Uterine, but not ovarian, female reproductive organ involvement at presentation by diffuse large B-cell lymphoma is associated with poor outcomes and a high frequency of secondary CNS involvement

TY - JOUR

T1 - Uterine, but not ovarian, female reproductive organ involvement at presentation by diffuse large B-cell lymphoma is associated with poor outcomes and a high frequency of secondary CNS involvement

AU - El-Galaly, Tarec Christoffer

AU - Cheah, Chan Y

AU - Hutchings, Martin

AU - Mikhaeel, Nabegh George

AU - Savage, Kerry J

AU - Sehn, Laurie H

AU - Barrington, Sally F

AU - Hansen, Jakob W

AU - Poulsen, Mette Ø

AU - Smith, Daniel L

AU - Rady, Kirsty

AU - Mylam, Karen Juul

AU - Larsen, Thomas S

AU - Holmberg, Staffan

AU - Juul, Maja B

AU - Cordua, Sabrina

AU - Clausen, Michael Roost

AU - Jensen, Kristina B

AU - Boegsted, Martin

AU - Johnsen, Hans E

AU - Seymour, John F

AU - Connors, Joseph M

AU - Brown, Peter D N

AU - Villa, Diego

N1 - © 2016 John Wiley & Sons Ltd.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Involvement of the internal female reproductive organs by diffuse large B-cell lymphoma (DLBCL) is uncommon, and there are sparse data describing the outcomes of such cases. In total, 678 female patients with DLBCL staged with positron emission tomography/computed tomography and treated with rituximab-containing chemotherapy were identified from databases in Denmark, Great Britain, Australia, and Canada. Overall, 27/678 (4%) had internal reproductive organ involvement: uterus (n = 14), ovaries (n = 10) or both (n = 3). In multivariate analysis, women with uterine DLBCL experienced inferior progression-free survival and overall survival compared to those without reproductive organ involvement, whereas ovarian DLBCL was not predictive of outcome. Secondary central nervous system (CNS) involvement (SCNS) occurred in 7/17 (41%) women with uterine DLBCL (two patients with concomitant ovarian DLBCL) and 0/10 women with ovarian DLBCL without concomitant uterine involvement. In multivariate analysis adjusted for other risk factors for SCNS, uterine involvement by DLBCL remained strongly associated with SCNS (Hazard ratio 14·13, 95% confidence interval 5·09-39·25, P < 0·001). Because involvement of the uterus by DLBCL appears to be associated with a high risk of SCNS, those patients should be considered for CNS staging and prophylaxis. However, more studies are needed to determine whether the increased risk of secondary CNS involvement also applies to women with localized reproductive organ DLBCL.

AB - Involvement of the internal female reproductive organs by diffuse large B-cell lymphoma (DLBCL) is uncommon, and there are sparse data describing the outcomes of such cases. In total, 678 female patients with DLBCL staged with positron emission tomography/computed tomography and treated with rituximab-containing chemotherapy were identified from databases in Denmark, Great Britain, Australia, and Canada. Overall, 27/678 (4%) had internal reproductive organ involvement: uterus (n = 14), ovaries (n = 10) or both (n = 3). In multivariate analysis, women with uterine DLBCL experienced inferior progression-free survival and overall survival compared to those without reproductive organ involvement, whereas ovarian DLBCL was not predictive of outcome. Secondary central nervous system (CNS) involvement (SCNS) occurred in 7/17 (41%) women with uterine DLBCL (two patients with concomitant ovarian DLBCL) and 0/10 women with ovarian DLBCL without concomitant uterine involvement. In multivariate analysis adjusted for other risk factors for SCNS, uterine involvement by DLBCL remained strongly associated with SCNS (Hazard ratio 14·13, 95% confidence interval 5·09-39·25, P < 0·001). Because involvement of the uterus by DLBCL appears to be associated with a high risk of SCNS, those patients should be considered for CNS staging and prophylaxis. However, more studies are needed to determine whether the increased risk of secondary CNS involvement also applies to women with localized reproductive organ DLBCL.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Central Nervous System Neoplasms

KW - Databases, Factual

KW - Disease-Free Survival

KW - Female

KW - Humans

KW - Lymphoma, Large B-Cell, Diffuse

KW - Middle Aged

KW - Ovarian Neoplasms

KW - Prognosis

KW - Retrospective Studies

KW - Rituximab

KW - Survival Rate

KW - Uterine Neoplasms

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

U2 - 10.1111/bjh.14325

DO - 10.1111/bjh.14325

M3 - Journal article

C2 - 27681999

SN - 0963-1860

VL - 175

SP - 876

EP - 883

JO - British Journal of Haematology, Supplement

JF - British Journal of Haematology, Supplement

IS - 5

ER -