Objective： Extranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma（DLBCL）. Previous studies have suggested that older patients are more prone to extranodal involvement. This study...Objective： Extranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma（DLBCL）. Previous studies have suggested that older patients are more prone to extranodal involvement. This study retrospectively addressed the distribution, prognostic value and treatment options of extranodal involvement in young patients with DLBCL.Methods： A total of 329 patients were enrolled according to the inclusion requirements. The effects of gender,extranodal involvement, age-adjusted international prognostic index（aa IPI）, rituximab infusion and radiotherapy on patient outcomes were evaluated.Results： Among these patients, 59% presented extranodal involvement in 16 anatomic sites. More than one instance was linked to many poorer clinical characteristics and poorer survival compared with either nodal disease or one instance. In patients with one extranodal lesion, multivariate analysis revealed that the site of extranodal involvement, but not the aa IPI or rituximab infusion, was independently related to the outcome, and radiotherapy had a negative influence on survival.Conclusions： Extranodal involvement is common in younger patients and exhibits a ubiquitous distribution.The site of extranodal involvement is of strong prognostic significance. Radiotherapy for extranodal lesions does not improve patient outcomes.展开更多
Objective To explore the efficacy and safety of orelabrutinib combined with R-CHOP in patients with high-risk nongerminal center B-cell(non-GCB)diffuse large B-cell lymphoma(DLBCL)with extranodal involvement.Methods T...Objective To explore the efficacy and safety of orelabrutinib combined with R-CHOP in patients with high-risk nongerminal center B-cell(non-GCB)diffuse large B-cell lymphoma(DLBCL)with extranodal involvement.Methods This retrospectiveestudywas conducted on 35 patients whowereseen at Guangxi Medical University Cancer Hospital and were immunohistochemically confirmed to have non-GCB DLBCL,had an International Prognostic Index score of 3-5,and confirmed to have≥2 extranodal involvement on PET/CT.The treatment comprised the standard RCHOP regimen combined with oral orelabrutinib(150 mg/day)for six cycles.In patients who developed neutropenia or grade 3 neutropenia with fever during treatment,administration of prophylacticpegylated granulocyte colony-stimulating factor 48 h after the end of chemotherapy was started on the next cycle.The endpoints included overall responserate(ORR),complete response(CR)rate,progression-free survival(PFS)time,overall survival(OS)time,and safety assessment.Results The 35 eligible patients enrolled had a median age of 53 years(21-72 years)and a median follow-up time of 28 months(12-36 months);19 patients had double-expressor(DE)status.The ORR was 88.6%,and the CR rate was 68.6%.The 2-year PFS and 0S rates were 68.6%(95%CI 54.0%-7.2%)and 87.5%(95%CI 76.7%-100%),respectively.The 2-year PFS rate was significantly lower in patients with DE status than in those without DE status[54.4%(95%CI35.4%-84.2%)vs.85.2%(95%CI 68.3%-100%),P=0.048].Serious adverse events included febrile neutropenia,pneumonia,and atrial flutterb,ut no treatment-related deaths.Conclusion In patients with high-risk non-GCB DLBCL andextranodal involvement,thecombinationof orelabrutinib with R-CHOP regimen has good efficacy and manageable toxicity.展开更多
A series of imaging features of extranodal, multi-systemic involvements in Non-Hodgkin's lymphoma (NHL) were investigated The clinical data and imaging findings of 16 patients with pathologically proved NHL were...A series of imaging features of extranodal, multi-systemic involvements in Non-Hodgkin's lymphoma (NHL) were investigated The clinical data and imaging findings of 16 patients with pathologically proved NHL were retrospectively analyzed The related literatures were reviewed Of the 16 cases of NHL, skeletal involvement was found in 4, nasal cavity and nasal sinuses were involved in 4, too Lesion in the thorax was seen in 3 patients, hepatic