Large Cell non-Hodgkin Lymphoma Research Articles

Intravascular Large Cell non-Hodgkin Lymphoma in Subacute-Chronic Subdural Hematoma: a case report

Introduction: Intravascular lymphoma (IVL) is a rare subtype of non-Hodgkin extranodal lymphoma with characterized by a positive CD20 B cell proliferation in small lumens and medium-sized blood vessels, except veins and large arteries. Blood vessels in the central nervous system (CNS) and the skin is most often affected. These tumors usually occur in older adults and aggressive. Methodology: Descriptive study of the case report type, whose data were obtained from the patient’s medical record and has received the patient's consent to be published. Case presentation: This paper reports a 63-year-old man, who suffered Parkinson disease and neurological symptoms for 6 months. From imaging, there is a chronic subacute subdural hematoma in the right frontotemporoparietal area. Operation performed, histopathological examination of the tissue with Hematoxylin-Eosin staining and immunohistochemical examination confirmed diagnosis Intravascular Large Cell non-Hodgkin Lymphoma (IVLCL) type B-cell CD20 (+) in subacute-chronic subdural hematoma (SDH). Discussion: This tumor is characterized by selective growth of lymphoma cells within the lumen of blood vessels, particularly capillaries, and with the exception of the larger arteries and veins, occurred in adults, with a median age of 67 years. Sixty five percent show neurological symptoms with rapidly progressive cognitive dysfunction or subacute dementia. The cause of chronic SDH in this patient is unknown, but it can occur due to increasing age, brain atrophy, and enlargement of the subdural space, relatively minor trauma. Conclusion: This lymphoma is aggressive with a poor prognosis but a chemotherapy regimen with rituximab significantly improves the clinical outcome of this patient, with an overall survival of 3 years 60-81%.

Survival of HIV-infected patients with high-grade non-Hodgkin's lymphomas: A retrospective study of experiences in Zimbabwe.

BackgroundRituximab in combination with chemotherapy is now widely accepted as standard of care for AIDS-related lymphomas (ARLs) of B-cell origin. However, the clinical impact of rituximab in resource limited settings remains unknown. Different settings and patient heterogeneity may affect the effect of any given treatment. The study objectives were to determine if rituximab use was associated with improved 18-month overall survival (OS) of patients with ARLs and to identify correlates of 18-month OS.MethodsA retrospective review of medical records of adult HIV infected patients treated for high-grade large cell non-Hodgkin’s lymphoma with chemotherapy +/- rituximab between 2015–2017 was conducted. Vital status and disease progression/relapse at 18 months were determined. Survival functions were estimated using Kaplan-Meier methodology. Equality of survival functions were assessed using Log-rank tests and Cox regression analysis to identify risk factors for mortality.ResultsOne hundred and twenty-four eligible medical records were identified. This was a cohort of black Africans with a median age of 42 (IQR: 33–47) and a 57% male gender distribution. Overall survival at 6, 12 and 18 months for the population was 75.9%, 44.0% and 30.6% respectively. Over the study period, 72.6% of patients were diagnosed with disease progression/ relapse. There was a higher rate of rituximab use in patients who were treated at a private institution and those with medical insurance. Rituximab use was not associated with a reduction in 18-month mortality [adjusted hazard ratio (aHR)1.28, (95% CI 0.63–2.60)]. Risk factors for 18-month mortality were male gender [aHR 1.89, (95% CI 1.04–3.43)], age 40+ years [aHR 2.49, (1.33–4.67)], receipt of <3 chemotherapy cycles [aHR 2.48, (95% CI 1.33–4.60)] and low socioeconomic status [aHR 2.44, (95% CI 1.28–4.67)].ConclusionsPredictors of mortality were male gender, older age, low socioeconomic status and receipt of a less than half of the recommended number of chemotherapy cycles. Rituximab use was not associated with an improvement in 18-month OS in Zimbabwean patients with ARLs.

