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.
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.
Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.
Tarec Christoffer
TC
El-Galaly
Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.
Chan Y
http://orcid.org/0000-0001-7988-1565
CY
Cheah
Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Martin
M
Hutchings
Department of Clinical Oncology, Guy's and St Thomas' Hospital, London, UK.
Nabegh George
NG
Mikhaeel
Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada.
Kerry J
KJ
Savage
Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada.
Laurie H
LH
Sehn
PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
Sally
S
Barrington
Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Jakob W
JW
Hansen
Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.
Mette Ø
MØ
Poulsen
Department of Clinical Oncology, Guy's and St Thomas' Hospital, London, UK.
Daniel
D
Smith
Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
Kirsty
K
Rady
Department of Haematology, Odense University Hospital, Odense, Denmark.
Karen J
KJ
Mylam
Department of Haematology, Odense University Hospital, Odense, Denmark.
Thomas S
TS
Larsen
Department of Haematology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
Staffan
S
Holmberg
Department of Haematology, Vejle Hospital, Vejle, Denmark.
Maja B
MB
Juul
Department of Haematology, Roskilde Hospital, Roskilde, Denmark.
Sabrina
S
Cordua
Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.
Michael R
MR
Clausen
Department of Haematology, Holstebro Hospital, Holstebro, Denmark.
Kristina B
KB
Jensen
Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.
Martin
M
Bøgsted
Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.
Hans E
HE
Johnsen
Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
John F
JF
Seymour
Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada.
Joseph M
JM
Connors
Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Peter D N
PD
Brown
Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada.
Diego
D
Villa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000556:secondary; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology; D055815:Young Adult
D000069283:Rituximab
central nervous system relapse; diffuse large B-cell lymphoma; gynaecological involvement; positron emission tomography; uterus involvement