Retrospective study of intravascular large B-cell lymphoma cases diagnosed in Quebec: A retrospective study of 29 case reports.
BACKGROUND
Intravascular large B-cell lymphoma (IVL) is an extremely rare malignancy, mainly studied through European and Asian series. Due to the low incidence of this condition, our understanding of the clinical presentation as well as the management of IVL relies on a limited number of patients.We report the largest North American study to date on IVL with 29 cases from Quebec hospital diagnosed between 1990 and 2016. The aim of our study is to describe the clinical presentations, diagnostic and staging procedures, therapeutic management and clinical outcomes of IVL patients in our population and compare the disease phenotype to European and Asian series reported.In our cohort, all patients had stage IV IVL at diagnosis, with a median age of 66.7 years (range 47.2-90.8). Clinical presentation was characterized by constitutional symptoms (100%), poor ECOG-PS (100% ≥ 2), cytopenias (93% anemia), and elevated lactate dehydrogenase (97%) and C-reactive protein (96%). Our cohort presented with mainly cutaneous and neurological symptoms. However, neurological involvement (75.9%) was predominant and no "cutaneous variant" was observed; this differs from European literature, where "classical" IVL is reported with mainly cutaneous involvement. Two of our Caucasian patients presented "Asian variant" IVL; this observation is not unusual, as cases of "classical" IVL have been reported in Asians and "Asian variant" IVL has been reported in Europeans. All patients were classified according to their immunophenotypic features in 3 different subgroups (CD5 or CD5CD10, CD5CD10, CD5CD10) with no difference in outcome. Finally, 62% of our cohort received anthracycline-based chemotherapy and 53% of them achieved a complete response. After a median follow-up of 328 days, OS at 3 years was 42.7% for the entire cohort and 47.4% for the cases with in vivo diagnosis.


CONCLUSIONS
Unlike European studies on "classical" IVL, our study showed that the French Canadian presentation of this subtype of IVL is more frequently observed with neurological rather than cutaneous involvement. Finally, an early diagnosis is of primary importance since almost a quarter of patients receive a post-mortem diagnosis. A prompt diagnosis allows the introduction of an early treatment, associated with a CR in 53% of patients.
Department of Hematology-Oncology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke Department of Pathology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke Department of Hematology-Oncology at McGill University Health Centre, CIUSSS Centre-Ouest-de-l'Île-de-Montréal, McGill University, Montreal Department of Pathology at Laval University Hospital Center, CIUSSS Capitale Nationale, University Laval, Quebec Department of Hematology-Oncology at Chicoutimi Hospital, CIUSSS Saguenay-Lac-Saint-Jean, University of Sherbrooke, Chicoutimi Department of Pathology at Montreal University Hospital Center, CIUSSS Est-de-l'Île-de-Montréal, University of Montreal, Montreal Department of Pathology at Charles-Lemoyne Hospital, CIUSSS Montérégie-Centre, University of Sherbrooke, Longueuil Department of Pathology at Cité-de-la-Santé Hospital, CIUSSS Laval, Laval Department of Hematology-Oncology at Montreal University Hospital Center in Trois-Rivières, CIUSSS Mauricie-et-du-Centre-du-Québec, Trois-Rivieres Department of Hematology-Oncology at Maisonneuve-Rosemont Hospital, CIUSSS Est-de-l'Île-de Montréal, University of Montreal, Montreal, Quebec, Canada.
Vanessa
V
Brunet
Sofia
S
Marouan
Jean-Pierre
JP
Routy
Mohamed Amin
MA
Hashem
Vincent
V
Bernier
Raynald
R
Simard
Tony
T
Petrella
Louis
L
Lamarre
Gilles
G
Théorêt
Christian
C
Carrier
Hans
H
Knecht
Isabelle
I
Fleury
Michel
M
Pavic
D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D044466:Asian People / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011792:Quebec; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology*; D015996:Survival Rate; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000188:drug therapy / Q000473:pathology*; D044465:White People / Q000706:statistics & numerical data
D018943:Anthracyclines