Primary Diffuse Large B-cell Lymphoma of the Breast: Treatment and Long-Term Outcome of Two Cases

AbstractPrimary breast lymphoma (PBL) is a rare form of extranodal non-Hodgkin’s lymphoma (NHL). It accounts for &lt;0.5% of all breast malignancies and 2% extranodal NHL. Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype. We report three cases of PBL diagnosed and treated at our center. The clinical records of three female patients diagnosed with PBL from 2004 to 2015 were reviewed. Two patients had DLBCL, and the third patient had anaplastic large cell (ALCL) NHL. The mean age at presentation was 56 years. One patient with DLBCL was treated with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy and the second patient with rituximab plus CHOP chemotherapy. Both the patients showed complete response and have had a disease-free survival of 84 and 96 months, respectively. The third patient with ALCL refused further treatment after confirmation of diagnosis. PBL-DLBCL can be successful treated with chemotherapy, and long-term survival is similar to nodal NHL.

Anaplastic Lymphoma Kinase Immunocytochemistry in Fine Needle Aspiration Diagnosis of Anaplastic Large-cell Lymphoma.

Background:Anaplastic large-cell lymphoma (ALCL) is a rare subtype of non-Hodgkin's lymphoma (NHL) characterized by the presence of unusual giant cells. It is a CD30+lymphoma of T-cells lineage, which shows anaplastic lymphoma kinase-nucleophosmin (ALK-NPM) rearrangement. ALCL on fine needle aspiration cytology (FNAC) shows unusually large and bizarre tumor cells.Materials and Methods:All aspirates seen over a 6-year period from November 2009 to November 2015 in which a diagnosis of ALCL or Hodgkin's lymphoma (HL) with bizarre giant cells were suspected on cytomorphology were prospectively selected. Twenty such aspirates were subjected to CD-30 and ALK-1 immunocytochemistry (ICC). Subsequent biopsy was available in all cases.Results:Out of 20 cases, seven cases, suspected to be ALCL on FNAC, were confirmed on biopsy. ALK-1 was positive in both cytology and biopsy of 6/7 of these. Two cases suspected to be ALCL on cytomorphology were HL (1) and diffuse large B-cell lymphoma (DLBCL) (1) on biopsy, both of which were ALK-1 negative on cytology. Eight cases of HL and three cases of large-cell NHL, which were all ALK negative on cytology, were confirmed on biopsy.Conclusion:ICC for ALK and CD30 is useful in aspiration cytodiagnosis of ALCL. One CD30 positive DLBCL and one ALK negative ALCL showed concordant results of ICC on cytology and histology.

Simultaneous occurrence of RET-negative Medullary Thyroid Carcinoma (MTC) and extrathyroidal B large cell Non-Hodgkin Lymphoma (NHL)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Autologous Transplantation As Consolidation for High Risk Aggressive T-Cell Non-Hodgkin's Lymphoma: A SWOG S9704 Intergroup Trial Subgroup Analysis

