Experience with high-dose chemotherapy in patients with testicular diffuse large B-cell lymphoma


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AIM. To evaluate the efficiency of high-dose therapy according to the DLBL-CNS-2007 protocol in patients with testicular diffuse large B-cell lymphoma (DLBL). MATERIALS AND METHODS. Out of 408 male patients with non-Hodgkin lymphoma, 8 patients aged 50 to 69 years (median age 55.5 years) with primary testicular (n=3) or with generalized-stage testicular DLBL (n=5) were included in the study. These patients were followed up at the Hematology Research Center, Ministry of Health of the Russian Federation, in 2007 to 2013. Systemic chemotherapy was performed in accordance with the DLBL-CNS-2007 protocol. RESULTS. The DLBL-CNS-2007 protocol was implemented in first-line therapy in 7 patients. At the first diagnostic stage, one patient was found to have anaplastic seminoma; in this connection right orchifuniculectomy was carried out, followed by radiotherapy applied to the scrotal region in a total focal dose of 34 Gy. This patient with disease recurrence was included in the DLBL-CNS-2007 treatment protocol. The number of polychemotherapy (PCT) cycles (n=4 or 6) was determined by the time to achieve complete remission. After completion of DLBL-CNS-2007 PCT, 6 patients achieved complete remission; the primary resistant disease was noted in 2 cases. At this moment 6 patients are alive in first complete remission during the median follow-up of 50 months (10-54 months). CONCLUSION. The findings suggest that high-dose therapy according to the DLBL-CNS-2007 protocol in patients with testicular DLBL can achieve complete remission and increase overall and event-free survival rates. This fact should be borne out by a large number of observations.

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Опыт применения высокодозной химиотерапии у больных диффузной В-крупноклеточной лимфомой с поражением яичка. - Резюме. Цель исследования. Оценить эффективность высокодозной терапии по протоколу ДВККЛ-ЦНС-2007 у больных диффузной В-крупноклеточной лимфомой (ДВККЛ) с поражением яичка. Материалы и методы. Из 408 пациентов мужского пола с неходжкинской лимфомой в исследование включено 8 больных ДВККЛ с первичным вовлечением яичка (у 3) или с генерализованной стадией ДВККЛ, у которых клиническая картина дебютировала с поражения яичка (у 5) в возрасте от 50 до 69 лет (медиана возраста 55,5 года). Данные пациенты наблюдались с 2007 по 2013 г. в ФГБУ "Гематологический научный центр" (ГНЦ) Минздрава России. Системная химиотерапия проводилась согласно протоколу ДВККЛ ЦНС-2007. Результаты. В первой линии терапии протокол ДВККЛ ЦНС-2007 выполнен у 7 пациентов. Одному пациенту на первом этапе диагностики установлен диагноз анапластической семиномы, в связи с чем произведена орхифуникулэктомия справа и в дальнейшем проведена лучевая терапия на область мошонки в суммарной очаговой дозе 34 Гр. В рецидиве заболевания данный пациент включен в протокол лечения ДВККЛ ЦНС-2007. Количество курсов ПХТ (4 или 6) определялось периодом достижения полной ремиссии. После завершения полихимиотерапии по схеме ДВККЛ-ЦНС-2007 полная ремиссия достигнута у 6 пациентов, в 2 случаях отмечалось первично-резистентное течение заболевания. В настоящий момент 6 пациентов живы в первой полной ремиссии при медиане наблюдения 50 (10-54) мес. Заключение. Полученные результаты позволяют предположить, что терапия в высоких дозах согласно протоколу ДВККЛ-ЦНС-2007 у больных ДВККЛ с поражением яичка позволяет достичь полной ремиссии заболевания, увеличить общую и "бессобытийную" выживаемость пациентов. Для подтверждения данного факта необходимо большее количество наблюдений.
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References

  1. Cheville J.C., Sebo T.J., Lager D.J. et al. Leydig cell tumour of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. Am J Surg Pathol 1998; 22 (11): 1361-1367.
