Abstract
Among high-grade malignant non-Hodgkin's lymphomas the updated Kiel classification identifies three major B-cell entities: centroblastic (CB), B-immunoblastic (B-IB), and B-large cell anaplastic (Ki-1+) (now termed anaplastic large cell [CD30+], [B-ALC]). The clinical prognostic relevance of this distinction was evaluated in a randomized prospective treatment trial (COP-BLAM/IMVP-16 regimen randomly combined +/- radiotherapy in complete responders) conducted in adult (age 15 to 75) patients with Ann Arbor stage II-IV disease (n = 219) diagnosed by optimal histomorphology (Giemsa staining) and by immunohistochemistry. Overall survival was significantly better in CB lymphoma as compared to B-IB (P = .0002) or B-ALC (P = .046). Relapse-free survival was worse for B-IB (P = .0003) as compared to CB lymphomas. The prognostic differences between CB and B-IB were confirmed by multivariate analyses including the risk factors of the International Index. Overall survival was significantly determined by performance status (P = .0003), serum-LDH (P = .036), and B-IB histology subtype (P = .036). Relapse-free survival was influenced by age (P = .007) and histological subtype (P = .007). Thus, the diagnosis of the CB and B-IB lymphomas by the histological criteria of the Kiel classification was identified as an independent prognostic factor in diffuse large B-cell lymphomas.
Publication types
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Clinical Trial
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Comparative Study
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Randomized Controlled Trial
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Research Support, Non-U.S. Gov't
MeSH terms
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Adolescent
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Adult
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Age Factors
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Aged
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Bleomycin / administration & dosage
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Combined Modality Therapy
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Cyclophosphamide / administration & dosage
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Disease-Free Survival
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Doxorubicin / administration & dosage
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Etoposide / administration & dosage
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Female
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Humans
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Ifosfamide / administration & dosage
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Life Tables
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Lymphoma, Large B-Cell, Diffuse / classification*
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Lymphoma, Large B-Cell, Diffuse / drug therapy
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Lymphoma, Large B-Cell, Diffuse / mortality*
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Lymphoma, Large B-Cell, Diffuse / pathology
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Lymphoma, Large B-Cell, Diffuse / radiotherapy
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Lymphoma, Large-Cell, Anaplastic / drug therapy
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Lymphoma, Large-Cell, Anaplastic / mortality*
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Lymphoma, Large-Cell, Anaplastic / radiotherapy
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Lymphoma, Large-Cell, Immunoblastic / drug therapy
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Lymphoma, Large-Cell, Immunoblastic / mortality*
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Lymphoma, Large-Cell, Immunoblastic / radiotherapy
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Male
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Methotrexate / administration & dosage
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Middle Aged
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Multivariate Analysis
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Prednisone / administration & dosage
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Procarbazine / administration & dosage
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Prognosis
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Prospective Studies
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Radiotherapy, Adjuvant
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Risk Factors
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Survival Analysis
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Treatment Outcome
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Vincristine / administration & dosage
Substances
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Bleomycin
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Procarbazine
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Vincristine
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Etoposide
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Doxorubicin
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Cyclophosphamide
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Ifosfamide
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Prednisone
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Methotrexate
Supplementary concepts
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COP-BLAM protocol
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IMVP-16 protocol