Impact of bone marrow involvement on outcome in relapsed and refractory transplant eligible diffuse large B-cell lymphoma and transformed indolent lymphoma
In front-line treatment of diffuse large B-cell lymphoma (DLBCL), prior studies suggest that concordant but not discordant involvement of the bone marrow (BM) portends a poor prognosis. The prognostic impact of bone marrow infiltration (BMI) in recurrent or refractory DLBCL (r/rDLBCL) and transforme...
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| description | In front-line treatment of diffuse large B-cell lymphoma (DLBCL), prior studies suggest that concordant but not discordant involvement of the bone marrow (BM) portends a poor prognosis. The prognostic impact of bone marrow infiltration (BMI) in recurrent or refractory DLBCL (r/rDLBCL) and transformed indolent lymphoma (r/rTRIL) patients is less clear. Thus, we examined the prognostic significance of the infiltration of bone marrow (BMI) by concordant, large B-cells (conBMI) and discordant, small B-cells (disBMI) in this patient group. We performed a single center retrospective analysis of the prognostic impact of BMI diagnosed before start of second-line treatment as well as multiple clinicopathologic variables in 82 patients with r/rDLBCL or r/rTRIL intended to treat with autologous SCT. Twenty-five of 82 patients (30.5%) had BMI. Out of these, 19 (76%) had conBMI and 6 (24%) had disBMI. In patients with conBMI but not disBMI, uni- and multivariate analysis revealed inferior progression free survival (PFS) and overall survival (OS) compared to patients without BMI (median PFS, 9.2 vs 17.45 months, log rank: p = 0.049; Hazard Ratio, 2.34 (Confidence Interval, 1.24-4.44), p = 0.009; median OS 14.72 vs 28.91 months, log rank: p = 0.017; Hazard Ratio, 2.76 (Confidence Interval, 1.43-5.31), p = 0.002). ConBMI was strongly associated with nonGCB subtype as classified by the Hans algorithm (82.4% vs 17.6%, p = 0.01). ConBMI comprised an independent predictor of poor prognosis in primary and secondary r/rDLBCL. Incorporating conBMI in the pretherapeutic risk assessment for r/rDLBCL and r/rTRIL patients may be useful for prognostication, for stratification in clinical trials, and to assess new therapies for this high-risk patient subset that might not benefit from SCT in second-line treatment. |
| doi_str_mv | 10.1371/journal.pone.0235786 |
| format | Article |
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The prognostic impact of bone marrow infiltration (BMI) in recurrent or refractory DLBCL (r/rDLBCL) and transformed indolent lymphoma (r/rTRIL) patients is less clear. Thus, we examined the prognostic significance of the infiltration of bone marrow (BMI) by concordant, large B-cells (conBMI) and discordant, small B-cells (disBMI) in this patient group. We performed a single center retrospective analysis of the prognostic impact of BMI diagnosed before start of second-line treatment as well as multiple clinicopathologic variables in 82 patients with r/rDLBCL or r/rTRIL intended to treat with autologous SCT. Twenty-five of 82 patients (30.5%) had BMI. Out of these, 19 (76%) had conBMI and 6 (24%) had disBMI. In patients with conBMI but not disBMI, uni- and multivariate analysis revealed inferior progression free survival (PFS) and overall survival (OS) compared to patients without BMI (median PFS, 9.2 vs 17.45 months, log rank: p = 0.049; Hazard Ratio, 2.34 (Confidence Interval, 1.24-4.44), p = 0.009; median OS 14.72 vs 28.91 months, log rank: p = 0.017; Hazard Ratio, 2.76 (Confidence Interval, 1.43-5.31), p = 0.002). ConBMI was strongly associated with nonGCB subtype as classified by the Hans algorithm (82.4% vs 17.6%, p = 0.01). ConBMI comprised an independent predictor of poor prognosis in primary and secondary r/rDLBCL. Incorporating conBMI in the pretherapeutic risk assessment for r/rDLBCL and r/rTRIL patients may be useful for prognostication, for stratification in clinical trials, and to assess new therapies for this high-risk patient subset that might not benefit from SCT in second-line treatment.