title: Clinico-biological characterization and outcome of primary nodal and extranodal diffuse large B-cell lymphoma in the rituximab era.
abstract: To study the main clinico-biological characteristics and the outcome of patients with diffuse large B-cell lymphoma (DLBCL) according to the primary site (nodal vs. extranodal), we included 262 patients consecutively diagnosed with DLBCL in a single institution, 5 years before and after immunochemotherapy was considered as the standard treatment. Altogether 116 patients received CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) and 146 rituximab plus CHOP (R-CHOP). The primary site was the lymph node in 140 patients (53%), Waldeyer's ring (WR) in 22, gastrointestinal (GI) in 33, and other extranodal in 67. The addition of rituximab significantly improved the CR rate in nodal, but not in extranodal, lymphomas. Patients receiving R-CHOP showed higher OS than those treated with CHOP alone (5-year OS: 71% vs. 48%). This difference was maintained in primary nodal (5-year OS: 69% vs. 37%, p < 0.0001), but was not observed in primary extranodal (75% vs. 65%, p = 0.45) lymphomas. The IPI, treatment, and primary site were the main variables for OS in multivariate analysis. In nodal cases, IPI and treatment maintained value, whereas only IPI predicted OS in extranodal cases. In conclusion, immunochemotherapy treatment dramatically improved the outcome of patients with nodal DLBCL; however, its effect was less in primary extranodal cases, so the prognosis of patients with nodal and extranodal lymphomas has been equalized in the rituximab era.
authors.affiliation: Department of Hematology, Hospital Clínic, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gutiérrez-García
authors.forename: Lluis
authors.initials: L
authors.lastname: Colomo
authors.forename: Neus
authors.initials: N
authors.lastname: Villamor
authors.forename: Leonor
authors.initials: L
authors.lastname: Arenillas
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez
authors.forename: Teresa
authors.initials: T
authors.lastname: Cardesa
authors.forename: Adriana
authors.initials: A
authors.lastname: García-Herrera
authors.forename: Xavier
authors.initials: X
authors.lastname: Setoain
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ghita
authors.forename: Pau
authors.initials: P
authors.lastname: Abrisqueta
authors.forename: Eva
authors.initials: E
authors.lastname: Giné
authors.forename: Francesc
authors.initials: F
authors.lastname: Bosch
authors.forename: Elías
authors.initials: E
authors.lastname: Campo
authors.forename: Emilio
authors.initials: E
authors.lastname: Montserrat
authors.forename: Armando
authors.initials: A
authors.lastname: López-Guillermo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D011241:Prednisone