  2. Shahab N., Doll D.C. Testicular lymphoma. Semin Oncol 1999; 26: 259-269.
  3. Muttarak M., Chaiwun B. Painless scrotal swelling: ultrasonographical features with pathological correlation. Singapore Med J 2005; 46: 196-201.
  4. Nozawa Y., Wang J., Weiss L.M. et al. Diffuse large B-cell lymphoma with spindle cell features. Histopathology 2001; 38: 177-178.
  5. Bueso-Ramos C.E., Pugh W.C., Butler J.J. Anaplastic large cell lymphoma presenting as a soft-tissue mass mimicking sarcoma. Mod Pathol 1994; 7: 497-500.
  6. Wang J., Sun N.C., Nozawa Y. et al. Histologic and immunohistochemical characterization of extranodal diffuse large-cell lymphomas with prominent spindle cell features. Histopathology 2001; 39: 476-481.
  7. Alizadeh A.A., Eisen M.B., Davis R.E. et al. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature 2000; 403: 503-511.
  8. Swerdlow S.H., Campo E., Harris N.L. et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press; 2008.
  9. Al-Abbadi M.A., Hattab E.M., Tarawneh M.S. et al. Primary testicular diff use large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup: a study of 18 cases. Mod Pathol 2006; 19: 1521-1527.
  10. Booman M., Douwes J., Glas A.M. et al. Primary testicular diffuse large B-cell lymphomas have activated B-cell-like subtype characteristics. J Pathol 2006; 210: 163-171.
  11. Leval L., Harris N.L. Variability immunophenotype in diffuse large B-cell lymphoma and its clinical relevance. Histopathology 2003; 43: 509-528.
  12. Bea S., Zettl A., Wright G. et al. Diffuse large B-cell lymphoma subgroups have distinct genetic profiles that influence tumor biology and improve gene-expression-based survival prediction. Blood 2005; 106: 3183-3190.
  13. Cigudosa J.C., Parsa N.Z., Louie D.C. et al. Cytogenetic analysis of 363 consecutively ascertained diffuse large B-cell lymphomas. Genes, Chromosomes & Cancer 1999; 25: 123-133.
  14. Barans S., Connor S., Evans P. et al. Rearrangement of the BCL-6 locus at 3q27 is an independent poor prognostic factor in nodal diffuse large B-cell lymphoma. Br J Hematol 2002; 117: 322-332.
  15. Магомедова А.У., Кравченко С.К., Кременецкая А.М. Диффузная В-крупноклеточная лимфосаркома. Диагностические критерии, алгоритм обследования и основные программы лечения. Пробл гематол 2004; 2: 26-28.
  16. Huang J., Sanger G., Greiner T. et al. The t(14;18) defines a unique subset of large B-cell lymphoma with a germinal center B-cell gene expression profile. Blood 2002; 99 (7): 2285-2290.
  17. Sonnen R., Schmidt W.P., Kuse R. et al. Treatment of aggressive B non-Hodgkin`s lymphoma in advanced age considering comorbidity. Br J Hematol 2002; 119: 634-639.
  18. Bea S., Colomo L. López-Guillermo А. et al. Clinicopathologic significance and prognostic value of chromosomal imbalances in diffuse large B-cell lymphomas. J Clin Oncol 2004; 22 (17): 3498-3506.
  19. Friedberg J.W., Fisher R.I. Diffuse large B cell lymphoma. Hematol Oncol Clin North Am 2008; 22: 941-952.
  20. Li S., Lin P., Fayad L. B-cell lymphomas with MYC/8q24 rearrangements and IGH@BCL2/t (14;18)(q32;q21): an aggressive disease with heterogeneous histology, germinal center B-cell immunophenotype and poor outcome. Modern Pathol 2012; 25: 145-156.