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0235786</identifier><identifier>PMID: 32639975</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Age ; Aged ; Algorithms ; Autografts ; B cells ; B-cell lymphoma ; B-Lymphocytes - pathology ; Biology and Life Sciences ; Biopsy ; Bone marrow ; Bone Marrow - pathology ; Bone marrow transplantation ; Chemotherapy ; Clinical trials ; Confidence intervals ; Female ; Health aspects ; Hematology ; Hospitals ; Humans ; Infiltration ; Internal medicine ; Lymphocytes B ; Lymphoma ; Lymphoma, Large B-Cell, Diffuse - diagnosis ; Lymphoma, Large B-Cell, Diffuse - pathology ; Lymphoma, Non-Hodgkin - diagnosis ; Lymphoma, Non-Hodgkin - pathology ; Lymphomas ; Male ; Medical prognosis ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Multivariate analysis ; Neoplasm Recurrence, Local - diagnosis ; Neoplasm Recurrence, Local - pathology ; Nervous system ; Oncology ; Pathology ; Patient outcomes ; Patients ; Prognosis ; Research and Analysis Methods ; Retrospective Studies ; Risk assessment ; Risk groups ; Stem cell transplantation ; Stem cells ; Survival ; Syngeneic grafts ; Tomography ; Transplants & implants ; Young Adult</subject><ispartof>PloS one, 2020-07, Vol.15 (7), p.e0235786</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Terziev et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Terziev et al 2020 Terziev et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-ec7d2dd7b20bd64e46a59226dccd69ccf4750a2a84cefeaf3c233170bfe5035d3</citedby><cites>FETCH-LOGICAL-c692t-ec7d2dd7b20bd64e46a59226dccd69ccf4750a2a84cefeaf3c233170bfe5035d3</cites><orcidid>0000-0002-8724-9348</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343149/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343149/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23865,27923,27924,53790,53792,79371,79372</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32639975$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bertolini, Francesco</contributor><creatorcontrib>Terziev, Denis</creatorcontrib><creatorcontrib>Bauer, Marcus</creatorcontrib><creatorcontrib>Paschold, Lisa</creatorcontrib><creatorcontrib>Wickenhauser, Claudia</creatorcontrib><creatorcontrib>Wienke, Andreas</creatorcontrib><creatorcontrib>Binder, Mascha</creatorcontrib><creatorcontrib>Müller, Lutz P</creatorcontrib><creatorcontrib>Weber, Thomas</creatorcontrib><title>Impact of bone marrow involvement on outcome in relapsed and refractory transplant eligible diffuse large B-cell lymphoma and transformed indolent lymphoma</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In front-line treatment of diffuse large B-cell lymphoma (DLBCL), prior studies suggest that concordant but not discordant involvement of the bone marrow (BM) portends a poor prognosis. The prognostic impact of bone marrow infiltration (BMI) in recurrent or refractory DLBCL (r/rDLBCL) and transformed indolent lymphoma (r/rTRIL) patients is less clear. Thus, we examined the prognostic significance of the infiltration of bone marrow (BMI) by concordant, large B-cells (conBMI) and discordant, small B-cells (disBMI) in this patient group. We performed a single center retrospective analysis of the prognostic impact of BMI diagnosed before start of second-line treatment as well as multiple clinicopathologic variables in 82 patients with r/rDLBCL or r/rTRIL intended to treat with autologous SCT. Twenty-five of 82 patients (30.5%) had BMI. Out of these, 19 (76%) had conBMI and 6 (24%) had disBMI. In patients with conBMI but not disBMI, uni- and multivariate analysis revealed inferior progression free survival (PFS) and overall survival (OS) compared to patients without BMI (median PFS, 9.2 vs 17.45 months, log rank: p = 0.049; Hazard Ratio, 2.34 (Confidence Interval, 1.24-4.44), p = 0.009; median OS 14.72 vs 28.91 months, log rank: p = 0.017; Hazard Ratio, 2.76 (Confidence Interval, 1.43-5.31), p = 0.002). ConBMI was strongly associated with nonGCB subtype as classified by the Hans algorithm (82.4% vs 17.6%, p = 0.01). ConBMI comprised an independent predictor of poor prognosis in primary and secondary r/rDLBCL. Incorporating conBMI in the pretherapeutic risk assessment for r/rDLBCL and r/rTRIL patients may be useful for prognostication, for stratification in clinical trials, and to assess new therapies for this high-risk patient subset that might not benefit from SCT in second-line treatment.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Algorithms</subject><subject>Autografts</subject><subject>B cells</subject><subject>B-cell lymphoma</subject><subject>B-Lymphocytes - pathology</subject><subject>Biology and Life Sciences</subject><subject>Biopsy</subject><subject>Bone marrow</subject><subject>Bone Marrow - pathology</subject><subject>Bone marrow transplantation</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Female</subject><subject>Health aspects</subject><subject>Hematology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infiltration</subject><subject>Internal medicine</subject><subject>Lymphocytes B</subject><subject>Lymphoma</subject><subject>Lymphoma, Large B-Cell, Diffuse - diagnosis</subject><subject>Lymphoma, Large B-Cell, Diffuse - pathology</subject><subject>Lymphoma, Non-Hodgkin - diagnosis</subject><subject>Lymphoma, Non-Hodgkin - pathology</subject><subject>Lymphomas</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neoplasm Recurrence, Local - diagnosis</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Nervous system</subject><subject>Oncology</subject><subject>Pathology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Research and Analysis Methods</subject><subject>Retrospective Studies</subject><subject>Risk assessment</subject><subject>Risk groups</subject><subject>Stem cell transplantation</subject><subject>Stem cells</subject><subject>Survival</subject><subject>Syngeneic grafts</subject><subject>Tomography</subject><subject>Transplants & implants</subject><subject>Young 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Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of bone marrow involvement on outcome in relapsed and refractory transplant eligible diffuse large B-cell lymphoma and transformed indolent lymphoma</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-07-08</date><risdate>2020</risdate><volume>15</volume><issue>7</issue><spage>e0235786</spage><pages>e0235786-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In front-line treatment of diffuse large B-cell lymphoma (DLBCL), prior studies suggest that concordant but not discordant involvement of the bone marrow (BM) portends a poor prognosis. The prognostic impact of bone marrow infiltration (BMI) in recurrent or refractory DLBCL (r/rDLBCL) and transformed indolent lymphoma (r/rTRIL) patients is less clear. Thus, we examined the prognostic significance of the infiltration of bone marrow (BMI) by concordant, large B-cells (conBMI) and discordant, small B-cells (disBMI) in this patient group. We performed a single center retrospective analysis of the prognostic impact of BMI diagnosed before start of second-line treatment as well as multiple clinicopathologic variables in 82 patients with r/rDLBCL or r/rTRIL intended to treat with autologous SCT. Twenty-five of 82 patients (30.5%) had BMI. Out of these, 19 (76%) had conBMI and 6 (24%) had disBMI. In patients with conBMI but not disBMI, uni- and multivariate analysis revealed inferior progression free survival (PFS) and overall survival (OS) compared to patients without BMI (median PFS, 9.2 vs 17.45 months, log rank: p = 0.049; Hazard Ratio, 2.34 (Confidence Interval, 1.24-4.44), p = 0.009; median OS 14.72 vs 28.91 months, log rank: p = 0.017; Hazard Ratio, 2.76 (Confidence Interval, 1.43-5.31), p = 0.002). ConBMI was strongly associated with nonGCB subtype as classified by the Hans algorithm (82.4% vs 17.6%, p = 0.01). ConBMI comprised an independent predictor of poor prognosis in primary and secondary r/rDLBCL. Incorporating conBMI in the pretherapeutic risk assessment for r/rDLBCL and r/rTRIL patients may be useful for prognostication, for stratification in clinical trials, and to assess new therapies for this high-risk patient subset that might not benefit from SCT in second-line treatment.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32639975</pmid><doi>10.1371/journal.pone.0235786</doi><tpages>e0235786</tpages><orcidid>https://orcid.org/0000-0002-8724-9348</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-07, Vol.15 (7), p.e0235786 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2421427878 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Age Aged Algorithms Autografts B cells B-cell lymphoma B-Lymphocytes - pathology Biology and Life Sciences Biopsy Bone marrow Bone Marrow - pathology Bone marrow transplantation Chemotherapy Clinical trials Confidence intervals Female Health aspects Hematology Hospitals Humans Infiltration Internal medicine Lymphocytes B Lymphoma Lymphoma, Large B-Cell, Diffuse - diagnosis Lymphoma, Large B-Cell, Diffuse - pathology Lymphoma, Non-Hodgkin - diagnosis Lymphoma, Non-Hodgkin - pathology Lymphomas Male Medical prognosis Medicine Medicine and Health Sciences Middle Aged Multivariate analysis Neoplasm Recurrence, Local - diagnosis Neoplasm Recurrence, Local - pathology Nervous system Oncology Pathology Patient outcomes Patients Prognosis Research and Analysis Methods Retrospective Studies Risk assessment Risk groups Stem cell transplantation Stem cells Survival Syngeneic grafts Tomography Transplants & implants Young Adult |
| title | Impact of bone marrow involvement on outcome in relapsed and refractory transplant eligible diffuse large B-cell lymphoma and transformed indolent lymphoma |
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