Tumor necrosis could reflect advanced disease status in patients with diffuse large B cell lymphoma treated with R-CHOP therapy.
Tumor necrosis (TN) can lower responsiveness to chemotherapy and confer basic resistance to anti-cancer therapy. We investigated the association of TN with poor clinical features and outcome in diffuse large B cell lymphoma (DLBCL). We examined the presence or absence of TN in 476 DLBCL patients of who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Eighty-nine (18.7 %) patients had TN at diagnosis. Patients with TN had a progression-free survival (PFS) and overall survival (OS) of 39.3 and 46.7 %, whereas patients without TN had a PFS and OS of 73.4 and 82.6 %. Adverse clinical factors of poor Eastern Cooperative Oncology Group performance status ≥ grade 2 (p = 0.005), elevated lactate dehydrogenase ratio >1 (p < 0.001), advanced Ann Arbor stage (p = 0.002), and bulky disease (p = 0.026) were more prevalent in the TN group than the non-TN group. Cox regression model analysis revealed TN as an independent prognostic factor for PFS and OS in DLBCL (PFS, hazard ratio [HR] = 1.967, 95 % confidence interval [CI] = 1.399-2.765, p < 0.001; OS, HR = 2.445, 95 % CI = 1.689-3.640, p < 0.001). The results indicate that TN could reflect adverse clinical features and worse prognosis in DLBCL patients receiving R-CHOP therapy.
Department of Hematology-Oncology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea.
Moo-Kon
MK
Song
Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, Republic of Korea. song9676@hanmail.net.
Joo-Seop
JS
Chung
Department of Hematology, Seoul National University Hospital, Seoul, Korea.
Dong-Yeop
DY
Shin
Department of Hematology, Busan Haeundae Paik Hospital, Busan, Korea.
Sung-Nam
SN
Lim
Department of Hematology, Gyeong-Sang National University Hospital, School of medicine, Gyeong-Sang National University, Jinju, Korea.
Gyeong-Won
GW
Lee
Department of Laboratory Medicine, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea.
Jae-Cheol
JC
Choi
Department of Pathology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea.
Won-Young
WY
Park
Department of Hematology-Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea.
So-Yeon
SY
Oh
D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
Ann Arbor stage; Diffuse large B cell lymphoma; Survival; Tumor necrosis