1
|
Davis O, Lessani C, Kasht R, Cohoon A, Ibrahimi S, Asch A, Day S, Al-Juhaishi T. Impact of Primary Disease Site of Involvement by Early-Stage Follicular Lymphoma on Patient Outcomes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00269-6. [PMID: 39147647 DOI: 10.1016/j.clml.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Follicular lymphoma is a common non-Hodgkin lymphoma that can start in a diverse array of tissues throughout the body. While the majority of patients may be able to live many years with this disease, cure remains very difficult to achieve. OBJECTIVE We sought to investigate the impact of follicular lymphoma primary disease site in early-stage disease on patient outcomes using a large national database. METHODS Baseline demographic and disease data for patients diagnosed with follicular lymphoma from 2000-2015 was identified and extracted from the NCI Surveillance, Epidemiology, and End Results (SEER) database. Primary disease sites were grouped into one of two cohorts: nodal disease (lymph nodes and spleen) and extranodal disease (everything else). Analysis was performed using summary statistics, Kaplan-Meier method, and Cox-proportional hazards models for univariate and multivariate analysis. RESULTS A total of 13,400 patients were included in the final analysis and the majority were non-Hispanic white (81%), with stage I (63%), and nodal FL (79%). Median overall survival for nodal disease was 15.1 years [95% CI (14.6-15.6)] while median overall survival for extranodal disease was 15.8 years [95% CI (14.9-16.3)]. Overall survival was slightly better for patients with extranodal disease [HR = 0.89, 95% CI (0.84-0.96); p-value = 0.00012]. This finding remained consistent after controlling for age and race [HR = 0.84, 95% CI (0.79-0.90); p-value <0.0001]. CONCLUSIONS The primary site of involvement by early-stage follicular lymphoma may have an impact on patient outcomes and warrants further investigation.
Collapse
Affiliation(s)
- Olivia Davis
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Carmen Lessani
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rana Kasht
- Department of Internal Medicine, OU Health, Oklahoma City, OK
| | - Andrew Cohoon
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sami Ibrahimi
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK
| | - Adam Asch
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK
| | - Silas Day
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK
| | - Taha Al-Juhaishi
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK.
| |
Collapse
|
2
|
Naik KY, Bustamante D, Kaleem A, Brockhoff HC. A rapidly growing nasal mass. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00374-2. [PMID: 39191635 DOI: 10.1016/j.oooo.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 08/29/2024]
Affiliation(s)
- Keyur Y Naik
- Head and Neck Oncologic and Microvascular Reconstructive Surgery, High Desert Oral and Facial Surgery, El Paso, Texas.
| | - Daniel Bustamante
- El Paso Children's Hospital, Division of Anatomic and Clinical Pathology, Pediatric Pathology and Hematopathology, El Paso, Texas
| | - Arshad Kaleem
- El Paso Head and Neck and Oncologic and Microvascular Reconstructive, Texas Tech University Health Sciences Center of El Paso, El Paso, Texas
| | - Hans C Brockhoff
- El Paso Head and Neck and Oncologic and Microvascular Reconstructive, Texas Tech University Health Sciences Center of El Paso, El Paso, Texas
| |
Collapse
|
3
|
Khan SR, Muhammad A, Soomar SM, Shoaib D, Arshad Ali A, Muhammad T, Zahir MN, Abdul Jabbar A, Abdul Rashid Y, Heger M, Moosajee MS. No difference in treatment outcome between patients with nodal versus extranodal diffuse large B-cell lymphoma. J Clin Transl Res 2022; 9:37-49. [PMID: 36687299 PMCID: PMC9844226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/24/2022] [Accepted: 11/23/2022] [Indexed: 01/24/2023] Open
Abstract
Background and Aim Diffuse large B-cell lymphoma (DLBCL) has been classified using various parameters, including the site of origin. Studies have reported conflicting outcomes when DLBLC patients were stratified according to the site of origin. This study aimed to investigate the response rate and survival outcomes in nodal versus extranodal DLBCL and compare the results to a region-matched study covering the 1988 - 2005 period. Methods A single-center retrospective cohort study was conducted on all patients diagnosed with DLBCL and treated in a tertiary care hospital in Pakistan during 2014 - 2019. We calculated the mean and median for continuous variables and frequency and percentages for all categorical variables. