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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
Author(s) -
ElGalaly Tarec Christoffer,
Cheah Chan Y.,
Hutchings Martin,
Mikhaeel Nabegh George,
Savage Kerry J.,
Sehn Laurie H.,
Barrington Sally,
Hansen Jakob W.,
Poulsen Mette Ø.,
Smith Daniel,
Rady Kirsty,
Mylam Karen J.,
Larsen Thomas S.,
Holmberg Staffan,
Juul Maja B.,
Cordua Sabrina,
Clausen Michael R.,
Jensen Kristina B.,
Bøgsted Martin,
Johnsen Hans E.,
Seymour John F.,
Connors Joseph M.,
Brown Peter d. N.,
Villa Diego
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14325
Subject(s) - medicine , diffuse large b cell lymphoma , hazard ratio , concomitant , rituximab , oncology , uterus , lymphoma , gynecology , confidence interval
Summary 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 .