involvement occurred in one case, cerebral ventricle was affected in 3 cases, mesentery was involved in one case Even though extranodal involvement of NHL exhibited extremely variable patterns, there were some relatively typical imaging findings Emphasized in this report were the relatively specific imaging manifestations of different systems, which may mimic infectious or other neoplasms of different sites The importance of imaging studies lies in the availability for diagnosis, staging and follow-up of NHL Combined with the clinical and other related information, the diagnostic accuracy can be further improved, thus, providing reliable evidence in guiding clinical management展开更多
Introduction: The frequency of extranodal involvement in lymphoma is not rare, but variously described by authors in Africa. The objective of our work is to describe the profile of patients followed for lymphoma with ...Introduction: The frequency of extranodal involvement in lymphoma is not rare, but variously described by authors in Africa. The objective of our work is to describe the profile of patients followed for lymphoma with extranodal locations. Methods: We conducted a descriptive, retrospective and analytic study at the clinical hematology department of Dalal Jamm Hospital, from September 2016 to June 2022. We included patients with a diagnosis of lymphoma immunohistochemistry, with extranodal involvement. The epidemiological, diagnostic, prognostic and survival aspects were studied. Results: Fifty-two (52) patients with extranodal localizations of their lymphoma were included. The mean age was 44.2 ± 17.6 years and the sex ratio was 1.2. The average time to diagnostic was 9.4 ± 3.6 months. We found a performance status ≥ 2 in 65.4% and at least one B symptom in 71.2% of cases. The extranodal manifestations were digestive (19%), cutaneous (17.5%), pleuropulmonary (17.5%), bone marrow (4.8%), thyroid (1.6%), parotid gland (1.6%) and breast (1.6%). Patients presented with Hodgkin’s lymphoma (HL) in 19.2% of cases and non-Hodgkin’s lymphoma (NHL) in 80.8% of cases. At the end of the extension checkup reviews, 61.5% were at an advanced stage and prognostic indices were unfavorable in 32% of patients. Conventional chemotherapy was conducted in 63.5% of patients of which 24 had NHL and 9 had HL. Immuno-chemoterapy was used in 26.9% of patients (13 cases of NHL, 1 case of HL). During the follow-up, we noted only 29.7% of complete remission. The median overall survival was 25.1 months [23.5 - 34.1 months] in HL group and 20.5 months [18.7 - 72.2 months] in NHL patients (p = 0.14). Conclusion: Our study shows that extranodal involvements of lymphomas are various, encountered more during NHL. In our practice, diagnosis is generally made at an advanced stage, with poor response to treatment.展开更多
Background Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of aggressive non-Hodgkin's lymphoma with distinct clinical and molecular heterogeneity.DLBCL that arises in extranodal organs is particula...Background Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of aggressive non-Hodgkin's lymphoma with distinct clinical and molecular heterogeneity.DLBCL that arises in extranodal organs is particularly linked to poor prognosis.This study aimed to determine the clinical and molecular characteristics of extranodal involvement(ENI)in DLBCL and assess the actual survival status of the patients.Methods In this population-based cohort study,we investigated the clinical features of 5,023 patients newly diagnosed with DLBCL.Their clinical conditions,eligibility criteria,and sociodemographic details were recorded and analyzed.Gene panel sequencing was performed on 1,050 patients to discern molecular patterns according to ENI.Results The 2-year overall survival(OS)rate was 76.2%[95%confidence interval(CI),74.0%-78.2%],and the 5-year OS rate was 67.9%(95%CI,65.2%-70.4%).The primary treatment was immunochemotherapy with rituximab.Specific lymphoma involvement sites,especially the bones,bone marrow,and central nervous system,were identified as independent adverse prognostic factors.A high prevalence of non-germinal center