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Tumor necrosis could reflect advanced disease status in patients with diffuse large B cell lymphoma treated with R-CHOP therapy

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Abstract

Tumor necrosis (TN) can lower responsiveness to chemotherapy and confer basic resistance to anti-cancer therapy. We investigated the association of TN with poor clinical features and outcome in diffuse large B cell lymphoma (DLBCL). We examined the presence or absence of TN in 476 DLBCL patients of who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Eighty-nine (18.7 %) patients had TN at diagnosis. Patients with TN had a progression-free survival (PFS) and overall survival (OS) of 39.3 and 46.7 %, whereas patients without TN had a PFS and OS of 73.4 and 82.6 %. Adverse clinical factors of poor Eastern Cooperative Oncology Group performance status ≥ grade 2 (p = 0.005), elevated lactate dehydrogenase ratio >1 (p < 0.001), advanced Ann Arbor stage (p = 0.002), and bulky disease (p = 0.026) were more prevalent in the TN group than the non-TN group. Cox regression model analysis revealed TN as an independent prognostic factor for PFS and OS in DLBCL (PFS, hazard ratio [HR] = 1.967, 95 % confidence interval [CI] = 1.399–2.765, p < 0.001; OS, HR = 2.445, 95 % CI = 1.689–3.640, p < 0.001). The results indicate that TN could reflect adverse clinical features and worse prognosis in DLBCL patients receiving R-CHOP therapy.

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Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (0920050).

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Authors and Affiliations

  1. Department of Hematology–Oncology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea

    Moo-Kon Song

  2. Department of Hematology–Oncology, Pusan National University Hospital Medical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, Republic of Korea

    Joo-Seop Chung

  3. Department of Hematology, Seoul National University Hospital, Seoul, Korea

    Dong-Yeop Shin

  4. Department of Hematology, Busan Haeundae Paik Hospital, Busan, Korea

    Sung-Nam Lim

  5. Department of Hematology, Gyeong-Sang National University Hospital, School of medicine, Gyeong-Sang National University, Jinju, Korea

    Gyeong-won Lee

  6. Department of Laboratory Medicine, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea

    Jae-Cheol Choi

  7. Department of Pathology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea

    Won-Young Park

  8. Department of Hematology–Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea

    So-Yeon Oh

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  1. Moo-Kon Song
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Correspondence to Joo-Seop Chung.

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Approval for retrospective review of the records was obtained from the Institutional Review Boards of all participating medical centers.

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The authors declare that they have no conflict of interest.

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Song, MK., Chung, JS., Shin, DY. et al. Tumor necrosis could reflect advanced disease status in patients with diffuse large B cell lymphoma treated with R-CHOP therapy. Ann Hematol 96, 17–23 (2017). https://doi.org/10.1007/s00277-016-2822-8

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  • DOI: https://doi.org/10.1007/s00277-016-2822-8

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