AI Summary & Key Takeaways
AI InsightAlthough we had a relatively low number of patients, it could be concluded that whether or not radiation therapy is per- formed, rituximab in combination with systemic chemotherapy has been proven beneficial on survival.
📌 3 Key Takeaways
Abstract
Objective: Non-Hodgkin’s lymphoma (NHL) of bone is a rare entity. The most common histological subtype is diffuse large B cell lymphoma (DLBCL). The major presenting symptoms are soft tissue swelling, bone pain and pathological fracture. Treatment options are chemotherapy, radiotherapy, surgery, or a combination of these modalities. Materials and Methods: We retrospectively analyzed the 18 patients (11 females, 7 males) with NHL of bone who were diagnosed and treated between 1995-2005. The median age was 56.5 years. The median duration of symptoms was 4.5 months. The bone pain was the first symptom in all patients. Tru-cut biopsy was performed for diagnosis in most of the cases. Diagnosis in five patients (27.8%) required open biopsy. Results: DLBCL (77.8%) was the most common histological type among all patients. Other histological subtypes were anaplastic large cell lymphoma (11.1%), Burkitt-like lymphoma (5.6%) and marginal zone lymphoma (5.6%). According to Ann Arbor staging system, 44.4% of patients were Stage I, 11.1% were Stage II and 44.4% were Stage IV. Bone marrow involvement was determined in four patients (22.2%). All patients except one were treated with anthracycline-containing regimens and eight patients (44.4%) received rituximab combination with chemotherapy. Radiation therapy was per- formed as the first-line therapy in 9 (50%) patients. The median follow-up was 37 months (range, 2-124 months). Among the 17 patients who achieved complete remission, five (27.8%) relapsed. All patients were still alive. The five-year relapse- free survival was 73.5%. Conclusion: The treatment of bone lymphoma can be planned according to the stage and location of the disease. Although we had a relatively low number of patients, it could be concluded that whether or not radiation therapy is per- formed, rituximab in combination with systemic chemotherapy has been proven beneficial on survival.
Özet
Amaç: Kemik lenfomalarI oldukça nadirdir ve en sIk görülen histolojik alt tip diffüz büyük B-hücreli (DBBHL) non-Hodgkin lenfomadIr (NHL). Hastalar çoğunlukla kemik ya da yumuşak dokuda şişlik, kemik ağrIsI ve patolojik kIrIk yakInmalarI ile başvururlar. Tedavi genellikle cerrahi, radyoterapi, kemoterapi veya bunlarIn kombinasyonu şeklindedir. Yöntem ve Gereçler: Bu çalIşmada, merkezimizde 1995 ve 2005 yIllarI arasInda tanI alan 18 primer kemik NHL’lI (11 kadIn, 7 erkek) hasta retrospektif olarak analiz edilmiştir. HastalarIn tanI anIndaki medyan yaşI 56.5 (27-78) yIl olup, medy- an 4.5 (1-36) aylIk semptom süresinden sonra kliniğe başvurmuşlardIr. Tüm hastalarda ağrI semptomu birinci sIrada yer almakla birlikte 3 hastada (%16.7) B-semptomlarI da saptanmIştIr. TanI yöntemi olarak çoğunlukla “tru-cut” biyopsi (%66.7) uygulanIrken, hastalarIn %27.8’inde açIk operasyonla tanI konulmuştur. Bulgular: DBBHL % 77.8 (14 hasta) oranInda en sIk görülen histolojik alt tip olup, %11.1’i anaplastik büyük hücreli len- foma, %5.6’I Burkitt-benzeri, %5.6’I marjinal zon lenfoma olarak belirlenmiştir. Ann Arbor klinik evreleme sistemine göre hastalarIn %44.4’ü Evre-I, %11,1’i Evre-II, %44.4’ü Evre-IV olarak değerlendirilmiş, kemik iliği tutulumu %22.2 hastada saptanmIştIr. Bir hasta dIşInda tümüne CHOP veya benzeri antrasiklin içeren kemoterapi protokolleri uygulanmIş, 8 has- tada (%44.4) Rituximab tedaviye eklenmiştir ve bu hastalarIn hiçbirinde relaps izlenmemiştir. %50 hastada radyoterapi birinci sIra tedavisi olarak uygulanmIştIr. Medyan 37 (2-124) aylIk izlemde, tedavilerini tamamlayan ve tam remisyon sağlanan 17 hastanIn 5’inde (%27.8) relaps gelişmiş olup halen tüm hastalar sağdIr. 5 yIllIk hastalIksIz sağ kalIm oranI %73.5 olarak belirlenmiştir. Sonuç: Kemik lenfomalarIn tedavisi hastalIğIn evresi ve lokalizasyonuna göre planlanmalIdIr. Radyoterapi uygulansIn veya uygulanmasIn, özellikle rituximab ile birlikte sistemik kemoterapi yaşam süresini olumlu yönde etkiler görünmektedir.