Contributions
Abstract: PB1449
Type: Publication Only
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Cutaneous infiltration by systemic B-cell lymphoma is rare and frequently associated with advanced-stage disease. Radiotherapy is recommended as consolidation therapy in some extranodal B-cell lymphomas and as front-line treatment in primary cutaneous B-cell lymphoma. Studies that address the role of radiotherapy in the treatment of cutaneous infiltration by systemic B-cell lymphoma are lacking.
Aims
1) to compare response to treatment in patients treated with and without radiotherapy;
2) to analyse disease-free survival (DFS) and relapse location after cutaneous infiltration in systemic B-cell lymphoma.
Methods
Retrospective unicentric cohort study including patients with systemic B-cell lymphoma with cutaneous infiltration treated on a tertiary hospital from 2010 to 2021. Patients were divided in 3 groups according to type of treatment after cutaneous infiltration: chemotherapy (CHEMO), radiotherapy (RT) and chemotherapy followed by consolidation radiotherapy (CHEMO+RT). Primary outcome was response to treatment and secondary outcomes were DFS and relapse location after cutaneous infiltration. We used Fisher’s exact test for group comparisons and survival analysis for DFS calculation. Data was collected by clinical records consultation and SPSS was used for statistical analysis.
Results
Twenty one patients were included in the analysis, 12 were female and median age at diagnosis was 67 years [Q1-Q3 58.5-75.0]. Median follow-up was 22 months [Q1-Q3 12.5-109.0]. Cutaneous infiltration was present at diagnosis in 15 patients (71%); in the 6 patients without infiltration at diagnosis, the median number of treatment lines was 1.5 [Q1-Q3 0.75-3.25]. The most frequent type of lymphoma was diffuse large B cell (DLBCL) (n=13), followed by follicular (n=3) and lymphocytic lymphoma (n=2). Eighty percent of patients had advanced-stage disease at diagnosis (AA stage IV); 2 patients were HIV positive. The head & neck region was the most frequently involved (n=11) and the most frequent types of lesion were nodules (n=8) and tumours (n=8). 6 patients had extensive/distant cutaneous disease. First line of treatment after cutaneous infiltration was CHEMO in 15 patients (R-CHOP in10, R-CVP in 4, GEMOX followed by autologous bone marrow transplant in 1 patient), CHEMO+RT in 3 patients (R-CHOP in 2 and Rituximab in 1; RT dose 25-36 Gy) and RT in 3 patients (12-40 Gy). There were no differences between the groups regarding age at presentation, gender, staging or DLBCL predominance. Complete response (CR) rate was higher in the CHEMO group (80%) than in the RT group (0%) (p=0.025); no difference in CR rate was found between the CHEMO and CHEMO+RT group (67%)(p=1.00). Of the 14 patients that achieved CR, 5 relapsed in the skin and 1 in the skin and nodes. Two of these patients were in the CHEMO+RT group and 4 were in the CHEMO group. All the cutaneous relapses occurred in the site of initial cutaneous infiltration. There were no differences in median DFS between CHEMO and CHEMO+RT (p=0.638).
Conclusion
Radiotherapy as consolidation treatment and as single treatment is not associated with better CR rates or more prolonged DFS than isolated chemotherapy. Relapse after CR in these patients is frequently located in the same cutaneous territory of the initial infiltration. These findings raise the question of the utility of skin radiotherapy in systemic B-cell lymphoma with cutaneous involvement, although more studies with larger sample sizes are needed to confirm our conclusions.
Keyword(s): Cutaneous lymphoma, Non-Hodgkin's lymphoma, Radiotherapy
Abstract: PB1449
Type: Publication Only
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Cutaneous infiltration by systemic B-cell lymphoma is rare and frequently associated with advanced-stage disease. Radiotherapy is recommended as consolidation therapy in some extranodal B-cell lymphomas and as front-line treatment in primary cutaneous B-cell lymphoma. Studies that address the role of radiotherapy in the treatment of cutaneous infiltration by systemic B-cell lymphoma are lacking.
Aims
1) to compare response to treatment in patients treated with and without radiotherapy;
2) to analyse disease-free survival (DFS) and relapse location after cutaneous infiltration in systemic B-cell lymphoma.
Methods
Retrospective unicentric cohort study including patients with systemic B-cell lymphoma with cutaneous infiltration treated on a tertiary hospital from 2010 to 2021. Patients were divided in 3 groups according to type of treatment after cutaneous infiltration: chemotherapy (CHEMO), radiotherapy (RT) and chemotherapy followed by consolidation radiotherapy (CHEMO+RT). Primary outcome was response to treatment and secondary outcomes were DFS and relapse location after cutaneous infiltration. We used Fisher’s exact test for group comparisons and survival analysis for DFS calculation. Data was collected by clinical records consultation and SPSS was used for statistical analysis.
Results
Twenty one patients were included in the analysis, 12 were female and median age at diagnosis was 67 years [Q1-Q3 58.5-75.0]. Median follow-up was 22 months [Q1-Q3 12.5-109.0]. Cutaneous infiltration was present at diagnosis in 15 patients (71%); in the 6 patients without infiltration at diagnosis, the median number of treatment lines was 1.5 [Q1-Q3 0.75-3.25]. The most frequent type of lymphoma was diffuse large B cell (DLBCL) (n=13), followed by follicular (n=3) and lymphocytic lymphoma (n=2). Eighty percent of patients had advanced-stage disease at diagnosis (AA stage IV); 2 patients were HIV positive. The head & neck region was the most frequently involved (n=11) and the most frequent types of lesion were nodules (n=8) and tumours (n=8). 6 patients had extensive/distant cutaneous disease. First line of treatment after cutaneous infiltration was CHEMO in 15 patients (R-CHOP in10, R-CVP in 4, GEMOX followed by autologous bone marrow transplant in 1 patient), CHEMO+RT in 3 patients (R-CHOP in 2 and Rituximab in 1; RT dose 25-36 Gy) and RT in 3 patients (12-40 Gy). There were no differences between the groups regarding age at presentation, gender, staging or DLBCL predominance. Complete response (CR) rate was higher in the CHEMO group (80%) than in the RT group (0%) (p=0.025); no difference in CR rate was found between the CHEMO and CHEMO+RT group (67%)(p=1.00). Of the 14 patients that achieved CR, 5 relapsed in the skin and 1 in the skin and nodes. Two of these patients were in the CHEMO+RT group and 4 were in the CHEMO group. All the cutaneous relapses occurred in the site of initial cutaneous infiltration. There were no differences in median DFS between CHEMO and CHEMO+RT (p=0.638).
Conclusion
Radiotherapy as consolidation treatment and as single treatment is not associated with better CR rates or more prolonged DFS than isolated chemotherapy. Relapse after CR in these patients is frequently located in the same cutaneous territory of the initial infiltration. These findings raise the question of the utility of skin radiotherapy in systemic B-cell lymphoma with cutaneous involvement, although more studies with larger sample sizes are needed to confirm our conclusions.
Keyword(s): Cutaneous lymphoma, Non-Hodgkin's lymphoma, Radiotherapy