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CLINICAL CHARACTARISTICS AND PROGNOSIS OF PATIENTS WITH INDOLENT NON-HODGKIN LYMPHOMA AND RISK OF TRANSFORMATION TO AGGRESSIVE LYMPHOMA: A SINGLE JORDANIAN CENTER EXPERIENCE
Author(s):
Deeb Zahran
,
Deeb Zahran
Affiliations:
Internal Medicine,King Abdulla University Hospital (KAUH),Irbid,Jordan
Mahmoud Ayesh (Haj Yousef)
,
Mahmoud Ayesh (Haj Yousef)
Affiliations:
Internal Medicine,King Abdulla University Hospital (KAUH),Irbid,Jordan
Tariq Kewan
,
Tariq Kewan
Affiliations:
Internal Medicine,King Abdulla University Hospital (KAUH),Irbid,Jordan
Samir Al Bashir
Samir Al Bashir
Affiliations:
Pathology,King Abdulla University Hospital (KAUH),Irbid,Jordan
(Abstract release date: 05/18/17) EHA Library. Zahran D. 05/18/17; 182596; PB1882
Deeb Zahran
Deeb Zahran
Contributions
PDF Abstract
Abstract

Abstract: PB1882

Type: Publication Only

Background
Indolent Non Hodgkin Lymphomas (INHL) are slow growing lymphomas that usually arise from B-cells. They are characterized by slow appearance and progression of symptoms compared to aggressive non Hodgkin lymphoma (NHL) namely Diffuse large B-cell Lymphoma (DLBL). Small percentage of INHL might transform to aggressive NHL.

Aims
We aim to describe the clinical characteristics, prognosis and risk of transformation to aggressive lymphoma in patients with INHL in North Jordan as a model for other Middle East countries in which such data is lacking.

Methods
All patients diagnosed with INHL between Jan 2003 to Jan 2017 were retrospectively reviewed. Clinical and laboratory data at time of diagnosis including gender, age, lactate dehydrogenase level (LDH), pathological subtypes, CT and PET/CT scans were studied. Extranodal involvement was confirmed either by histopathological studies or CT and PET/CT scan. Transformation to aggressive lymphoma was confirmed by histopathological studies. Patients were followed and overall survival rate was calculated. Mean survival times were calculated using Kaplan-Meier method.

Results
Among 265 patients diagnosed with NHL, only 88 patients (33.20%) confirmed to have INHL. 54 patients (61.4%) were males and 34 patients (38.6%) were females. Their ages at diagnosis ranged from (29-83) years with a mean (SD) of 59.26 (12.39).

Among these patients, 45 patients (51.1%) had small lymphocytic lymphoma / chronic lymphocytic leukemia (CLL), 20 patients (22.7%) had follicular lymphoma (FL), 15 patients (17%) had marginal zone lymphoma (MZL), 6 patients (6.8%) had mantel cell lymphoma (MCL) and 2 patients (.78%) had unspecified INHL. Mean age of MZL (53.2 years) and FL (55.3 years) were significantly lower than mean age of MCL (58 years) and CLL (62.77 years).
22 patients (23.9%) had extra nodal Involvement. There was significant association between INHL subtypes and extra nodal sites involvement. (P-value = .001). 60% of patients with MZL, 50% of patients with MCL, 20 % of patients with FL and 8.9 % of patients with CLL had extranodal sites involvement.
11 patients (12.5%) from all INHL had transformed to Diffuse Large B-cell Lymphoma (DLBL). There was significant association between INHL subtypes and transformation to DLBL, (P-value=.02). 7 from 20 patients with FL (35%) and 4 from 45 patients with CLL (8.9%) had transformed to DLBL. Mean LDH level (886.1 U/L) in patients with transformation to DLBL was significantly higher than mean LDH level (490.7U/L) in other patients, (P-value=.0004). There was no significant association between mean age and mean albumin level with risk of transformation to DLBL.
The overall survival rate was 56.8 %. 10 years and 5 years survival rates were 47% and 60 % respectively. Mean survival time in patients with MCL (31.8 months) was significantly lower than mean survival time in patients with follicular (85.48 months), MZL (90.6 months) and CLL(103.6 months) patients, (p-value=.oooo4).
There was no significant difference in survival rate between patients who transformed and patients who didn’t transform to DLBL.

