Clinical and Survival Outcomes in Patients with Supra-Diaphragmatic Vs İnfra-Diaphragmatic Diffuse Large B Cell Lymphoma

Öz

Limited-stage diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30% of all DLBCL cases. This study aimed to investigate the impact of the lymphoma involvement side relative to the diaphragm on clinical and survival outcomes in patients with limited-stage DLBCL treated with first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Data from 93 patients with limited-stage DLBCL between 2010 and 2019 receiving R-CHOP were retrospectively analyzed. Patients were divided into two subgroups according to the side of the diaphragm: 29 patients with infradiaphragmatic (InD) and 64 patients with supradiaphragmatic (SpD). There were no significant differences in survival outcomes [5-year PFS rate of SpD and InD groups, 76.7% and 85.7%, respectively (P =0.553); 5-year OS rates of SpD and InD groups, 82.1% and 89.1%, respectively (P = 0,524)] and clinical characteristics, except that extra nodal involvement was dominant in the InD group and the SpD group had a higher IPI. In conclusion, in early-stage DLBCL, extra nodal involvement is expected more if the primary involvement area is below the diaphragm, however whether the primary involvement area is below or above the diaphragm has no effect on survival outcomes. The results of this study need to be confirmed by further studies with a larger case group.

Anahtar Kelimeler

• Infradiaphragmatic
• supradiaphragmatic
• diffuse large B-cell lymphoma
• prognosis.

Supra-Diyafragmatik ve İnfra-Diyafragmatik Diffüz Büyük B Hücreli Lenfoma Hastalarında Klinik ve Sağkalım Sonuçları

Öz

Erken evre diffüz büyük B hücreli lenfoma (DBBHL), tüm DBBHL olgularının yaklaşık %30'unu oluşturur. Bu çalışma, birinci basamak rituksimab, siklofosfamid, doksorubisin, vinkristin ve prednizon (R-CHOP) ile tedavi edilen erken evre DBBHL tanılı hastalarda diyaframa göre lenfoma tutulum tarafının klinik ve sağkalım sonuçları üzerine etkisini araştırmayı amaçladı. 2010 ve 2019 yılları arasında R-CHOP alan erken evreli 93 DBBHL tanılı hastadan veriler geriye dönük olarak analiz edildi. Hastalar diyafram tarafına göre iki alt gruba ayrıldı: 29 infradiyafragmatik (InD) ve 64 supradiyafragmatik (SpD) hasta. Sağkalım sonuçlarında anlamlı bir fark yoktu [SpD ve InD gruplarının 5 yıllık PFS oranı, sırasıyla %76.7 ve %85.7 (P =0.553); SpD ve InD gruplarının 5 yıllık OS oranları, sırasıyla %82.1 ve %89,1 (P = 0,524)]. Ayrıca, klinik özellikler açısından InD grupta ekstra nodal tutulumun baskın olması ve SpD grupta daha yüksek IPI mevcut olması dışında anlamlı farklılık yoktu. Sonuç olarak, erken evre DBBHL'de, tutulum alanı diyaframın altındaysa ekstra nodal tutulum daha fazla beklenir, ancak tutulum alanının diyaframın altında veya üstünde olmasının sağkalım sonuçları üzerine etkisi yoktur. Bu sonuçlarının daha geniş bir hasta grubuyla yapılacak yeni çalışmalarla doğrulanması gerekmektedir.

Anahtar Kelimeler

• İnfradiyafragmatik
• supradiyafragmatik
• diffüz büyük B hücreli lenfoma
• prognoz.

Kaynakça

1. 1. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of hodgkin and non-hodgkin lymphoma: The lugano classification. J Clin Oncol. 2014;32(27):3059-3067.
2. 2. Darabi K, Sieber M, Chaitowitz M, et al. Infradiaphragmatic versus supradiaphragmatic Hodgkin lymphoma : a retrospective review of 1114 patients. Leuk Lymphoma. 2005;46(12):1715-1720.
3. 3. Sasse S, Goergen H, Pl A, et al. Outcome of Patients With Early-Stage Infradiaphragmatic Hodgkin Lymphoma : A Comprehensive Analysis From the German Hodgkin Study Group. J Clin Oncol. 2018;36(25):2603-2611.
4. 4. Km K, Enblad G, Gustavsson A, et al. Infradiaphragmatic Hodgkin ’ s disease : the Swedish National Care Programme. Eur J Haematol. 1997;59(1):31-37.
5. 5. Hui D, Proctor B, Donaldson J, et al. Prognostic implications of extranodal involvement in patients with diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide , doxorubicin , vincristine , and prednisone. Leuk Lymphoma. 2010;51(9):1658-1667.
6. 6. Hospital G, Clinic H, Cancer T, et al. Pure infradiaphragmatic Hodgkin’s lymphoma. Clinical features, prognostic factors and comparison with supradiaphragmatic disease. Haematologica. 2006;91:32-39.
7. 7. Nakajima Y, Tomita N, Itabashi M, et al. Analysis of outcomes in patients with supra-diaphragmatic vs infra-diaphragmatic diffuse large B cell lymphoma treated with R-CHOP therapy. Leuk Res. 2015;39(2):198-203.
8. 8. Network NCC.National Comprehensive Cancer Network (NCCN) Guidelines B-Cell Lymphoma. 2021 May 21 2021 [cited; Available from: https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf. B-Cell Lymphomas. Published online 2020.

9. 9. Hans CP, Weisenburger DD, Greiner TC, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004;103(1):275-282.
10. 10. Abdulla M, Guglielmo P, Hollander P, Ahlström H, Enblad G. Prognostic impact of abdominal lymph node involvement in diffuse large B-cell lymphoma. Eur J Haematol. 2020;104(3):207-213.
11. 11. Castillo JJ, Winer ES, Olszewski AJ. Sites of extranodal involvement are prognostic in patients with diffuse large B-cell lymphoma in the rituximab era: An analysis of the Surveillance, Epidemiology and End Results database. Am J Hematol. 2014;89(3):310-314.
12. 12. Armando Lo´pez-Guillermo, Luis Colomo, Mo´nica Jiménez, Francesc Bosch, Neus Villamor, Leonor Arenillas, Ana Muntan˜ola, Silvia Montoto, Eva Giné, Dolors Colomer, Silvia Beà EC. Diffuse Large B-Cell Lymphoma : Clinical and Biological Characterization and Outcome According to the Nodal or Extranodal Primary Origin. J Clin Oncol. 2005;23(12):2797-2804.
13. 13. Chairman PPC, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the Committee on Hodgkin ’ s Disease Staging Classification. Cancer Res . 1971;31(11):1860-1861.