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Original Article

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Korean J Hematol 2012; 47(3):

Published online September 25, 2012

https://doi.org/10.5045/kjh.2012.47.3.213

© The Korean Society of Hematology

Clinical characteristics and outcomes of primary bone lymphoma in Korea

So Yeon Kim1,#, Dong-Yeop Shin1,#, Seung-Sook Lee2, Cheolwon Suh3, Jae-Yong Kwak4, Hoon-Gu Kim5, Jae Hoon Lee6, Soon Il Lee7, Ye Rim Lee1, Seung Hwa Kang1, Se Kwon Mun1, Min Jae Lee1, Hyo-Rak Lee1, Sung Hyun Yang1, and Hye Jin Kang1*

Author Info. +

1Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

2Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

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

4Division of Hematology-Oncology, Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

5Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

6Department of Internal Medicine, Gachon University Hospital, Gachon University of Medicine and Science School of Medicine, Incheon, Korea.

7Division of Hematology-Oncology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea.

Correspondence to : Correspondence to Hye Jin Kang, M.D., Ph.D. Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-970-1289, Fax: +82-2-970-2410, mdhyejin@gmail.com

Received: July 11, 2012; Revised: August 8, 2012; Accepted: September 10, 2012

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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Background

This study evaluates the effectiveness of immunochemotherapy and radiation therapy in the treatment of patients with primary bone lymphoma (PBL).

Methods

We retrospectively reviewed the medical records of 33 patients with PBL who were treated at 6 medical centers in Korea from 1992 to 2010. Clinicopathological features and treatment outcomes were analyzed.

Results

The median age of the patients participating in our study was 40 years. The most common sites of involvement were the pelvis (12.36%) and femur (11.33%). CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like regimens were administered to 20 patients (61%), and R-CHOP (rituximab plus CHOP) was administered to the remaining 13 patients (39%). The overall response rate was 89% (complete response, 76%; partial response, 12%). The overall survival (OS) of patients with solitary bone lesions was longer than that of patients with multiple bone lesions (median OS: not reached vs. 166 months, respectively; P=0.089). Addition of rituximab to CHOP did not significantly affect either OS or progression-free survival (P=0.53 and P=0.23, respectively). Combining radiation therapy with chemotherapy also did not improve the OS or progression-free survival of patients with solitary bone lesions.

Conclusion

Conventional cytotoxic chemotherapy remains an effective treatment option for patients with PBL. Additional benefits of supplementing chemotherapy with either rituximab or radiation therapy were not observed in this study. Further investigation is needed to characterize the role of immunochemotherapy in treating patients with PBL.

Keywords Bone lymphoma, Radiotherapy, Rituximab

Article

Original Article

Korean J Hematol 2012; 47(3): 213-218

Published online September 25, 2012 https://doi.org/10.5045/kjh.2012.47.3.213

Copyright © The Korean Society of Hematology.

Clinical characteristics and outcomes of primary bone lymphoma in Korea

So Yeon Kim1,#, Dong-Yeop Shin1,#, Seung-Sook Lee2, Cheolwon Suh3, Jae-Yong Kwak4, Hoon-Gu Kim5, Jae Hoon Lee6, Soon Il Lee7, Ye Rim Lee1, Seung Hwa Kang1, Se Kwon Mun1, Min Jae Lee1, Hyo-Rak Lee1, Sung Hyun Yang1, and Hye Jin Kang1*

1Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

2Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

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

4Division of Hematology-Oncology, Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

5Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

6Department of Internal Medicine, Gachon University Hospital, Gachon University of Medicine and Science School of Medicine, Incheon, Korea.

7Division of Hematology-Oncology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea.

Correspondence to: Correspondence to Hye Jin Kang, M.D., Ph.D. Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-970-1289, Fax: +82-2-970-2410, mdhyejin@gmail.com

Received: July 11, 2012; Revised: August 8, 2012; Accepted: September 10, 2012

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

Background

This study evaluates the effectiveness of immunochemotherapy and radiation therapy in the treatment of patients with primary bone lymphoma (PBL).

Methods

We retrospectively reviewed the medical records of 33 patients with PBL who were treated at 6 medical centers in Korea from 1992 to 2010. Clinicopathological features and treatment outcomes were analyzed.

Results

The median age of the patients participating in our study was 40 years. The most common sites of involvement were the pelvis (12.36%) and femur (11.33%). CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like regimens were administered to 20 patients (61%), and R-CHOP (rituximab plus CHOP) was administered to the remaining 13 patients (39%). The overall response rate was 89% (complete response, 76%; partial response, 12%). The overall survival (OS) of patients with solitary bone lesions was longer than that of patients with multiple bone lesions (median OS: not reached vs. 166 months, respectively; P=0.089). Addition of rituximab to CHOP did not significantly affect either OS or progression-free survival (P=0.53 and P=0.23, respectively). Combining radiation therapy with chemotherapy also did not improve the OS or progression-free survival of patients with solitary bone lesions.

Conclusion

Conventional cytotoxic chemotherapy remains an effective treatment option for patients with PBL. Additional benefits of supplementing chemotherapy with either rituximab or radiation therapy were not observed in this study. Further investigation is needed to characterize the role of immunochemotherapy in treating patients with PBL.

Keywords: Bone lymphoma, Radiotherapy, Rituximab

Fig 1.

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Figure 1.

Overall survival of all participating patients with primary bone lymphoma (median overall survival: 166 months, 95% CI: 0-339).

Blood Research 2012; 47: 213-218https://doi.org/10.5045/kjh.2012.47.3.213

Fig 2.

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Figure 2.

Survival by number of bones involved. (A) Overall survival (OS) of patients with solitary bone lesions compared to that of patients with multiple bone lesions (median OS: not reached vs. 166 months, P=0.089) and (B) Progression-free survival (PFS) of patients with solitary bone lesions compared to that of patients with multiple bone lesions (median PFS: 74 months vs. 74 months, P=0.99).

Blood Research 2012; 47: 213-218https://doi.org/10.5045/kjh.2012.47.3.213

Fig 3.

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Figure 3.

Progression-free survival of patients with solitary bone lesions treated with radiation therapy (Median progression-free survival: 74 months vs. 87 months, P=0.78). Abbreviation: RT, radiation therapy.

Blood Research 2012; 47: 213-218https://doi.org/10.5045/kjh.2012.47.3.213

Fig 4.

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Figure 4.

Overall survival of patients at stage IV of the disease, treated with rituximab (Median overall survival: not reached, P=0.53).

Blood Research 2012; 47: 213-218https://doi.org/10.5045/kjh.2012.47.3.213

Table 1 . Patient characteristics (N=33)..

Abbreviation: IPI, International Prognostic Index..

Table 2 . Distribution of the sites of bone involvement..


Table 3 . Treatment..

Abbreviations: CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisolone; R-CHOP, rituximab plus CHOP; RT, radiation therapy..
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