Conclusion
Prevalence of INHL among patients with NHL in North Jordan is 33.2%. The most common INHL subtypes in our patients were CLL (51.1%) and FL (20.7%). These findings are significantly different from Saudi Arabia and Western Countries in which FL is the most common subtype. FL and CLL are associated with higher risk of transformation to DLBL. High LDH level is considered a risk factor for transformation to DLBL in our patients. MCL is associated with significantly lower mean survival time than other INHL subtypes.

Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical

Keyword(s): Indolent Non-Hodgkin's Lymphoma, Transformation, prognosis

Abstract: PB1882

Type: Publication Only

Background
Indolent Non Hodgkin Lymphomas (INHL) are slow growing lymphomas that usually arise from B-cells. They are characterized by slow appearance and progression of symptoms compared to aggressive non Hodgkin lymphoma (NHL) namely Diffuse large B-cell Lymphoma (DLBL). Small percentage of INHL might transform to aggressive NHL.

Aims
We aim to describe the clinical characteristics, prognosis and risk of transformation to aggressive lymphoma in patients with INHL in North Jordan as a model for other Middle East countries in which such data is lacking.

Methods
All patients diagnosed with INHL between Jan 2003 to Jan 2017 were retrospectively reviewed. Clinical and laboratory data at time of diagnosis including gender, age, lactate dehydrogenase level (LDH), pathological subtypes, CT and PET/CT scans were studied. Extranodal involvement was confirmed either by histopathological studies or CT and PET/CT scan. Transformation to aggressive lymphoma was confirmed by histopathological studies. Patients were followed and overall survival rate was calculated. Mean survival times were calculated using Kaplan-Meier method.

Results
Among 265 patients diagnosed with NHL, only 88 patients (33.20%) confirmed to have INHL. 54 patients (61.4%) were males and 34 patients (38.6%) were females. Their ages at diagnosis ranged from (29-83) years with a mean (SD) of 59.26 (12.39).

Among these patients, 45 patients (51.1%) had small lymphocytic lymphoma / chronic lymphocytic leukemia (CLL), 20 patients (22.7%) had follicular lymphoma (FL), 15 patients (17%) had marginal zone lymphoma (MZL), 6 patients (6.8%) had mantel cell lymphoma (MCL) and 2 patients (.78%) had unspecified INHL. Mean age of MZL (53.2 years) and FL (55.3 years) were significantly lower than mean age of MCL (58 years) and CLL (62.77 years).
22 patients (23.9%) had extra nodal Involvement. There was significant association between INHL subtypes and extra nodal sites involvement. (P-value = .001). 60% of patients with MZL, 50% of patients with MCL, 20 % of patients with FL and 8.9 % of patients with CLL had extranodal sites involvement.
11 patients (12.5%) from all INHL had transformed to Diffuse Large B-cell Lymphoma (DLBL). There was significant association between INHL subtypes and transformation to DLBL, (P-value=.02). 7 from 20 patients with FL (35%) and 4 from 45 patients with CLL (8.9%) had transformed to DLBL. Mean LDH level (886.1 U/L) in patients with transformation to DLBL was significantly higher than mean LDH level (490.7U/L) in other patients, (P-value=.0004). There was no significant association between mean age and mean albumin level with risk of transformation to DLBL.
The overall survival rate was 56.8 %. 10 years and 5 years survival rates were 47% and 60 % respectively. Mean survival time in patients with MCL (31.8 months) was significantly lower than mean survival time in patients with follicular (85.48 months), MZL (90.6 months) and CLL(103.6 months) patients, (p-value=.oooo4).
There was no significant difference in survival rate between patients who transformed and patients who didn’t transform to DLBL.

Conclusion
Prevalence of INHL among patients with NHL in North Jordan is 33.2%. The most common INHL subtypes in our patients were CLL (51.1%) and FL (20.7%). These findings are significantly different from Saudi Arabia and Western Countries in which FL is the most common subtype. FL and CLL are associated with higher risk of transformation to DLBL. High LDH level is considered a risk factor for transformation to DLBL in our patients. MCL is associated with significantly lower mean survival time than other INHL subtypes.

Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical

Keyword(s): Indolent Non-Hodgkin's Lymphoma, Transformation, prognosis

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