Histologic transformation in marginal zone lymphomas Conconi, A.; Franceschetti, S.; Aprile von Hohenstaufen, K. ...
Annals of oncology,
November 2015, 2015-Nov, 2015-11-00, 20151101, Letnik:
26, Številka:
11
Journal Article
Recenzirano
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Histologic transformation (HT) is a poorly understood event in patients with marginal zone lymphoma (MZL). The aim of this study was to analyze incidence and risk factors for HT in a large series of ...MZL patients.
The studied cohort included 340 MZL patients diagnosed and treated between 1995 and 2012: 157 extranodal MZLs mucosa-associated lymphoid tissue (MALT) lymphoma, 46%, 85 splenic MZLs (SMZLs, 25%) and 37 nodal MZLs (NMZLs, 11%). Sixty-one patients (18%) had bone marrow infiltration at presentation, with or without detectable involvement of peripheral blood, but without other involved sites; they were considered clonal B-cell lymphocytosis of marginal zone origin (CBL-MZ).
With a median follow-up of 4.8 years, the median overall survival and progression-free survival of the whole population were 14.5 and 5 years, respectively. HT was observed in 13 cases 3.8%, 95% confidence interval (95% CI) 2%–6.5%. Elevated lactate dehydrogenase (LDH) at diagnosis was associated with the risk of HT (P = 0.019). HT occurred in 5% of SMZLs, 4% of MALT lymphomas, 3% of NMZLs and 3% of CBL-MZ (P = 0.974). The risk of HT was 5% (95% CI 3–9%) at 5 and 10 years after diagnosis and 10% (95% CI 5%–20%) at 12 years. At the time of HT, most patients had high LDH and B symptoms. At a median follow-up of 12 months after HT, 4 of 13 patients died, all for lymphoma-related causes, with a 2-year post-transformation survival rate of 57% (95% CI 13%–86%).
In this large retrospective series, the risk of HT across all MZL types appeared lower than the one reported for follicular lymphoma.
Abstract
Aim: Clinical trials have led to a remarkable improvement of treatment outcome for patients with Hodgkin's lymphoma (HL) over the last 3 decades. Prognosis of patients enrolled in clinical ...trials may even be superior than the one of patients treated in the community. Since the mid 90ies, many patients with HL treated in our Institution have been prospectively included in the German Hodgkin Lymphoma Group (GHSG) trials. However, many other patients with HL have not been included in these trials for various reasons.
Methods: We performed a retrospective population-based analysis using the electronic lymphoma database of our Institution and included all patients with HL from January 1996 to December 2012. Primary endpoint was OS which was defined according to the NCI criteria and estimated by the method of Kaplan–Meier. The Cox proportional hazards model was used for the estimation of hazard ratio and its confidence interval in a multivariate analysis.
Results: 172 patients were identified. Clinical characteristics at diagnosis were: median age 38 years, 54% male, 13% stage I, 56% stage II, 15% stage III, 16% stage IV, 40% B symptoms, 10% GHSG early stage, 40% GHSG early unfavorable stage and 50% had GHSG advanced stage. With a median follow-up of 5.6 years, the 5-year overall survival of the whole studied population was 79%. The rate of enrollment in the GHSG trials in our Institution was 24%; participation of patients younger than 40 years in randomized trials was significantly higher compared with those older than 40 years. Patients entered in clinical trials had a significantly better outcome irrespectively of age (p = 0.0047). The inclusion in a clinical study maintained its prognostic value at a multivariate analysis in a Cox model controlling for age and for the GHSG risk group.
Conclusions: This analysis suggests that patients enrolled in clinical trials may have a better outcome than patients with similar clinical characteristics at diagnosis. We plan to conduct a national survey in collaboration with the Swiss Cancer registries; the proposed research project may allow a better understanding of the different parameters behind this observation and their impact on treatment modalities and prognosis.
Disclosure: All authors have declared no conflicts of interest.
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