B-cell(non-GCB)phenotype and myeloid differentiation primary response 88(MYD88)/CD79B mutations were noted in lymphomas affecting the breasts,skin,uterus,and immune-privileged sites.Conversely,the thyroid and gastrointestinal tract showed a low occurrence of non-GCB phenotype.Remarkably,patients with multiple ENIs exhibited a high frequency of MYD88,tet methylcytosine dioxygenase 2(TET2),CREB binding protein(CREBBP)mutations,increased MYD88L265P and CD79B mutation(MCD)-like subtypes,and poor prognosis.Genetic subtype-guided immunochemotherapy showed good efficacy in subgroup analyses after propensity score matching with 5-year OS and progression-free survival rates of 85.0%(95%CI,80.6%-89.5%)and 72.1%(95%CI,67.3%-76.7%).Conclusions In the rituximab era,this large-scale retrospective analysis from Asia confirmed the poor prognosis of DLBCL with multiple ENIs and underscored the efficacy of genetic subtype-guided immunochemotherapy in treating extranodal DLBCL.展开更多
基金supported by the National Nature Science Foundation of China (No. 81071938, 81470365)
文摘Objective： Extranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma（DLBCL）. Previous studies have suggested that older patients are more prone to extranodal involvement. This study retrospectively addressed the distribution, prognostic value and treatment options of extranodal involvement in young patients with DLBCL.Methods： A total of 329 patients were enrolled according to the inclusion requirements. The effects of gender,extranodal involvement, age-adjusted international prognostic index（aa IPI）, rituximab infusion and radiotherapy on patient outcomes were evaluated.Results： Among these patients, 59% presented extranodal involvement in 16 anatomic sites. More than one instance was linked to many poorer clinical characteristics and poorer survival compared with either nodal disease or one instance. In patients with one extranodal lesion, multivariate analysis revealed that the site of extranodal involvement, but not the aa IPI or rituximab infusion, was independently related to the outcome, and radiotherapy had a negative influence on survival.Conclusions： Extranodal involvement is common in younger patients and exhibits a ubiquitous distribution.The site of extranodal involvement is of strong prognostic significance. Radiotherapy for extranodal lesions does not improve patient outcomes.
文摘Objective To explore the efficacy and safety of orelabrutinib combined with R-CHOP in patients with high-risk nongerminal center B-cell(non-GCB)diffuse large B-cell lymphoma(DLBCL)with extranodal involvement.Methods This retrospectiveestudywas conducted on 35 patients whowereseen at Guangxi Medical University Cancer Hospital and were immunohistochemically confirmed to have non-GCB DLBCL,had an International Prognostic Index score of 3-5,and confirmed to have≥2 extranodal involvement on PET/CT.The treatment comprised the standard RCHOP regimen combined with oral orelabrutinib(150 mg/day)for six cycles.In patients who developed neutropenia or grade 3 neutropenia with fever during treatment,administration of prophylacticpegylated granulocyte colony-stimulating factor 48 h after the end of chemotherapy was started on the next cycle.The endpoints included overall responserate(ORR),complete response(CR)rate,progression-free survival(PFS)time,overall survival(OS)time,and safety assessment.Results The 35 eligible patients enrolled had a median age of 53 years(21-72 years)and a median follow-up time of 28 months(12-36 months);19 patients had double-expressor(DE)status.The ORR was 88.6%,and the CR rate was 68.6%.The 2-year PFS and 0S rates were 68.6%(95%CI 54.0%-7.2%)and 87.5%(95%CI 76.7%-100%),respectively.The 2-year PFS rate was significantly lower in patients with DE status than in those without DE status[54.4%(95%CI35.4%-84.2%)vs.85.2%(95%CI 68.3%-100%),P=0.048].Serious adverse events included febrile neutropenia,pneumonia,and atrial flutterb,ut no treatment-related deaths.Conclusion In patients with high-risk non-GCB DLBCL andextranodal involvement,thecombinationof orelabrutinib with R-CHOP regimen has good efficacy and manageable toxicity.
文摘A series of imaging features of extranodal, multi-systemic involvements in Non-Hodgkin's lymphoma (NHL) were investigated The clinical data and imaging findings of 16 patients with pathologically proved NHL were retrospectively analyzed The related literatures were reviewed Of the 16 cases of NHL, skeletal involvement was found in 4, nasal cavity and nasal sinuses were involved in 4, too Lesion in the thorax was seen in 3 patients, hepatic involvement occurred in one case, cerebral ventricle was affected in 3 cases, mesentery was involved in one case Even though extranodal involvement of NHL exhibited extremely variable patterns, there were some relatively typical imaging findings Emphasized in this report were the relatively specific imaging manifestations of different systems, which may mimic infectious or other neoplasms of different sites The importance of imaging studies lies in the availability for diagnosis, staging and follow-up of NHL Combined with the clinical and other related information, the diagnostic accuracy can be further improved, thus, providing reliable evidence in guiding clinical management
文摘Introduction: The frequency of extranodal involvement in lymphoma is not rare, but variously described by authors in Africa. The objective of our work is to describe the profile of patients followed for lymphoma with extranodal locations. Methods: We conducted a descriptive, retrospective and analytic study at the clinical hematology department of Dalal Jamm Hospital, from September 2016 to June 2022. We included patients with a diagnosis of lymphoma immunohistochemistry, with extranodal involvement. The epidemiological, diagnostic, prognostic and survival aspects were studied. Results: Fifty-two (52) patients with extranodal localizations of their lymphoma were included. The mean age was 44.2 ± 17.6 years and the sex ratio was 1.2. The average time to diagnostic was 9.4 ± 3.6 months. We found a performance status ≥ 2 in 65.4% and at least one B symptom in 71.2% of cases. The extranodal manifestations were digestive (19%), cutaneous (17.5%), pleuropulmonary (17.5%), bone marrow (4.8%), thyroid (1.6%), parotid gland (1.6%) and breast (1.6%). Patients presented with Hodgkin’s lymphoma (HL) in 19.2% of cases and non-Hodgkin’s lymphoma (NHL) in 80.8% of cases. At the end of the extension checkup reviews, 61.5% were at an advanced stage and prognostic indices were unfavorable in 32% of patients. Conventional chemotherapy was conducted in 63.5% of patients of which 24 had NHL and 9 had HL. Immuno-chemoterapy was used in 26.9% of patients (13 cases of NHL, 1 case of HL). During the follow-up, we noted only 29.7% of complete remission. The median overall survival was 25.1 months [23.5 - 34.1 months] in HL group and 20.5 months [18.7 - 72.2 months] in NHL patients (p = 0.14). Conclusion: Our study shows that extranodal involvements of lymphomas are various, encountered more during NHL. In our practice, diagnosis is generally made at an advanced stage, with poor response to treatment.
基金Shanghai Clinical Research Center for Cell Therapy,Grant/Award Number:23J41900100National Natural Science Foundation of China,Grant/Award Number:82130004+2 种基金Clinical Research Plan of Shanghai Hospital DevelopmentCenter,Grant/Award Number:SHDC2020CR1032BNational Key Research and Development Program,Grant/Award Number:2022YFC2502600Multicenter Clinical Research Project byShanghai Jiao Tong University School ofMedicine,Grant/Award Number:DLY201601。
文摘Background Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of aggressive non-Hodgkin's lymphoma with distinct clinical and molecular heterogeneity.DLBCL that arises in extranodal organs is particularly linked to poor prognosis.This study aimed to determine the clinical and molecular characteristics of extranodal involvement(ENI)in DLBCL and assess the actual survival status of the patients.Methods In this population-based cohort study,we investigated the clinical features of 5,023 patients newly diagnosed with DLBCL.Their clinical conditions,eligibility criteria,and sociodemographic details were recorded and analyzed.Gene panel sequencing was performed on 1,050 patients to discern molecular patterns according to ENI.Results The 2-year overall survival(OS)rate was 76.2%[95%confidence interval(CI),74.0%-78.2%],and the 5-year OS rate was 67.9%(95%CI,65.2%-70.4%).The primary treatment was immunochemotherapy with rituximab.Specific lymphoma involvement sites,especially the bones,bone marrow,and central nervous system,were identified as independent adverse prognostic factors.A high prevalence of non-germinal center B-cell(non-GCB)phenotype and myeloid differentiation primary response 88(MYD88)/CD79B mutations were noted in lymphomas affecting the breasts,skin,uterus,and immune-privileged sites.Conversely,the thyroid and gastrointestinal tract showed a low occurrence of non-GCB phenotype.Remarkably,patients with multiple ENIs exhibited a high frequency of MYD88,tet methylcytosine dioxygenase 2(TET2),CREB binding protein(CREBBP)mutations,increased MYD88L265P and CD79B mutation(MCD)-like subtypes,and poor prognosis.Genetic subtype-guided immunochemotherapy showed good efficacy in subgroup analyses after propensity score matching with 5-year OS and progression-free survival rates of 85.0%(95%CI,80.6%-89.5%)and 72.1%(95%CI,67.3%-76.7%).Conclusions In the rituximab era,this large-scale retrospective analysis from Asia confirmed the poor prognosis of DLBCL with multiple ENIs and underscored the efficacy of genetic subtype-guided immunochemotherapy in treating extranodal DLBCL.
