A multi-institutional analysis of diffuse large B-cell lymphoma (DLBCL) treated with consolidative radiotherapy and the impact of cell-of-origin on outcomes
, , , , , and | Oct 25, 2019
About this article
Article Category: Research Article
Published Online: Oct 25, 2019
Page range: 473 - 479
Received: Jun 26, 2019
Accepted: Aug 11, 2019
DOI: https://doi.org/10.2478/raon-2019-0045
© 2019 Chrishanthi Rajasooriyar, Jeremy Tey, Lea Choung Wong, Michelle Poon, Rao Nandini, Ivan Tham, Balamurugan Vellayappan, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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UNI- and multivariable analysis for disease-free survival (DFS) and overall survival (OS)
| Variable | DFS | OS | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Univariable analysis | Multivariable analysis | Univariable analysis | |||||||
| HR | 95% CI | P | HR | 95% CI | P | HR | 95% CI | P | |
| Age (continuous) | 1.03 | 1–1.06 | 0.081 | 1.02 | 0.98–1.06 | 0.37 | 1 | 0.96–1.05 | 0.86 |
| Gender (ref: male) | 1.78 | 0.70–4.51 | 0.23 | 1.38 | 0.34–5.51 | 0.65 | |||
| ECOG (continuous) | 1.64 | 0.92–2.95 | 0.096 | 0.42 | 0.18–1.00 | 0.05 | 1.05 | 0.35–3.15 | 0.93 |
| Stage 1–2 (ref) | 1.19 | 0.46–3.01 | 0.71 | 1.84 | 0.44–.64 | 0.4 | |||
| B symptoms (ref: yes) | 0.51 | 0.8–1.48 | 0.22 | 0.25 | 0.5–1.23 | 0.088 | |||
| Elevated LDH yes (ref) | 1.06 | 0.34–3.34 | 0.92 | 2.38 | 0.28–20.18 | 0.43 | |||
| IPI (ref) | 1.48 | 0.55–3.99 | 0.43 | 2.32 | 0.46–11.69 | 0.31 | |||
| Bulk < 7.5 cm(ref) | 3.16 | 1.02–9.78 | 6.10 | 1.3427.87 – | 3.19 | 0.46–22.15 | 0.24 | ||
| Baseline PET SUV ≤ 20 (ref) | 0.25 | 0.45–1.35 | 0.11 | - | - | - | |||
| Chemotherapy | 2.24 | 0.78–6.34 | 0.13 | 1.73 | 0.39–7.69 | 0.47 | |||
| < 6 cycles (ref) | |||||||||
| Dose < 36 Gy (ref) | 0.89 | 0.34–2.30 | 0.81 | 2.21 | 0.52–9.37 | 0.28 | |||
| RT response CR(ref) | 11.05 | 4.11–29.70 | 5.64 | 2.7811.45 – | |||||
| Cell of origin (ref GC) | |||||||||
| NGC | 3.72 | 0.74–18.54 | 0.11 | 2.57 | 0.23–28.94 | 0.44 | |||
| unknown | 3.60 | 0.79–16.50 | 0.10 | 3.77 | 0.44–32.49 | 0.23 | |||
Patient characteristics and treatment details
| Variable | Level | Number patients of (%) |
|---|---|---|
| All patients | 74 (100) | |
| Age | Median (range) | 61 (14–88) |
| Males | 43 (58) | |
| Gender | Females | 31 (42) |
| Chinese | 54 (73) | |
| Malay | 10 (14) | |
| Ethnicity | Indian | 1 (1) |
| Others | 9 (12) | |
| Stage | I–II | 43 (58) |
| III–IV | 31 (42) | |
| No | 44 (59) | |
| Yes | 30 (41) | |
| Staging PET/CT | SUV max ≤ 20 | 12 (40) |
| SUV max > 20 | 18 (60) | |
| Involvement of extra- | Nodal only | 19 (26) |
| nodal sites | Extra-nodal +/- nodal | 55 (74) |
| 20 (27) | ||
| ECOG | 47 (64) 3 (4) | |
| 4 (5) | ||
| ≤ 7.5cm | 37 (57) | |
| Bulky disease | > 7.5 cm | 28 (43) |
| 0–1 | 28 (38) | |
| IPI score | 26 (35) 13 (18) | |
| 4–5 | 7 (9) | |
| Number of chemotherapy | < 6 | 28 (39) |
| cycles | ≥ 6 | 44 (61) |
| ≤ 36 Gy | 45 (61) | |
| Radiotherapy dose | > 36 Gy | 29 (39) |
| Germinal centre | 20 (27) | |
| Cell-of-origin | Non-germinal centre | 22(30) |
| Unknown | 32 (43) |
Survival outcomes of aggressive lymphoma treated with consolidative RT
| Author | Year of publication | Limited/advanced disease | DFS | OS |
|---|---|---|---|---|
| Horning | 2004 | Limited | 73% (6 yr) | 82% (6 yr) |
| Reyes | 2005 | Limited | 74 (5 yr) | 81 (5 yr) |
| Bonnet | 2007 | Limited | 63% (5 yr) | 68% (5 yr) |
| Held | 2014 | Limited & advanced | 68% (3 yr) | 78% (3 yr) |
| Aviles | 2018 | Advanced | Not reported | 91% (5 yr) |
| Lamy | 2018 | Limited | 92% (5 yr) | 96% (5yr) |
| Pfreundschuh | 2018 | Limited & advanced | 84% (3 yr) | 93% (3 yr) |
| Rajasooriyar et al. | 2019 | Limited & advanced | 73% (5 yr) | 92% (5 yr) |