Clinical features and outcome of the patients with sinonasal tract diffuse large B-cell lymphoma in the pre-rituximab and rituximab eras.

Abstract

Sinonasal tract diffuse large B-cell lymphoma (SNT-DLBCL), a rare extranodal lymphoma, is not well characterized. We performed a population-based study to determine cell-of-origin, clinical presentation and impact of rituximab (R) and central nervous system (CNS) directed chemotherapy on survival. Patients with SNT-DLBCL were identified from pathology databases. Clinical information was collected and outcomes between different treatment modalities evaluated. Thirty-two percent of the patients had germinal centre B-cell phenotype. Forty-six patients were treated with curative intent using CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like chemotherapy, 21 (46%) before and 25 (54%) in the R-era. Additionally, 24 (52%) received CNS-directed chemotherapy. Addition of R to chemotherapy reduced the risk of progression (RR=0.368, 95% CI 0.138-0.976, P=0.045) and death (RR=0.245, 95% CI 0.068-0.883, P=0.032), and translated into better survival (5-year PFS, 67% vs 38%, P=0.037; 5-year OS, 81% vs 48%, P=0.020). CNS-directed chemotherapy reduced the risk of progression (RR=0.404, 95% CI 0.159-1.029, P=0.057) and death (RR=0.298, 95% CI 0.093-0.950, P=0.041), and translated into favorable survival (5-year PFS, 67% vs 32%, P=0.050; 5-year OS 82% vs 43%, P=0.030). Patients with SNT-DLBCL benefit from rituximab and CNS-directed chemotherapy.