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves. A Cox proportional hazards model was used to determine the hazard ratio (HR) for OS. Results Of the 118 patients, 49 patients (41.5%) had nodal disease and 69 patients (58.5%) were diagnosed with extranodal DLBCL. The majority of patients in the nodal and extranodal cohorts presented with Stages III and IV disease (73.4% and 62.3%, respectively). A complete response to (immuno) chemotherapy was achieved in 71.4% of nodal DLBCL patients and 65.2% of extranodal DLBCL patients. The 5-year PFS and median PFS in the entire cohort were 0.8% and 17 m, respectively. The PFS and median PFS in the nodal and extranodal DLBCL cohort were 0% and 1.4%, respectively, and 15 m and 19 m, respectively. The 5-year OS and median OS in the entire cohort were 16.1% and 19 m, respectively. The OS and median OS in the nodal and extranodal DLBCL cohort were 8.2% and 21.7%, respectively, and 19 m and 21 m, respectively. Multivariable linear regression revealed that the ABC phenotype (nodal, HR = 1.37, 95% CI = 1.37 - 3.20; extranodal, HR = 1.65, 95% CI = 1.46 - 3.17; GBC as reference) and double and triple hit DLBCL (nodal, HR = 1.29, 95% CI = 1.19 - 2.81; extranodal, HR = 1.87, 95% CI = 1.28 - 2.43; and non-expressors as reference) are independent negative predictors of OS. Conclusions DLBCL incidence in the Karachi region has remained comparable but patient composition in the extranodal DLBCL cohort has shifted to predominantly advanced stage. Nodal and extranodal DLBCL were associated with similar PFS and OS profiles and first- and second-line treatment responses. Cell of origin and antigen expression status was independent negative predictors of OS, disfavoring the ABC phenotype and lesions with c-MYC and BCL2 and/or BCL6 overexpression. Relevance for Patients DLBCL is an aggressive type of non-Hodgkin's lymphoma, however; patients respond well to standard systemic chemotherapy. Extranodal type of DLBCL patients tend to have more residual disease after first-line systemic chemotherapy, but physicians should keep in mind that the subsequent line treatment mitigates its negative impact on survival.
Collapse
Affiliation(s)
- Saqib Raza Khan
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan,Corresponding author: Saqib Raza Khan Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | - Afzal Muhammad
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Daania Shoaib
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Adnan Abdul Jabbar
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Michal Heger
- 4Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, P. R. China,5Laboratory Experimental Oncology, Department of Pathology, Erasmus MC, Rotterdam, the Netherlands,6Membrane Biochemistry and Biophysics, Department of Chemistry, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | | |
Collapse
|
4
|
Khan QA, Mumtaz A, Baqi A, Ain HU, Mahfooz RS, Asim N, Iram S, Hussien Mohamed Ahmed KA, Tahir MJ, Yousaf Z. Non-Hodgkin's lymphoma masquerading as splenic abscess: A case report. Ann Med Surg (Lond) 2022; 81:104449. [PMID: 36147111 PMCID: PMC9486706 DOI: 10.1016/j.amsu.2022.104449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background Non-Hodgkin's lymphoma (NHL) is a monoclonal proliferation of lymphoid cells from B lineage. Although NHLs are primarily hematological tumors of lymph nodes but rarely can involve extranodal sites such as the spleen. Case report A 29-year-old female patient presented with low-grade fever, cough, anemia, weight loss, tender left hypochondrium, and splenomegaly. A hypodense lesion in the spleen with central necrosis, having strong positivity for common leukocyte antigen (LCA), CD 20, and CD 10, led to a diffuse large B cell lymphoma diagnosis. The patient had an excellent clinical post-splenectomy response to combination chemotherapy and immunotherapy. Conclusion NHL can present with symptomatic extra-nodal involvement without enlarged lymph nodes. Non-Hodgkin's lymphoma (NHL) is a group of malignant lymphoproliferative disorders (LPD) that primarily involve the lymph nodes. NHL is characterized by an irregular proliferation of T or B lymphocytes. Most NHLs are of B-cell origin. NHLs range from indolent malignancies (low-grade histology) to rapidly growing, highly aggressive tumors (high-grade histology). Extra-nodal involvement is common in the spleen, with prevalence being 20%–30%. Here we described a 29-year-old female patient presented with low-grade fever, cough, anemia, weight loss, tender left hypochondrium, and splenomegaly.
