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Outcome of patients with diffuse large B-cell lymphoma and testicular involvement - real world data

H. Mocikova, A. Janikova, A. Sykorova, V. Prochazka, J. Pirnos, J. Duras, K. Kopeckova, K. Steinerova, R. Pytlik, P. Blahovcova, D. Salek, T. Kozak, V. Bachanova, D. Belada

. 2025 ; 104 (1) : 675-684. [pub] 20241001

Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc25010509

Patients with testicular lymphoma are at an increased risk of central nervous system (CNS) disease. Optimal strategy for CNS relapse prevention is unknown. We analyzed treatment strategies, cumulative incidence of CNS relapse and prognosis in 229 patients with diffuse large B-cell lymphoma (DLBCL) and testicular involvement: 157 primary testicular lymphomas (PTL) in clinical stages IE/IIE and 72 patients in advanced stages (T-DLBCL) IIIE/IV. Treatments for PTL vs. T-DLBCL included: rituximab-based chemotherapy (80.9% vs. 90.3%), orchiectomy (94.3% vs. 65.3%) and contralateral testicular irradiation (59.8% vs. 44.4%). Majority (84.3%) received CNS prophylaxis with similar rates of prophylactic methotrexate (intravenous 19.1% vs. 16.6%, intrathecal 40.8% vs. 40.4%, or both 24.2% vs. 27.8%) between PTL and T-DLBCL (p = 0.89). Median follow-up was 51.8 months. CNS relapses occurred in 14 (6.1%) of 63 relapsing patients. The 5-year cumulative incidence of CNS relapse in PTL was 4.5% and in T-DLBCL 12.1%. Median time to CNS relapse was 21.9 months. In univariate analyses, orchiectomy was the single significant factor associated with lower risk of CNS relapse in PTL (HR = 0.11 [95% CI, 0-0.124], p = 0.001). Rituximab significantly reduced CNS relapse risk in T-DLBCL (HR = 0.1002, p = 0.0005). Median progression-free survival (PFS) and overall survival (OS) following CNS relapse was dismal in T-DLBCL compared to PTL (PFS 1.6 vs. 37.8 months, p = 0.04 and OS 2.3 vs. 37.8 months, p = 0.05). This study confirmed a favorable impact of rituximab in prevention of CNS relapse in T-DLBCL. Methotrexate prophylaxis did not alter CNS relapse risk. Prognosis of CNS relapse is particularly poor in T-DLBCL.

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$a Patients with testicular lymphoma are at an increased risk of central nervous system (CNS) disease. Optimal strategy for CNS relapse prevention is unknown. We analyzed treatment strategies, cumulative incidence of CNS relapse and prognosis in 229 patients with diffuse large B-cell lymphoma (DLBCL) and testicular involvement: 157 primary testicular lymphomas (PTL) in clinical stages IE/IIE and 72 patients in advanced stages (T-DLBCL) IIIE/IV. Treatments for PTL vs. T-DLBCL included: rituximab-based chemotherapy (80.9% vs. 90.3%), orchiectomy (94.3% vs. 65.3%) and contralateral testicular irradiation (59.8% vs. 44.4%). Majority (84.3%) received CNS prophylaxis with similar rates of prophylactic methotrexate (intravenous 19.1% vs. 16.6%, intrathecal 40.8% vs. 40.4%, or both 24.2% vs. 27.8%) between PTL and T-DLBCL (p = 0.89). Median follow-up was 51.8 months. CNS relapses occurred in 14 (6.1%) of 63 relapsing patients. The 5-year cumulative incidence of CNS relapse in PTL was 4.5% and in T-DLBCL 12.1%. Median time to CNS relapse was 21.9 months. In univariate analyses, orchiectomy was the single significant factor associated with lower risk of CNS relapse in PTL (HR = 0.11 [95% CI, 0-0.124], p = 0.001). Rituximab significantly reduced CNS relapse risk in T-DLBCL (HR = 0.1002, p = 0.0005). Median progression-free survival (PFS) and overall survival (OS) following CNS relapse was dismal in T-DLBCL compared to PTL (PFS 1.6 vs. 37.8 months, p = 0.04 and OS 2.3 vs. 37.8 months, p = 0.05). This study confirmed a favorable impact of rituximab in prevention of CNS relapse in T-DLBCL. Methotrexate prophylaxis did not alter CNS relapse risk. Prognosis of CNS relapse is particularly poor in T-DLBCL.
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$a Janikova, Andrea $u Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic
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$a Sykorova, Alice $u University Hospital and Faculty of Medicine, 4th Department of Internal Medicine- Hematology, Hradec Kralove, Czech Republic
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$a Kopeckova, Katerina $u Department of Oncology of the 2nd Faculty of Medicine of Charles University, Motol University Hospital, Prague, Czech Republic
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$a Steinerova, Katerina $u Department of Clinical Hematology, University Hospital, Pilsen, Czech Republic
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$a Pytlik, Robert $u Cell Therapy Department, Institute of Haematology and Blood Transfusion, Prague, Czech Republic
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$a Salek, David $u Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic
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$a Kozak, Tomas $u Fakultni nemocnice Kralovske Vinohrady, Department of Haematology and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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$a Bachanova, Veronika $u Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
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