  21. Vitolo U., Ferreri A.J., Zucca E. Primary testicular lymphoma. Crit Rev Oncol Hematol 2008; 65: 183-189.
  22. Vitolo U., Chiapealla A., Ferreri A.J. et al. First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOP, CNS prophilaxis, and contralateral testis irradiation: final results of an international phase II trial. J Clin Oncol 2011; 29 (20): 2766-2772.
  23. Kuper-Hommel M., Janssen-Heijnen M., Vreugdenhil G. Clinical and pathological features of testicular diffuse large B-cell lymphoma: a heterogeneous disease. Leukemia Lymphoma 2012; 53 (2): 242-246.
  24. Zouhair A., Herrmann E., Ugurluer G. Primary testicular lymphoma. Swiss Med Wkly 2010; 140: 13076.
  25. Zhang C., Wang X.P., Ying Z.T. Primary testicular non-Hodgkin's lymphoma: clinical analysis of 21 cases. Zhonghua Yi Xue Za Zhi 2013; 93 (28): 2209-2211.
  26. Fonseca R., Habermann T.M., Colgan J.P. et al. Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer 2000; 88 (1): 154-161.
  27. Smith B.E., Braun R.E. Germ Cell Migration Across Sertoli Cell Tight Junctions. Science 2012; 338 (6108): 798-802.
  28. Wolf S., Seehaus B., Minol K. et al. Die Blut-Hirn-Schranke: Eine Besonderheit des cerebralen Mikrozirkulationssystems. Naturwissenschaften 1996; 83: 302-311.
  29. Matter K., Balda M.S. Holey barrier: claudins and the regulation of brain endothelial permeability. J Cell Biol 2003; 161: 459-460.
  30. Seymour J. Extra-nodal lymphoma in rare localizations: bone, breast and testes. Hematol Oncol 2013; 31 (Suppl 1): 60-63.
  31. Gupta D., Sharma A., Raina V. Primary testicular non-Hodgkin lymphoma: A single institution experience from India. Indian J Cancer 2009; 46 (1): 46-49.
  32. Abrey L.E., Ben-Porat L., Panageas K.S. Primary central nervous system lymphoma: the Memorial Sloan-Kettering Cancer Center prognostic model. J Clin Oncol 2006; 24 (36): 5711-5715.
  33. Zouhair A., Weber D., Belkacémi Y. Outcome and patterns of failure in testicular lymphoma: a multicenter Rare Cancer Network study. Int J Radiat Oncol Biol Phys 2002; 52 (3): 652-656.
  34. Wang Y., Li Z.M., Huang J.J. Three prognostic factors influence clinical outcomes of primary testicular lymphoma. Tumour Biol 2013; 34 (1): 55-63.
  35. Horne M.J., Adeniran A.J. Primary Diffuse Large B-Cell Lymphoma of the Testis. Arch Pathol Lab Med 2011; 135 (10): 1363-1367.
  36. Schulz H., Pels H., Schmidt-Wolf I. Intraventricular treatment of relapsed central nervous system lymphoma with the anti-CD20 antibody rituximab. Haematologica 2004; 89 (6): 753-754.
  37. Zucca E., Conconi A., Mughal T.I. et al. Patterns of outcome and prognostic factors in primary large cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study group. J Clin Oncol 2003; 21: 20-27.
  38. Sussman E.B., Hajdu S.I., Lieberman P.H., Whitmore W.F. Malignant lymphoma of the testis: a clinicopathologic study of 37 cases. J Urol 1977; 118 (6): 1004-1007.
  39. Sun G.X., Cao X.S., Li Q., Wang Z.L. Correlation of BCL-6, MYC and p53 gene abnormalities with immunological subtypes and prognosis of diffuse large B-cell lymphoma. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2012; 29 (5): 576-581.
  40. Кравченко С.К., Капланская И.Б., Губкин А.В. и др. Первичная диффузная В-крупноклеточная лимфосаркома яичка с вовлечением центральной нервной системы. Гематол и трансфузиол 2009; 3: 25-28.

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