Patients with diffuse large B-cell lymphoma (DLBCL) and concurrent indolent lymphomas may experience similar outcomes compared with patients with DLBCL alone, according to results published in Blood.
Approximately 10% to 15% of patients with DLBCL have a concurrent indolent non-Hodgkin lymphoma (NHL) at the time of diagnosis. Researchers sought to characterize the prevalence, pathological features, and clinical outcomes of DLBCL with concurrent indolent lymphoma in a prospective study.
A total of 1324 patients with DLBCL who were treated with immunochemotherapy at a single center between March 2002 and June 2015 were included. Concurrent indolent lymphomas were present in 171 (12.9%) patients, including follicular lymphoma (FL) in 109 (8.2%) patients, marginal zone lymphoma in 15 (1.1%) patients, chronic lymphocytic leukemia/small lymphocytic lymphoma in 14 (1.1%) patients, lymphoplasmacytic lymphoma in 2 (0.2%) patients, and B-cell NHL not otherwise specified in 31 (2.3%) patients.
Patients with concurrent DLBCL and FL had fewer elevations in lactate dehydrogenase and lower International Prognostic Index (IPI) scores (P <.01 for both) compared with patients with DLBCL alone. DLBCL was germinal center B-cell-like (GCB) for 92.9% of patients with concurrent FL and 61.8% for patients with DLBCL alone (P <.01).
Median overall survival (OS) was not reached for patients with concurrent FL and 14.5 years for patients with DLBCL alone (P =.05); median event-free survival (EFS) was 11.5 years for patients with concurrent FL and 10.1 years for patients with DLBCL alone (P =.47). Patients with concurrent FL had similar median OS (not reached for both; P =.24) and median EFS (11.5 vs 10.6 years; P =.81) compared with patients who had GCB DLBCL alone.
In patients with concurrent DLBCL and other indolent lymphomas, disease stage was more advanced (P <.01) and IPI scores were higher (P =.09) compared with patients with DLBCL alone. A total of 47.7% of patients with other indolent lymphomas had non-GCB DLBCL (P =.06).
Median OS was similar between patients with other concurrent indolent lymphomas and patients with DLBCL alone (10.0 vs 14.5 years; P =.33), while median EFS was decreased for patients with other concurrent indolent lymphomas (4.8 vs 10.1 years; P =.09).
Site of indolent component did not appear to influence either EFS or OS.
The authors concluded that “patients [with DLBCL and] concurrent FL at the time of diagnosis [should] be included in clinical trials of newly diagnosed DLBCL.”
- Wang Y, Link B, Witzig T, et al. Impact of concurrent indolent lymphoma on the clinical outcome of newly diagnosed diffuse large B-cell lymphoma [published online July 26, 2019]. Blood. doi:10.1182/blood.2019000858
This article originally appeared on Hematology Advisor