Outcomes with R-CEOP for R-CHOP-ineligible patients with diffuse large B-cell lymphoma are highly dependent on cell of origin

Abstract

Immunohistochemical examination revealed DNA HHV-8 lymph nodes tissue in patients with plasma cell and mix cell morphology. Results: In 45 patients were diagnosed plasma cell or mix cell variant CD: in 21, 8% local, in 29, 9% MCD. Immunohistochemistry with LANA HHV-8 antigen performed in 13 case local and in 21 generalized lesions. HHV8 identified only in six (28.6 %) cases MCD: five male and one female with median age 48, 2 years (range 36-77). The median follow-up was 39.2 months (3.3 years). In four cases were diagnosed mixed cell variant CD and in two cases plasma cell variant CD. In all cases detected constitutional symptoms, generalized lymphadenopathy, hepatosplenomegaly. There were various laboratory changes but the most significant were anemia, leukocytosis, leukopenia, thrombocytopenia, hypergammaglobulinemia, M-component, increased ESR and circulating immune complexes. In two cases of HHV-8-positive MCD was combined with autoimmune hemolytic anemia and in two cases with non-Hodgkin’s lymphoma. Two patients are alive after CHOP and R-CHOP therapy with rituximab maintenance. Two patients died of uncontrolled autoimmune hemolysis against the backdrop of long-term use of prednisone. Another patient died in the fourth year of the disease, after numerous cycles of chemotherapy by transformation into plasmablastic lymphoma. Moreover, 78 y.o. female died of kidney failure after one cycle CHOP chemotherapy. Conclusions: HHV-8-positive MCD proceeds with aggressive multiorgan lesions, pronounced changes in laboratory tests and characterized by unfavorable prognosis with a high risk of transformation in plasmablastic lymphoma and lethal outcome. Timely chemotherapy in patients with HHV-8-positive MCD can achieve remission and prolong life.