title: Analysis of clinical characteristics and outcome of patients with previously untreated diffuse large B-cell lymphoma and renal involvement in the rituximab era.
abstract: Renal involvement in patients with lymphoma is rare but associated with poor prognosis. We analyzed characteristics and outcome of 22 patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) and renal involvement treated with a rituximab-containing regimen in curative intent. The majority of patients presented in advanced disease, 86% were Ann Arbor stage ≥ III and had an IPI score ≥ 3. Renal impairment was present in 32%. Outcome was poor with three-year progression-free survival (PFS) 44% and three-year overall survival (OS) 52% and significantly worse compared to DLBCL without renal involvement (p < 0.01). Patients with high-risk IPI had a significantly inferior prognosis compared to intermediate-risk IPI (three-year OS 0% vs. 75%, p = 0.01) as did those with renal impairment. A high rate of central nervous system (CNS) relapse (8/22) was observed. Intravenous high-dose methotrexate and intrathecal therapy showed a trend toward prolonged time to CNS relapse. Implementation of CNS prophylaxis might therefore be considered in these high-risk patients.
authors.affiliation: a Department of Hematology and Oncology , University of Heidelberg , Heidelberg , Germany ;
authors.forename: Nicola
authors.initials: N
authors.lastname: Lehners
authors.affiliation: a Department of Hematology and Oncology , University of Heidelberg , Heidelberg , Germany ;
authors.forename: Isabelle
authors.initials: I
authors.lastname: Krämer
authors.affiliation: b Barts Cancer Institute , Queen Mary University of London , London , UK.
authors.forename: Mark-Alexander
authors.initials: MA
authors.lastname: Schwarzbich
authors.affiliation: a Department of Hematology and Oncology , University of Heidelberg , Heidelberg , Germany ;
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.affiliation: a Department of Hematology and Oncology , University of Heidelberg , Heidelberg , Germany ;
authors.forename: Mathias
authors.initials: M
authors.lastname: Witzens-Harig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012008:Recurrence; D000069283:Rituximab / Q000008:administration & dosage / Q000627:therapeutic use; D063189:Symptom Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000069283:Rituximab
keywords: chemotherapeutic approaches; lymphoma and Hodgkin disease; prognostication