Osnat Bairey1,2, Lev Shvidel3,4, Chava Perry2,5, Eldad J Dann6,7, Rosa Ruchlemer8, Tamar Tadmor7,9, Neta Goldschmidt4,10. 1. Hematology Institute, Rabin Medical Center, Petach, Tikva, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Hematology Institute, Kaplan Medical Center, Rehovot, Israel. 4. Faculty of Medicine, Hebrew University, Jerusalem, Israel. 5. Sourasky Medical Center, Tel Aviv, Israel. 6. Blood Bank and Hematology Institute, Rambam Medical Center, Haifa, Israel. 7. Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 8. Hematology Department, Shaare Zedek Medical Center, Jerusalem, Israel. 9. Hematology Institute, Bnai-Zion Medical Center, Haifa, Israel. 10. Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Abstract
BACKGROUND: Primary splenic diffuse large B-cell lymphoma (PS-DLBCL), an uncommon type of non-Hodgkin lymphoma, has been investigated only in small patient series before the rituximab era. The therapeutic role of splenectomy in addition to immunochemotherapy is unknown. METHODS: The databases of 7 medical centers in Israel were searched for patients diagnosed with PS-DLBCL in 1982-2013, and clinical, treatment, and outcome data were collected for 87 patients. The mean patient age was 59.6 years; 57.5% were male. RESULTS: Patients presented with abdominal pain (81%), B symptoms (59%), splenomegaly (84%), splenic masses (97%), and high lactate dehydrogenase (LDH) levels (84%); 61% had stage I or II disease. The diagnosis was made with core-needle biopsy in 46 patients and with diagnostic splenectomy in 39 patients. Eighty patients (92%) were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone; 68 (78%) received rituximab. A complete response was achieved in 67 patients (77%), and a partial response was achieved in 8 (9%). At 5 years, the overall survival (OS) rate was 77%, and the progression-free survival (PFS) rate was 67%. When patients were stratified by splenectomy at diagnosis, the OS rates were 91% for splenectomized patients and 68% for nonsplenectomized patients (P = .08), and the PFS rates were 85% and 55%, respectively (P = .02). The respective values for the subgroup with early-stage disease were 96% and 63% for OS (P = .009) and 90% and 51% for PFS (P = .01). In a multivariate analysis, a low Eastern Cooperative Oncology Group performance status and splenectomy independently predicted better PFS (P < .03). CONCLUSIONS: Patients with PS-DLBCL usually present with abdominal pain, high LDH levels, and a splenic mass. This study shows for the first time that splenectomy at diagnosis improves survival, specifically in patients with early-stage disease.
BACKGROUND: Primary splenic diffuse large B-cell lymphoma (PS-DLBCL), an uncommon type of non-Hodgkin lymphoma, has been investigated only in small patient series before the rituximab era. The therapeutic role of splenectomy in addition to immunochemotherapy is unknown. METHODS: The databases of 7 medical centers in Israel were searched for patients diagnosed with PS-DLBCL in 1982-2013, and clinical, treatment, and outcome data were collected for 87 patients. The mean patient age was 59.6 years; 57.5% were male. RESULTS:Patients presented with abdominal pain (81%), B symptoms (59%), splenomegaly (84%), splenic masses (97%), and high lactate dehydrogenase (LDH) levels (84%); 61% had stage I or II disease. The diagnosis was made with core-needle biopsy in 46 patients and with diagnostic splenectomy in 39 patients. Eighty patients (92%) were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone; 68 (78%) received rituximab. A complete response was achieved in 67 patients (77%), and a partial response was achieved in 8 (9%). At 5 years, the overall survival (OS) rate was 77%, and the progression-free survival (PFS) rate was 67%. When patients were stratified by splenectomy at diagnosis, the OS rates were 91% for splenectomized patients and 68% for nonsplenectomized patients (P = .08), and the PFS rates were 85% and 55%, respectively (P = .02). The respective values for the subgroup with early-stage disease were 96% and 63% for OS (P = .009) and 90% and 51% for PFS (P = .01). In a multivariate analysis, a low Eastern Cooperative Oncology Group performance status and splenectomy independently predicted better PFS (P < .03). CONCLUSIONS:Patients with PS-DLBCL usually present with abdominal pain, high LDH levels, and a splenic mass. This study shows for the first time that splenectomy at diagnosis improves survival, specifically in patients with early-stage disease.
Authors: Qaisar Ali Khan; Arif Mumtaz; Abdul Baqi; Hoor Ul Ain; Rabia Salman Mahfooz; Nowshad Asim; Sumaira Iram; Khabab Abbasher Hussien Mohamed Ahmed; Muhammad Junaid Tahir; Zohaib Yousaf Journal: Ann Med Surg (Lond) Date: 2022-08-18
Authors: Christine Schmitz; Jan Rekowski; Stefan P Müller; Navid Farsijani; Bernd Hertenstein; Christiane Franzius; Ulla von Verschuer; Paul La Rosée; Martin Freesmeyer; Stefan Wilop; Thomas Krohn; Aruna Raghavachar; Arnold Ganser; Frank M Bengel; Gabriele Prange-Krex; Frank Kroschinsky; Jörg Kotzerke; Aristoteles Giagounidis; Ulrich Dührsen; Andreas Hüttmann Journal: Cancer Med Date: 2020-09-14 Impact factor: 4.452