Collapse
Affiliation(s)
| | - Arif Mumtaz
- Khyber Medical University, KMU-IMS, Kohat, Pakistan
| | - Abdul Baqi
- Mercy Saint Vincent Medical Center, Toledo, OH, United States
| | - Hoor Ul Ain
- Jinnah Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | - Nowshad Asim
- Khyber Medical University, KMU-IMS, Kohat, Pakistan
| | | | | | | | | |
Collapse
|
5
|
The role of ZNF384, DNAH17, and NDST2 gene expression in non-Hodgkin's lymphoma patients. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
6
|
Mahmood H, Habib M, Aslam W, Khursheed S, Fatima S, Aziz S, Habib M, Faheem M. Clinicopathological spectrum of Diffuse Large B Cell lymphoma: a study targeting population yet unexplored in Pakistan. BMC Res Notes 2021; 14:354. [PMID: 34507605 PMCID: PMC8434720 DOI: 10.1186/s13104-021-05768-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL). The aim of this study was to assess the clinico pathological characteristics of DLBCL specifically, among the affected individuals residing in Northern areas of Pakistan who had not been previously included in major lymphoma studies due to their remote location. Results Mean age of the patients was 49.7 years. Male: female ratio was 1.5:1. Primary site was lymph node in 99 (71.74%) patients, out of which, 36 (26.09%) patients had B symptoms and 19 (13.77%) patients had stage IV disease. 39 (28.26%) patients had primary extra nodal involvement, 4 (2.90%) patients had B symptoms and 3 (2.17%) had stage IV disease. Extra nodal sites involved in primary extra nodal DLBCL were gastrointestinal tract (GIT) 19 (48.72%), tonsils 6 (15.38%), spine 4 (10.26%), soft tissue swelling 3 (7.69%), parotid gland 2 (5.13%), thyroid 2 (5.13%) central nervous system (CNS) 1 (2.56), breast 1 (2.56%) and bone marrow 1 (2.56%). Our study revealed increased percentage of patients with nodal DLBCL in stage IV and with B symptoms. Few patients with primary extra nodal DLBCL had B symptoms and stage IV disease at presentation. GIT was the most common site of involvement in primary extra nodal DLBCL. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05768-5.
Collapse
Affiliation(s)
- H Mahmood
- Clinical Oncology, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - M Habib
- Hematology (Pathology), Shifa College of Medicine (Shifa Tameer-e-Millat University), Islamabad, Pakistan.
| | - W Aslam
- Hematology (Pathology), Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - S Khursheed
- Histopathology (Pathology), Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - S Fatima
- Nuclear Medicine, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - S Aziz
- Pathology, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| | - M Habib
- Restorative Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - M Faheem
- Clinical Oncology, Nuclear Medicine Oncology & Radiotherapy Institute, Islamabad, Pakistan
| |
Collapse
|
7
|
Narang V, Singh A, Sood N, Garg B, Kaur H, Jain K, Grover S. Primary Extranodal Non-Hodgkin Lymphomas: A First Tertiary Care Experience from Punjab, North India. South Asian J Cancer 2021; 9:230-232. [PMID: 34136424 PMCID: PMC8203326 DOI: 10.1055/s-0041-1723073] [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] [Indexed: 12/01/2022] Open
Abstract
Background
Primary extranodal lymphomas are less frequently encountered and difficult to diagnose in routine practice. The histopathological and immunohistochemical studies are essential in addition to clinical details to diagnose. The incidence is varied in different parts of India along with variation in histopathological spectrum.
Methodology
The clinical features and histopathological findings of patients diagnosed with primary extranodal lymphoma over 3-year period were retrieved from archives of pathology department and analyzed.
Results
During the 3-year study period, a total of 135 cases of non-Hodgkin lymphomas were evaluated, and of these, 41.4% (56/135) of cases presented with primary extranodal involvement. The mean age of primary extranodal lymphoma presentation was 61.3 ± 17.5 with M:F ratio of 1:1.1 Most common extranodal site involved was gastrointestinal tract 32.1%, 18/56 (small intestine [17.8%, 10 cases] and large intestine [8.9%, 5 cases]). Non-Hodgkin lymphomas of B cell type were the predominant subtype (48/56, 85.7%), while 8/56 (14.2%) cases were of T cell lineage. Of the B cell non-Hodgkin lymphoma diffuse, large B cell lymphoma was the predominant subtype constituting ~83.3% (40/48).
