Treatment of primary testicular diffuse large B cell lymphoma without prophylactic intrathecal chemotherapy: a single center experience

Jeongseok Kim; Dok Hyun Yoon; Inkeun Park; Shin Kim; Jung Sun Park; Sang-Wook Lee; Jooryung Huh; Chan-Sik Park; Cheolwon Suh

doi:10.5045/br.2014.49.3.170

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Original Article

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Blood Res 2014; 49(3):

Published online September 25, 2014

https://doi.org/10.5045/br.2014.49.3.170

Treatment of primary testicular diffuse large B cell lymphoma without prophylactic intrathecal chemotherapy: a single center experience

Jeongseok Kim¹, Dok Hyun Yoon¹, Inkeun Park⁴, Shin Kim¹, Jung Sun Park¹, Sang-Wook Lee², Jooryung Huh³, Chan-Sik Park³, and Cheolwon Suh^1*

Author Info. +

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁴Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.

Correspondence to : Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: May 13, 2014; Revised: June 14, 2014; Accepted: July 23, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

Primary testicular diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive extranodal lymphoma, and its relapse in the central nervous system (CNS) is a major concern during treatment. Despite this, the role of intrathecal prophylaxis in primary testicular DLBCL remains controversial.

Methods

We retrospectively reviewed the medical records of 14 patients with primary testicular DLBCL diagnosed between November 2000 and June 2012, and analyzed the CNS relapse rate in patients treated without intrathecal prophylaxis. Survival curves were estimated using the Kaplan-Meier method.

Results

The median age at diagnosis was 57 years (range, 41-79 years). Unilateral testicular involvement was observed in 13 patients. Nine patients had stage I, 1 had stage II, and 4 had stage IV disease. The international prognostic index was low or low-intermediate risk in 12 patients and high-intermediate risk in 2 patients. Thirteen patients underwent orchiectomy. All the patients received systemic chemotherapy without intrathecal prophylaxis, and prophylactic radiotherapy was administered to the contralateral testis in 12 patients. The median follow-up period of surviving patients was 39 months (range, 10-139 months). Median overall survival was not reached and the median progression-free survival was 3.8 years. Four patients experienced relapse, but CNS relapse was observed in only one patient (7.1%) with stage IV disease, 27 months after a complete response.

Conclusion

Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports.

Keywords Diffuse large B cell lymphoma, Intrathecal prophylaxis, Primary testicular lymphoma

Article

Original Article

Blood Res 2014; 49(3): 170-176

Published online September 25, 2014 https://doi.org/10.5045/br.2014.49.3.170

Treatment of primary testicular diffuse large B cell lymphoma without prophylactic intrathecal chemotherapy: a single center experience

Jeongseok Kim¹, Dok Hyun Yoon¹, Inkeun Park⁴, Shin Kim¹, Jung Sun Park¹, Sang-Wook Lee², Jooryung Huh³, Chan-Sik Park³, and Cheolwon Suh^1*

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁴Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.

Correspondence to: Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: May 13, 2014; Revised: June 14, 2014; Accepted: July 23, 2014

Abstract

Background

Methods

Results

Conclusion

Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports.

Keywords: Diffuse large B cell lymphoma, Intrathecal prophylaxis, Primary testicular lymphoma

Abstract

Fig 1.

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Figure 1.

Treatment flowchart of 14 patients with primary testicular DLBCL. Abbreviations: R-CHOP, rituximab+cyclophosphamide+doxorubicin+vincristine+prednisolone; RT, radiotherapy; LN, lymph node; CNS, central nervous system; DLBCL, diffuse large B-cell lymphoma.

Blood Research 2014; 49: 170-176https://doi.org/10.5045/br.2014.49.3.170

Fig 2.

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Figure 2.

Kaplan-Meier plots for progression-free and overall survival. Abbreviations: OS; overall survival, PFS; progression-free survival.

Blood Research 2014; 49: 170-176https://doi.org/10.5045/br.2014.49.3.170

Table 1 . Patient characteristics, treatment modalities, and outcomes..

^a)Elevated LDH: >250 IU/L..

Abbreviations: ECOG PS, Eastern Cooperative Oncology Group Performance Status; IPI, International Prognostic index; LDH, lactate dehydrogenase; R-CHOP, rituximab+cyclophosphamide+doxorubicin+vincristine+prednisolone; CNS, central nervous system..

Table 2 . Clinical characteristics, treatment modalities, and outcomes for each patient..

^a)Two patients died..

Abbreviations: LN, lymph node; IPI, International Prognostic Index; LDH, lactate dehydrogenase; CTX, chemotherapy; RT, radiotherapy; PFS, progression-free survival; OS, overall survival; Uni, unilateral; Bi, bilateral; Rt, right; Lt, left; B, both; BM, bone marrow; CNS, central nervous system; R-CHOP, rituximab+cyclophosphamide+doxorubicin+vincristine+prednisolone; CR, complete response; PAL, paraaortic lymph node..

Table 3 . Univariate analysis of OS and PFS according to clinical characteristics..

Abbreviations: OS, overall survival; PFS, progression-free survival; IPI, International Prognostic index; L, low; LI, low-intermediate; HI, high-intermediate; H, high; LDH, lactate dehydrogenase; RT, radiotherapy..