title: Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin.
abstract: OBJECTIVE
  To study the main clinicobiologic features, response, and outcome of patients with diffuse large B-cell lymphoma (DLBCL) according to the primary site, lymph node, or different extranodal organs of the disease.
  
  
  METHODS
  We included 382 patients consecutively diagnosed with DLBCL in a single institution during a 13-year period. Morphology, immunophenotyping, proliferation index, differentiation profile, bcl-2/JH rearrangement, and clinical characteristics were analyzed according to the primary site of the lymphoma.
  
  
  RESULTS
  Sites of the disease were: lymph node, 222 cases (58%); Waldeyer's ring (WR), 42 (11%); and extranodal sites, 118 (31%), including GI tract in 45 cases. Primary extranodal cases, particularly GI, showed a bcl-6 expression more frequently than nodal cases. Patients with primary WR or GI lymphomas presented with early-stage disease, no marrow infiltration, normal serum lactate dehydrogenase, and low- to low/intermediate-risk international prognostic index (IPI) more frequently than the remainder. Complete response (CR) rate was 63%, with WR and GI lymphomas having a higher CR rate (85% and 80%, respectively) than the other groups. In the whole series, 5-year overall survival (OS) was 52%. Patients with WR or GI lymphomas showed better OS (5-year OS: 77% and 68%, respectively) than patients with nodal or other extranodal sites. In the multivariate analysis, IPI, bulky disease, and beta2-microglobulin were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value.
  
  
  CONCLUSIONS
  In the present series, the primary site of disease was associated with particular clinicopathologic features and outcome, though the latter largely depended on other factors.
authors.affiliation: Department of Hematology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain. alopezg@clinic.ub.es
authors.forename: Armando
authors.initials: A
authors.lastname: López-Guillermo
authors.forename: Luis
authors.initials: L
authors.lastname: Colomo
authors.forename: Mónica
authors.initials: M
authors.lastname: Jiménez
authors.forename: Francesc
authors.initials: F
authors.lastname: Bosch
authors.forename: Neus
authors.initials: N
authors.lastname: Villamor
authors.forename: Leonor
authors.initials: L
authors.lastname: Arenillas
authors.forename: Ana
authors.initials: A
authors.lastname: Muntañola
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Eva
authors.initials: E
authors.lastname: Giné
authors.forename: Dolors
authors.initials: D
authors.lastname: Colomer
authors.forename: Silvia
authors.initials: S
authors.lastname: Beà
authors.forename: Elías
authors.initials: E
authors.lastname: Campo
authors.forename: Emili
authors.initials: E
authors.lastname: Montserrat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor