Clinical Characteristics And Outcomes Of Extranodal Stage I Diffuse Large B-Cell Lymphoma In The Rituximab Area

In a recent publication in the Journal Blood, from the American Society of Hematology, January 7, 2021, a team of investigators led by Dr. Younes reported the results of a large retrospective review.  The purpose of the study was to better define the characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma.  

Charts were reviewed between 2001 and 2015.  Only patients with stage I DLBCL were selected, who were treated with R-CHOP or R-CHOP like regimens with or without radiotherapy. 1,955 patients with newly diagnosed DLBCL were identified. 341 patients had stage I disease. Of  these 224 patients had extranodal presentation.  34% of the remaining 117 had nodal involvement.  Bone was the most common extranodal site at 21%.  This was followed closely by stomach at 19%, testes at 9%, intestine at 8% and finally breast at 8%.  69% of extranodal patients and 60% of nodal patients received radiotherapy.  

The median follow-up was 5.5 years.  10-year overall survival was 77%, and disease free survival was 77%.  With multivariate analysis, extranodal involvement was associated with an inferior overall survival, hazard ratio 3.44 as well as progression free survival, hazard ratio 3.25 compared with nodal involvement.  Consolidation radiotherapy was associated with better overall survival, hazard ratio 0.26 and progression free survival, hazard ratio 0.35.  The benefit disappeared in patients who were PET scan negative by the end of their treatment course.  The median relapse time was 37 months.  The most common relapse was in the lymph nodes followed by a central nervous system, 31% and 27% respectively.  

The authors concluded that extranodal stage I diffuse large B-cell lymphoma had a worse outcome done in nodal stage diffuse large B-cell lymphoma.