Background: We recently clarified the use of consolidative autologous stem cell transplantation (ASCT) as first remission consolidation therapy for high grade diffuse aggressive T and B non-Hodgkin's lymphoma (NHL)in patients with high-intermediate (HI) or High (H) age adjusted IPI disease (Stiff et al, NEJM 369:1681). After receiving CHOP or R-CHOP for 5 cycles responding patients were randomized to either 3 more induction cycles or 1 cycle followed by an ASCT using either a BCNU or TBI based preparative regimen. We found a PFS but not OS advantage for those randomized to transplant and no differential treatment effect for those with T-NHL patients as compared to B-NHL in the initial analysis of this study. In light of Phase II data suggesting a value of early ASCT for T-NHL, a lack of randomized ASCT trials for T-NHL and the inferior prognosis for T-NHL as compared to B cell disease, we further evaluated this sub group, since a post hoc analysis of the entire trial did find a survival advantage for those with H IPI disease. This then provided a unique opportunity to evaluate the role of ASCT consolidation for T-cell NHL in the setting of a prospective randomized trial.Method: Among the 370 eligible B-NHL and T-NHL patients with HI/H IPI disease treated on this trial, 40 had a T-NHL phenotype and were the subject of this analysis. Individual patient files were re-reviewed and those randomized after the first 5 cycles of CHOP were further analyzed for stage, IPI group, histology (centrally reviewed), and response to induction and consolidation and updated survival outcome.Results: Of the 40 T-NHL patients enrolled on study, 28 (70%) were randomized after induction therapy, a similar ratio to the entire trial (68%). Twelve were not randomized; 1 was ineligible for study, and of the eligible 11, 9 were HI IPI and 8 had peripheral T cell (PTCL-NOS). These 11 were not randomized due to patient choice in 2, and all of the remaining 9 pts progressed early: 2 after C1; 3 after C3, 1 after C4, and 3 after C5. For the 28 randomized, their median age was 50 and 19 were males. Of the group, 21/28 had B symptoms at diagnosis, 14 had stage IV disease, and 18 and 10 were in the HI and H IPI groups respectively. Histologies included 11 with PTCL-NOS, 7 angioimmunoblastic and 10 anaplastic large cell NHL. At randomization 13 were to continue CHOP and 15, ASCT. Of the 15 assigned to ASCT, 3 did not undergo transplant (2-refusals, 1- unable to mobilize); 7 received the BCNU-etoposide-cyclophosphamide and 5 the TBI-etoposide-cyclophosphamide preparative regimen. The 5 year estimates of PFS and OS for the randomized ASCT vs CHOP only groups (intent to treat) were 40% vs 38% (p=0.56) and 40% vs 45% (p=0.98) respectively. We found no difference in outcome based on IPI group, histology or stage of disease. Interestingly, only 1/7 patients who received BCV as the ASCT preparative regimen are long term survivors vs 4/5 receiving the TBI-based regimen.Conclusions: We did not observe a PFS/OS advantage for those with high-risk T-NHL in first remission randomized to ASCT following CHOP induction vs CHOP alone in this retrospective analysis. In addition, the 30% early drop out rate before randomization due primarily to early progression strongly suggests that more optimal induction regimens need to be developed for this disease. While the numbers are small the finding that TBI based preparative regimens might be associated with a higher PFS is of interest and deserves further study.Support: NIH/NCI grants CA180888 and CA180819; Bristol-Myers Squibb.Contributions of Dr. Raymond R Tubbs, deceased, are gratefully acknowledged. [Display omitted] DisclosuresPorcu:miRagen: Other: Investigator in a clinical trial; celgene: Other: Investigator in a clinical trial; Millenium: Other: investigator in a clinical trial; Innate Pharma: Other: Investigator in a clinical trial. Winter:Pharmacyclics: Research Funding; Medivation: Other: Provision of investigational agent for clinical trial; Seattle Genetics: Research Funding; GSK: Research Funding. Kahl:This study was coordinated by the ECOG-ACRIN Cancer Research Group (Robert L. Comis, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs) and supported by the National Cancer Institute of the National Institutes of Health under the following award number: Research Funding. Smith:Juno: Consultancy; TGTX: Consultancy; AbbVie: Consultancy; Celgene: Consultancy; Genentech: Consultancy, Other: on a DSMB for two trials ; Gilead: Consultancy; Portola: Consultancy; Amgen: Other: Educational lecture to sales force; Pharmacyclics: Consultancy. Rimsza:NCI/NIH: Patents & Royalties: L.M. Rimsza is a co-inventor on a provisional patent, owned by the NCI of the NIH, using Nanostring technology for determining cell of origin in DLBCL.. Fisher:Gilead: Consultancy; Seattle Genetics: Consultancy; Johnson and Johnson: Consultancy. Friedberg:Bayer: Honoraria, Other: Data Safety Monitoring Board.

Efficacy of crizotinib in ALK fusion variants

In 1995, rearrangement of the anaplastic lymphoma kinase ( ALK ) gene was first reported as a fusion gene in anaplastic large cell non-Hodgkin lymphoma, and in 2005 it was again on focus when Mano et al. reported that echinoderm microtubule-associated protein-like4 (EML4)-ALK fusion gene is a powerful oncogene in lung cancer (1,2).

