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Diffuse large B-cell lymphoma: experience from a tertiary care center in north India

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Abstract

Limited information is available from developing countries regarding clinico-pathological presentation of diffuse large B-cell lymphoma (DLBCL). We undertook a retrospective case record study to determine the clinico-laboratory characteristics, treatment outcomes, and prognostic factors for DLBCL and additionally analyzed percentage distribution and patient characteristics for other major subtypes of non-Hodgkin’s lymphoma (NHL). DLBCL, constituting 59.3% of all NHL cases, was the predominant subtype. For DLBCL, males:females ratio was 2.7:1 and the median age at presentation was 47 years. Lymphadenopathy was present in 57% patients and B symptoms in 56.7%. A total of 49.3% of patients had Ann Arbor Stage IV disease. Significant differences were observed between favorable (international prognostic index [IPI]—0, 1, and 2) and unfavorable prognosis groups (IPI—3, 4, and 5) with regards to mean hemoglobin levels (P < 0.005), platelet counts (P < 0.05), serum albumin levels (P < 0.05), and erythrocyte sedimentation rates (P < 0.005), thereby suggesting their role as prognostic markers in our population. The median event free survival was 32 months (95% CI: 0–92 months) and the median overall survival was 47 months (95% CI: 3–100 months). Among total NHL, the earlier age of onset, male dominant sex ratio, and higher frequency of B symptoms sets apart NHL in Indian population from that in the developed countries.

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References

  1. Cancer incidence in five continents. Volume VII. IARC scientific publications. 1997;143:i–xxxiv, 1–1240.

  2. Zheng T, Mayne ST, Boyle P, Holford TR, Liu WL, Flannery J. Epidemiology of non-Hodgkin lymphoma in Connecticut. 1935–1988. Cancer. 1992;70(4):840–9. doi:10.1002/1097-0142(19920815)70:4<840::AID-CNCR2820700420>3.0.CO;2-I.

    Article  CAS  PubMed  Google Scholar 

  3. Mitterlechner T, Fiegl M, Muhlbock H, Oberaigner W, Dirnhofer S, Tzankov A. Epidemiology of non-Hodgkin lymphomas in Tyrol/Austria from 1991 to 2000. J Clin Pathol. 2006;59(1):48–55. doi:10.1136/jcp.2005.026815.

    Article  CAS  PubMed  Google Scholar 

  4. Krol AD, le Cessie S, Snijder S, Kluin-Nelemans JC, Kluin PM, Noordijk EM. Non-Hodgkin’s lymphoma in the Netherlands: results from a population-based registry. Leuk Lymphoma. 2003;44(3):451–8. doi:10.1080/1042819021000038010.

    Article  CAS  PubMed  Google Scholar 

  5. Cowan RA, Jones M, Harris M, Steward WP, Radford JA, Wagstaff J, et al. Prognostic factors in high and intermediate grade non-Hodgkin’s lymphoma. Br J Cancer. 1989;59(2):276–82.

    CAS  PubMed  Google Scholar 

  6. Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin’s lymphomas: distributions of the major subtypes differ by geographic locations. Non-Hodgkin’s Lymphoma Classification Project. Ann Oncol. 1998;9(7):717–20. doi:10.1023/A:1008265532487.

    Article  CAS  PubMed  Google Scholar 

  7. Hunt KE, Reichard KK. Diffuse large B-cell lymphoma. Arch Pathol Lab Med. 2008;132(1):118–24.

    PubMed  Google Scholar 

  8. Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. NEJM. 1993;328(14):1002–6. 8.

    Article  CAS  PubMed  Google Scholar 

  9. Jagarlamudi R, Kumar L, Kochupillai V, Kapil A, Banerjee U, Thulkar S. Infections in acute leukemia: an analysis of 240 febrile episodes. Med Oncol. 2000;17(2):111–6. doi:10.1007/BF02796205.

    Article  CAS  PubMed  Google Scholar 

  10. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 1999;17(4):1244.

    CAS  PubMed  Google Scholar 

  11. Hampson FA, Shaw AS. Response assessment in lymphoma. Clin Radiol. 2008;63(2):125–35. doi:10.1016/j.crad.2007.10.005.