Conclusion
Primary extranodal lymphomas exhibit varied histomorphological and clinical presentation. The present study is first such analysis from Punjab that intends to compare with studies from other parts of India.
Collapse
Affiliation(s)
- Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Aminder Singh
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bhavna Garg
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kunal Jain
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumit Grover
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
8
|
Singh V, Kumar A, Singh P, Ora M, Gambhir S. Extensive Extranodal Involvement in a case of Non-Hodgkin's Lymphoma with sparing of lymph nodes and lymphatic organs. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2021; 9:39-44. [PMID: 33392348 PMCID: PMC7701225 DOI: 10.22038/aojnmb.2020.47774.1324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a group of malignant lymphoproliferative disorders arising predominantly in the lymph nodes with various clinical and histological characteristics. At least 25% of NHL originates from tissues other than lymph nodes and sometimes even from sites that do not contain lymphoid tissue. These are referred to as primary extranodal lymphomas (pENLs). pENL is a universal diagnostic challenge to the clinicians and pathologists due to their varied clinical presentations, morphological mimicry, and molecular alterations. The GIT is the most common site of pENL followed by nasopharynx/oropharynx, testis, uterus/ovary, thyroid, and central nervous system. Long bones (tibia), maxillary sinus, skin, and paraspinal soft tissues are the other rare anatomic sites of pENL. We reported a case of a 60-year-old female presented with pain and mass in the pelvis region. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and fused PET/CT was done, which revealed extensive extranodal involvement of the lung, bilateral kidneys, uterus, ovaries, bones, and muscles with no involvement of lymph nodes or lymphomatous organs. Extensive extranodal involvement with sparing of lymphomatous organ has not been reported earlier.
Collapse
Affiliation(s)
| | - Akshay Kumar
- Corresponding author: Akshay Kumar. Department of nuclear medicine, SGPGIMS, Lucknow (Uttar Pradesh), India- 226014. Tel: +919968947884
| | | | | | | |
Collapse
|
9
|
Gogia A, Das CK, Kumar L, Sharma A, Tiwari A, Sharma MC, Mallick S. Diffuse large B-cell lymphoma: An institutional analysis. South Asian J Cancer 2020; 7:200-202. [PMID: 30112341 PMCID: PMC6069326 DOI: 10.4103/sajc.sajc_65_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma. We conducted a retrospective study to analyze the clinicopathological characteristics, cell of origin, response to therapy, and the outcome of patients with DLBCL. Materials and Methods: This was a retrospective study which included all patients with DLBCL registered at our center, between May 1, 2013, and July 31, 2015. The data regarding demography, clinical presentation, histopathology, stage, prognostic index, treatment, and treatment-related outcome were collected from prospectively maintained clinical case records of the patients. Results: In the study, we included 267 patients. The median age is 49 (20–81) years with male: female ratio of 2:1. B symptoms were seen in 124 (45%) of patients. Early Stages (I and II) were seen in 130 (52%) patients, while advanced Stages (III and 1V) were seen in 119 (48%) patients. Bulky disease (>7.5 cm) was seen in 30% of cases, and bone marrow was involved in 12%. Extranodal involvement is present in 35% of cases. Cell of origin data was available in 160 (60%) of cases, of which 88 (55%) were germinal center and 72 (45%) were activated B cell in origin. The distribution according to the international prognostic index (IPI) was as follows: low risk 40%, intermediate risk 45%, and high risk in 15%. Rituximab was used in 45% of cases. The overall response rate was 84% with a complete response (CR) rate of 70.5%. The CR rates were better with RCHOP compared with CHOP (77% vs. 61.5%, P = 0.001) and good-risk IPI (83.3% vs. 65.2%, P < 0.001) compared with intermediate- and high-risk IPI. Median follow-up period was 24 months, and 2-year event-free survival (EFS) was 70%. The presence of B symptoms, high IPI, failure to attain CR, poor PS, and nonrituximab-based chemotherapy were significantly associated with lower EFS. Conclusions: This is the first study from India, which investigated the impact of chemotherapy with or without rituximab in context of cell of origin. Adding rituximab to CHOP showed better response rate and EFS irrespective of cell of origin.
Collapse
Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan K Das
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Tiwari
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|