Radiothérapie des lymphomes malins non hodgkiniens ganglionnaires folliculaires et diffus de stade limité

Treatment with monoclonal antibodies, especially rituximab, is more and more frequent and questions the interest of radiotherapy in limited stages of diffuse B-cell large cell and follicular non-Hodgkin's lymphomas. From a review of literature, it appears that radiotherapy is of interest in bulky disease, patients with incomplete metabolic response, elderly patients receiving short chemotherapy and those with recurrence after exclusive chemotherapy. Finally, this article gives recommendations on available techniques of radiotherapy and doses to be delivered.

Anaplastic Lymphoma Kinase as a Cancer Target in Pediatric Malignancies.

In this era of more rational therapies, substantial efforts are being made to identify optimal targets. The discovery of translocations involving the anaplastic lymphoma kinase (ALK) receptor tyrosine kinase in a subset of non-small cell lung cancers has become a paradigm for precision medicine. Notably, ALK was initially discovered as the fusion gene in anaplastic large cell non-Hodgkin lymphoma, a disease predominantly of childhood. The discovery of activating kinase domain mutations of the full-length ALK receptor as the major cause of hereditary neuroblastoma, and that somatically acquired mutations and amplification events often drive the malignant process in a subset of sporadic tumors, has established ALK as a tractable molecular target across histologically diverse tumors in which ALK is a critical mediator of oncogenesis. We are now uncovering the reexpression of this developmentally regulated protein in a broader subset of pediatric cancers, providing therapeutic targeting opportunities for diseases with shared molecular etiology. This review focuses on the role of ALK in pediatric malignancies, alongside the prospects and challenges associated with the development of effective ALK-inhibition strategies.

Herpes simplex lymphadenitis in association with chronic lymphocytic leukaemia

Herpes simplex lymphadenitis is a rare condition that is most commonly seen in immunocompromised patients. To date, less than 30 cases have been reported in the literature. It is most commonly seen in patients with haematological malignancy, especially with chronic lymphocytic leukaemia. However, it can be associated with other neoplasms such as Hodgkin lymphoma, mantle and marginal zone B-cell lymphoma, acute and chronic myeloid leukaemia. Presentation can be varied from localised lymphadenopathy, generalised lymphadenopathy with or without a rash, and disseminated HSV infection with multiple organ involvement. Histologically, it shows areas of coalescing necrosis and inflammatory cell infiltrates including histiocytes and neutrophils. Multinucleate cells with ground glass nuclei and Cowdry type A intranuclear inclusions are diagnostic; the diagnosis can be confirmed with herpes simplex virus in-situ hybridisation or immunohistochemistry. Differential diagnoses to consider include cat scratch lymphadenitis, mycobacterial tuberculosis lymphadenitis, Kikuchi-Fujimoto lymphadenitis, systemic lupus erythematosus, Hodgkin lymphoma and large cell non-Hodgkin lymphoma. Herpes simplex lymphadenitis is an important diagnosis which can mimic transformation of an underlying haematological malignancy. We present a case of a 68-year-old male with localised lymphadenopathy and history of chronic lymphocytic leukaemia.

Western Intravascular Lymphoma (IVL): Case Series of Published Reports Between 1994-2014