    Article  CAS  PubMed  Google Scholar 

  12. Oki Y, Yamamoto K, Kato H, Kuwatsuka Y, Taji H, Kagami Y, et al. Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patients’ survival benefit from rituximab. Eur J Haematol. 2008;81(6):448–53. doi:10.1111/j.1600-0609.2008.01129.x.

    Article  PubMed  Google Scholar 

  13. Garg A, Dawar R, Agarwal V, Rustagi RK, Kochupillai V. Non-Hodgkin’s lymphoma in northern India. A retrospective analysis of 238 cases. Cancer. 1985;56(4):972–7. doi:10.1002/1097-0142(19850815)56:4<972::AID-CNCR2820560445>3.0.CO;2-V.

    Article  CAS  PubMed  Google Scholar 

  14. Indian council of Medical Research. National Cancer Registry Programme Consolidated report of the population based cancer registries 1990–1996: incidence and distribution of cancer. Indian Council of Medical Research, New Delhi 2001.

  15. Intragumtornchai T, Wannakrairoj P, Chaimongkol B, Bhoopat L, Lekhakula A, Thamprasit T, et al. Non-Hodgkin’s lymphomas in Thailand. A retrospective pathologic and clinical analysis of 1391 cases. Cancer. 1996;78(8):1813–9. doi:10.1002/(SICI)1097-0142(19961015)78:8<1813::AID-CNCR24>3.0.CO;2-#.

    Article  CAS  PubMed  Google Scholar 

  16. Fisher SG, Fisher RI. The epidemiology of non-Hodgkin’s lymphoma. Oncogene. 2004;23(38):6524–34. doi:10.1038/sj.onc.1207843.

    Article  CAS  PubMed  Google Scholar 

  17. Muller AM, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of non-Hodgkin’s lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol. 2005;84(1):1–12. doi:10.1007/s00277-004-0939-7.

    Article  PubMed  Google Scholar 

  18. Tubbs RR, Fishleder A, Weiss RA, Savage RA, Sebek BA, Weick JK. Immunohistologic cellular phenotypes of lymphoproliferative disorders. Comprehensive evaluation of 564 cases including 257 non-Hodgkin’s lymphomas classified by the International Working Formulation. Am J Pathol. 1983;113(2):207–21.

    CAS  PubMed  Google Scholar 

  19. Yang K. A histopathologic and immunopathologic study of 209 malignant lymphoma cases from four regions of China: Suzhou, Nanjing, Qingdao and Shenyang. Zhonghua Zhong Liu Za Zhi [Chin J Oncol]. 1993;15(2):86–90.

    CAS  Google Scholar 

  20. Kushwaha MR, Chandra D, Misra NC, Misra PK, Agarwal SS. Leukaemias and lymphomas at Lucknow, India. Leuk Res. 1985;9(6):799–802. doi:10.1016/0145-2126(85)90295-4.

    Article  CAS  PubMed  Google Scholar 

  21. Shih LY, Liang DC. Non-Hodgkin’s lymphomas in Asia. Hematol Oncol Clin North Am. 1991;5(5):983–1001.

    CAS  PubMed  Google Scholar 

  22. Hasselblom S, Ridell B, Nilsson-Ehle H, Andersson PO. The impact of gender, age and patient selection on prognosis and outcome in diffuse large B-cell lymphoma—a population-based study. Leuk Lymphoma. 2007;48(4):736–45. doi:10.1080/10428190601187703.

    Article  PubMed  Google Scholar 

  23. Nakamura S, Lymphoma Study Group of Japanese Pathologists. The world health organization classification of malignant lymphomas in Japan: incidence of recently recognized entities. Pathol Int. 2000;50(9):696–702. doi:10.1046/j.1440-1827.2000.01108.x.

  24. Piankijagum A, Pacharee P, Wasi P. Malignant lymphomas in Thailand: an analysis of 1095 cases. J Med Assoc Thai. 1980;63(4):181–91.

    CAS  PubMed  Google Scholar 

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Khera, R., Jain, S., Kumar, L. et al. Diffuse large B-cell lymphoma: experience from a tertiary care center in north India. Med Oncol 27, 310–318 (2010). https://doi.org/10.1007/s12032-009-9211-2

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