Improved outcomes of localized diffuse large B-cell lymphoma at the Waldeyer ring in comparison to the sinonasal area in the rituximab era

Wei-Li Ma; Ruey-Long Hong; Pei-Jen Lou; Ming Yao; Shang-Ju Wu; Chung-Wu Lin; Chun-Wei Wang; Chin-Hao Chang; Ann-Lii Cheng; Sung-Hsin Kuo

doi:10.1002/cam4.6851

Improved outcomes of localized diffuse large B-cell lymphoma at the Waldeyer ring in comparison to the sinonasal area in the rituximab era

Cancer Med. 2023 Dec 26;13(1):e6851. doi: 10.1002/cam4.6851. Online ahead of print.

Authors

Wei-Li Ma^{1

2

3}, Ruey-Long Hong^{1

4}, Pei-Jen Lou⁵, Ming Yao⁶, Shang-Ju Wu⁶, Chung-Wu Lin^{7

8}, Chun-Wei Wang^{1

2}, Chin-Hao Chang⁹, Ann-Lii Cheng^{1

3

4

6}, Sung-Hsin Kuo^{1

2

3

10}

Affiliations

¹ Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
² Cancer Research Center, National Taiwan University College of Medicine, Taipei City, Taiwan.
³ Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei City, Taiwan.
⁴ Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei City, Taiwan.
⁵ Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
⁶ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
⁷ Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
⁸ Department of Pathology and Laboratory Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei City, Taiwan.
⁹ Department of Medical Research, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
¹⁰ Department of Radiation Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei City, Taiwan.

Abstract

Background: Diffuse large B-cell lymphoma (DLBCL) of the head-and-neck area primarily involves the Waldeyer ring (WR) and sinonasal area (SN). However, the differential clinical outcomes between patients with WR-DLBCL and those with SN-DLBCL in the rituximab era remain unclear.

Methods: To avoid confounding factors contributed by advanced DLBCL with WR and SN involvement, we assessed the clinical outcomes of patients with stage I/II WR-DLBCL and SN-DLBCL and compared them with those having corresponding stages of DLBCL in the lymph nodes but without other extranodal involvement (LN-DLBCL) in the same period. We compared the patients' clinical characteristics, treatment modalities, event-free survival (EFS), and overall survival (OS) among the three subgroups.

Results: We analyzed 67, 15, and 106 patients with WR-DLBCL, SN-DLBCL, and LN-DLBCL, respectively, between January 2000 and December 2019. All patients received front-line rituximab-based regimens, and > 80% received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone-based regimens. More patients with SN-DLBCL had revised International Prognostic Index (R-IPI) score 3 (27%) when compared with those with WR-DLBCL (7%) and those with LN-DLBCL (10%, p = 0.181). Patients with WR-DLBCL, LN-DLBCL, and SN-DLBCL had 5-year EFS and OS rates of 80.7%, 59.5%, and 41.9% (p = 0.021) and 83.7%, 70.8%, and 55.8% (p = 0.032), respectively. Compared to patients with LN-DLBCL, those with WR-DLBCL also had a significantly favorable 5-year EFS rate (p = 0.021) and 5-year OS rate (p = 0.023). Three of the 15 patients with SN-DLBCL experienced lymphoma recurrence in the brain after front-line treatment. In multivariate analyses, R-IPI scores of 1-2 and 3 served as significantly poor prognostic factors for patients with poor EFS and OS.

Conclusions: Compared to patients with LN-DLBCL, patients with WR-DLBCL receiving front-line rituximab-based treatments had favorable clinical outcomes; however, patients with SN-DLBCL had worse clinical outcomes. Further studies on molecular prognostic factors and treatment strategies for SN-DLBCL are warranted.

Keywords: DLBCL; R-IPI score; Taiwan; Waldeyer ring; extranodal; prognosis; sinonasal area.

Abstract

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