Introduction: IVL is rare entity that often associated with disseminated aggressive pattern and fatal clinical course. It is characterized byproliferation of clonal lymphoma cells within blood vessel lumina of various organs that can represent diagnostic challenge due to with non-specific symptoms. IVL is categorized as a subset of large cell non-Hodgkin lymphoma and divided into western and Asian types. We hereby present this systematic review to better describe the salient features of the western subtype, treatment options and overall prognosis. Methods:A systematic review of the Medline and Embase databases via OVID engine was conducted to search for primary articles and case reports under keywords “intravascular lymphoma”,” angiotropic lymphoma” and “malignant angioendotheliomatosis”. Search was limited to publications between January 1994 and April 2014 including all the following; human cases, English language, pathologically confirmed cases and western subtype. Asian variants and cases without sufficient information were excluded. End points were overall survival and treatment, in addition to description of western types and related demographics. Chi-square test was used to analyze categorical covariates data. Student T test was used to compare subgroups means for continuous covariates. Statistical analysis was performed using SAS 9.3 software. Results: A total of 155 patients (Pts) were identified with western type IVL. 53% of cases were males (n=82) and median age on presentation was 64 years (median for B-cell and T-cell IVL 64 & 54 respectively). B-cell IVL (77%, n=119) was the most common subtype (T-cell 9%, NK-cell 1%, unspecified 13%).All cases staged as stage IV with 14% bone marrow involvement (n=21). Presenting symptoms were fever (52%), neurological (51%), fatigue (46%), skin lesions (28%), night sweats (23%), weight loss (23%), edema (22%), gastrointestinal (14%), respiratory (14%), genitourinary (7%), musculoskeletal (5%) and cardiovascular (1%). Median over-all survival from diagnosis was 5 months (mean B-cell 10.8 months, T-cell 10.4,P=0.9472). Fifty seven percent of pts treated with chemotherapy (19% CHOP, 16% R-CHOP 25, and 21% other). Pts treated with chemotherapy had mean survival of 16 months (95% confidence interval [CI] 12-20 months) compared to 2 months (95% CI: 2-4 moths) for those who did not receive chemotherapy (P<0.0001). The median survival of B and T-cells was similar in chemo treated pts (10.4, 10.8 respectively, P=0.9472). Rituximab was used in 19% of pts while 10% treated with intravenous methotrexate (MTX) regimen. In B-cell pts treated with R-CHOP vs CHOP, the mean survival was 21.2 and 10.2 months respectively, P<0.0247, while those treated with MTX vs no MTX mean OS was 37.4 and 14.3 months respectively, P=0.115, and rituximab vs no rituximab mean OS were 19.5 and 14.7 respectively, P=0.2294. In all pts treated with chemotherapy, median survival of those who received MTX was 25 months (95% CI 11.3-38.7) versus a mean OS of 14.3 months (95% CI 10.4-10.8) for those who did not receive MTX (P=0.0232). Conclusions: Western IVL is an aggressive type of lymphoma with a relative poor prognosis. In this systemic review, we found no statistical difference in OS between B- and T-cell types. In chemotherapy treated B-cell IVL, MTX and rituximab clinically prolonged survival but were not statistically significant. However, those who received RCHOP had better OS than those who received CHOP therapy. In all pts treated with chemotherapy, MTX significantly prolonged survival. The addition of MTX to all patients with IVL and rituximab for B-cell IVL to the backbone of multi-agent chemotherapy maybe beneficial and the use of CNS directed therapy should be considered. DisclosuresNo relevant conflicts of interest to declare.

Rare Presentation of Large Cell Lymphoma

Lymphoma is a common cancer of childhood. Its pathologic subtype of anaplastic large cell Non-Hodgkins Lymphoma (NHL) is rare and spread to the central nervous system (CNS) is even rarer. We present here such a case who presented to us with an acute history of fever and diplopia and co-existent polyarthritis since 8 years diagnosed as NHL with CNS involvement. CNS involvement is a rare presenting manifestation of NHL and is an important cause of morbidity and mortality in these patients. Chronic arthritis could be a risk factor or manifestation of immunodeficiency or immune dysregulation when associated with lymphoma. It is important to suspect NHL in children presenting with these symptoms for prompt evaluation and better clinical outcome.

Primary Effusion Lymphoma

Primary effusion lymphoma is a large cell non-Hodgkin lymphoma localized predominantly in body cavities and occasionally in extracavitary regions. It presents with characteristic lymphomatous effusions in the absence of solid tumor masses, and pleural, peritoneal, and pericardial spaces are most often involved. It is typically associated with human herpesvirus 8 infection in immunocompromised individuals, in the setting of human immunodeficiency virus infection, organ transplantation, or in rare cases advanced age. Histologically, primary effusion lymphoma is characterized by atypical lymphoid cells of B-cell lineage with large nuclei and prominent nucleoli. Demonstration of human herpesvirus 8 latent antigens is required for diagnosis, and treatment modalities are limited at this time. In this review, we aim to summarize clinicopathologic features of this rare and unique entity.

Linfomas asociados a infección por VIH en pacientes del Hospital Clínico San Borja Arriarán / Fundación Arriarán2001-2008

Hodgkin lymphomas (HL) and non Hodgkin lymphomas (NHL) are frequently associated to acquired immunodeficiency syndrome in adults.To systematize the clinical features and histological characteristics of lymphomas in AIDS patients, its treatment and outcomes in our institution.Retrospective analysis of patients with HIV-associated lymphoma between January 2001 and December 2008 at the San Borja Arriarán Hospital complex.Information was obtained from 30 patients with NHL and 7 with HL, with a median of 40 years. The majority of tumors were Burkitt lymphoma (47%), diffuse large cell lymphoma B-cell (37%) and NHL of T lineage (10%). There was no CNS or cavities lymphoma. Almost all patients (86.7%) with NHL were treated with CHOP chemotherapy, 57% of those receiving treatment had progression or relapse from complete remission. A rescue chemotherapy was indicated in 4 patients. 73% of patients receiving CHOP, complete 5 to 6 cycles of chemotherapy. The use of CHOP chemotherapy for the subgroup of patients with Burkitt lymphoma achieved low rates of complete remission and frequent relapse and disease progression, showing that CHOP was ineffective in improving survival, especially in high risk patients. We found statistically significant differences in survival according to IPIae (International prognostic Index age-adjusted).Non-Hodgkin lymphoma in HIV patients treated with chemotherapy protocols PAlNDA persists in our environment as a disease with a poor prognosis compared with findings in the international literature. The incorporation of new drugs of proven utility as rituximab and specific schemes chemotherapy could improve these results. The establishment of prognostic groups established by IPIae can guide clinical work for the use of chemotherapy tailored to their specific risk and optimized according to histological type.

Value of Computed Tomography–guided Core Needle Biopsy in Diagnosis of Primary Pulmonary Lymphomas

PurposeTo evaluate the value of computed tomography (CT)–guided core needle biopsy in diagnosis of primary pulmonary lymphoma and its subtypes. Materials and MethodsA retrospective analysis of the records of all patients with primary pulmonary lymphoma between January 2005 and August 2011 was performed. There were 25 patients referred to the radiology department for CT-guided core needle biopsy. The success rate and complications were assessed. ResultsA definitive diagnosis and accurate histologic subtype were obtained in 21 patients with a success rate of 84.0%. Diagnosis was made in the other four patients with bronchoscopy and surgery. Non-Hodgkin lymphoma (NHL) was the diagnosis in all patients. Most subtypes were mucosa-associated lymphoid tissue (MALT) lymphomas (n = 19). The remaining subtypes included three diffuse large B-cell NHLs, two peripheral T-cell lymphomas not otherwise specified, and one anaplastic large cell NHL. The success rate of core needle biopsy was 95% (18 of 19) for MALT lymphomas, 67% (2 of 3) for diffuse large B cell NHLs, and 33% (1 of 3) for other NHLs. The success rate for MALT lymphomas was significantly higher than that of non-MALT lymphomas according to Fisher exact t test (P = .031). No serious complications occurred in any patients. ConclusionsCT-guided core needle biopsy is a reliable procedure to assist in diagnosis and classification of primary pulmonary lymphomas, especially MALT lymphomas.

A Phase II Trial of R-CHOP Followed by Zevalin Radioimmunotherapy for Patients with Previously Untreated Stages I and II CD20+ Diffuse Large Cell Non-Hodgkin's Lymphoma: an Eastern Cooperative Oncology Group Study (E3402).

AbstractAbstract 2687 Background:Patients with early stage (Stages I, II) diffuse large B cell (DLBCL) have been traditionally treated with either CHOP x6 alone or with CHOP followed by involved field external beam radiotherapy (IFRT). With the demonstration of the superiority of rituximab CHOP (RCHOP) in advanced stage DLBCL, RCHOP has been adopted as the chemoimmunotherapy standard of care in early stage disease with or without IFRT. Radioimmunotherapy (RIT) has the advantage of delivering high-energy, short path length radiation in a targeted approach using an anti-CD20 antibody as the carrier. Thus, radiation is potentially targeted to microscopic sites outside of known disease. Goals:To evaluate the complete response (CR) rate and functional CR rate (CR or CRu/PR and PET negative) to a treatment regimen of RCHOP followed by 90Y-ibritumomab tiuxetan (Zevalin, Spectrum Pharmaceuticals) radioimmunotherapy (RIT); only patients not achieving PET negative status after RIT were to be given IFRT. The study goal was to achieve a functional CR rate of ≥75%. Patients and Methods:Eligible patients were those with new, untreated Stages I or II DLBCL as determined by standard CT scanning, adequate blood counts, creatinine and bilirubin <2.0 mg/dl, cardiac ejection fraction >45%, and a performance status 0–2. Stage I patients were required to have ≥1 adverse risk factor (≥60 years, bulky disease, elevated LDH or PS2). Patients received standard RCHOP21 × 2 cycles and then were restaged. Patients in CR received 2 additional cycles; those in PR or CRu received 4 additional cycles. At end of RCHOP a PET scan was repeated and centrally reviewed; those with a PR or functional CR proceeded to Zevalin RIT 0.4 mCi/kg (maximum 32 mCi) within 12 weeks of the last RCHOP. Patients were restaged 12 weeks post-RIT; PET negative patients were observed without maintenance; PET positive patients received 30Gy involved field radiation and then were restaged. Descriptive statistics were used to summarize the patient characteristics, treatment and response. The Kaplan-Meier method was used to estimate failure rates. Results:Between Dec 2004 and Nov 2008, 62 patients were enrolled; after pathology review 53 were considered eligible. 42% (22/53) patients were stage I/IE; 58% (31/53) were stage II/IIE. 57% (30/53) received 6 cycles of RCHOP; 40% (21/53) received 4 cycles; and 2 patients received 1 and 2 cycles, respectively. After immunochemotherapy, 79% (42/53) were in functional CR and 19% (10/53) PR; 1 was unevaluable. Of the 53 eligible patients who completed RCHOP therapy 91% (48/53) proceeded to RIT. After RIT, 87% (46/53; 95% CI: 75–95) were in CR/CRu and 89% (47/53; 95% CI:77–96%) were in functional CR. One patient proceeded to IFRT. The median follow-up is now 4.3 years. Seven (13%) of patients have had tumor progression but only 2 have died (1 of disease). At 4 years, 88% of patients remain progression free and 98% remain alive (Fig 1,2). The median has not been reached for either PFS or OS. There has been one case of myelodysplastic syndrome. Conclusions:Combination immunochemotherapy and RIT is an active regimen for patients with early stage DLBCL. Nearly all patients will achieve functional CR without the requirement of IFRT. The regimen of RCHOP and RIT for early stage DLBCL is worthy of further study. [Display omitted] [Display omitted] Disclosures:Witzig:Spectrum: Membership on an entity's Board of Directors or advisory committees, Research Funding, uncompensated Other. Off Label Use: Use of Zevalin in treating patients with Stage I-II DLBCL. Kahl:Roche: Consultancy; Genentech: Consultancy, Research Funding. Horning:Genentech: Employment; Roche: Equity Ownership.

Second Transplants for NHL: If at First You Don't Succeed…

unrelated donors (90% of the population), and the high frequency of mismatched unrelated donors (one third of the total population). Unfortunately, no separate analyses on the outcome of these poorly matched patients or according to different numbers of risk factors are provided, so their individual effects are hard to quantify. So what else can we learn from this analysis that will inform our decisions in the future? It would seem that the most important question is that given the outcomes described, would this population have done better if they were to undergo allogeneic transplantation in first remission rather than waiting for progression? Large series that have looked at the results of allogeneic transplantation for large cell lymphoma have not identified a population of patients that would do better with an allogeneic rather than an autologous transplantation, although there is a hint that high-risk patients did better than expected with allografts as compared to their projected outcome with an autologous approach as initial therapy for recurrent or refractory disease [3]. Given the high relapse rates reported in the CORAL trial [4] for patients who recur quickly after initial chemotherapy, particularly if they failed a rituximab-containing regimen, perhaps an allograft in this patient population would be more effective than an autologous approach. It is however, speculation as to whether this would be the case, particularly given the difficulty in finding appropriate matches quickly enough to benefit patients with rapidly progressive non-Hodgkin lymphoma (NHL). In contrast to the paradigm of therapy for patients with large cell NHL, patients with mantle cell lymphoma are frequently treated with very aggressive induction regimens such as rituximab plus hypercyclophosphamide,vincristine,adriamycin,dexameth

Sellar and Parasellar Intravascular Lymphoma Mimicking Pituitary Apoplexy

Intravascular lymphoma (IVL) is a rare subtype of large-cell non-Hodgkin lymphoma, characterized by proliferation of lymphoma cells within the lumina of small vessels. There are no previously reported cases of IVL involving the pituitary gland presenting with neuro-ophthalmic findings. A 68-year-old female presented with headache, right third nerve palsy, and Horner syndrome. MRI showed a 1.4-cm sellar mass consistent with a pituitary macroadenoma. Two weeks later, despite treatment with dexamethasone, the patient developed complete bilateral ophthalmoplegia and ptosis. Repeat MRI showed invasion of the clivus and cavernous sinuses, and a transsphenoidal pituitary biopsy was undertaken. The preliminary histopathology was consistent with bland pituitary apoplexy, but subsequent examination of an incidentally biopsied nasal polyp revealed endovascular malignant lymphoid cells that, on further scrutiny, were also present in the pituitary tissue. The diagnosis of IVL was confirmed, and the patient had an excellent clinical and radiological response to cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (CHOP-R) chemotherapy. IVL may involve the pituitary gland, causing sellar mass effect, cavernous sinus infiltration, and pituitary ischemia, mimicking pituitary apoplexy with neuro-ophthalmic features. It can be effectively treated with CHOP-R chemotherapy.

Severe High-Density Lipoprotein Deficiency Associated With Autoantibodies Against Lecithin:Cholesterol Acyltransferase in Non-Hodgkin Lymphoma

An antibody against the lecithin:cholesterol acyltransferase (LCAT) enzyme, which negates cholesterol esterification in plasma, causing severe high-density lipoprotein deficiency (HD), was identified in a woman with a large-cell non-Hodgkin lymphoma. Successful treatment of the lymphoma resulted in clearance of the antibody and complete correction of the defective cholesterol esterification and HD. To our knowledge, an acquired LCAT deficiency leading to severe HD has not been reported previously in association with a malignant disease, and this patient represents the first such documented case.

Correlation of fluorodeoxyglucose uptake and tumor-proliferating antigen Ki-67 in lymphomas

To investigate the correlation between cellular proliferation and the fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography (PET/CT) imaging by comparing 50 cases of different subtypes of lymphoma. Fifty cases of lymphomas were collected. Each case was labeled with Ki-67 stain, a marker of cellular proliferation, and a PET/CT examination was performed. All lymphoma cases were sorted according to the World Health Organization's classification, and the International Non-Hodgkin's Lymphoma Working Formulation was used to differentiate groups of large and small cell non-Hodgkin's lymphoma. The Ki-67 staining was described as slight, mild, middle, or strong according to the nuclear staining of positive cells. FDG uptake by lesions in PET/CT images was semi-quantitatively analyzed to calculate the average standard uptake value. The statistics software SPSS13.0 was used to calculate the mean and standard deviation of the FDG uptake value of the lymphoma subtypes, the difference between the large and small cell lymphoma group with a Student's t-test, and the correlation between the Ki-67 level and FDG uptake of lesion with a Spearman's analysis. The FDG uptake value of large cell origin lymphoma was significantly higher than that of small cell origin lymphoma (t = 6.19, P < 0.01). The correlation coefficients between the Ki-67 level and FDG uptake value in lymph nodal and extranodal lesions was 0.750 and 0.843, respectively. Ki-67 staining, a reflection of tumor-proliferation activity, was significantly related to the FDG uptake value in lymphoma lesions.