Biological Findings and Clinical Outcomes in Patients Treated With R-CHOP Plus High-Dose Methotrexate as First-Line Therapy in Large B-Cell Lymphoma With Testis Involvement

R Liévin; B Burroni; E Balducci; P Palmic; J Decroocq; B Deau-Fischer; P Franchi; M Vignon; J Zerbit; A S Cottereau; A Touzart; P Villarese; S Kaltenbach; L Lhermitte; V Asnafi; D Bouscary; L Willems

doi:10.1111/ejh.14325

Biological Findings and Clinical Outcomes in Patients Treated With R-CHOP Plus High-Dose Methotrexate as First-Line Therapy in Large B-Cell Lymphoma With Testis Involvement

Eur J Haematol. 2025 Jan;114(1):186-194. doi: 10.1111/ejh.14325. Epub 2024 Oct 12.

Authors

R Liévin^{1

2}, B Burroni³, E Balducci⁴, P Palmic³, J Decroocq¹, B Deau-Fischer¹, P Franchi¹, M Vignon¹, J Zerbit⁵, A S Cottereau⁶, A Touzart^{7

8}, P Villarese⁴, S Kaltenbach⁴, L Lhermitte⁴, V Asnafi⁴, D Bouscary¹, L Willems¹

Affiliations

¹ Clinical Hematology Department, AP-HP, Hôpital Cochin, Université de Paris, Paris, France.
² Laboratory of Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U 1163, Institut Imagine, Paris, France.
³ Pathology Department, AP-HP, Hôpital Cochin, Université de Paris, Paris, France.
⁴ Cytogenetics Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.
⁵ Pharmacy Department, AP-HP, Hospitalisation à Domicile APHP, Université de Paris, Paris, France.
⁶ Nuclear Medicine Department, AP-HP, Hôpital Cochin, Université de Paris, Paris, France.
⁷ Laboratory of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France.
⁸ Hematology Laboratory, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.

Abstract

Primary testicular lymphoma (PTL) is a rare occurrence of diffuse large B-cell lymphoma (DLBCL) that accounts for 1%-2% of all cases. Nodal DLBCL with testis involvement (DLBCL-T) and PTL are associated with poor prognosis, with high incidence of central nervous system relapse. Fifteen patients (median age 60 years) with PTL (n = 5) or DLBCL-T (n = 10) received high-dose methotrexate + R-CHOP. Overall, complete response (CR) rate was 73% and overall response rate 86%. With a 3.9-year median follow-up, 100% of patients with PTL had CR and none relapsed. On the contrary, 55% of DLBCL-T patients achieved CR among which only one was still in remission at the end of follow-up. Molecular parallels between PTL and Primary CNS Lymphoma (PCNSL) suggest shared origins, urging further research for tailored treatments and enhanced understanding of these lymphomas' biology.

Keywords: CNS relapse; DLBCL; methotrexate; testis.

MeSH terms

Adult
Aged
Antibodies, Monoclonal, Murine-Derived* / administration & dosage
Antibodies, Monoclonal, Murine-Derived* / adverse effects
Antibodies, Monoclonal, Murine-Derived* / therapeutic use
Antineoplastic Combined Chemotherapy Protocols* / adverse effects
Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
Cyclophosphamide* / administration & dosage
Cyclophosphamide* / therapeutic use
Doxorubicin* / administration & dosage
Doxorubicin* / therapeutic use
Humans
Lymphoma, Large B-Cell, Diffuse* / diagnosis
Lymphoma, Large B-Cell, Diffuse* / drug therapy
Lymphoma, Large B-Cell, Diffuse* / mortality
Male
Methotrexate* / administration & dosage
Methotrexate* / therapeutic use
Middle Aged
Prednisone* / administration & dosage
Prednisone* / therapeutic use
Rituximab* / administration & dosage
Testicular Neoplasms* / diagnosis
Testicular Neoplasms* / drug therapy
Testicular Neoplasms* / mortality
Testicular Neoplasms* / pathology
Treatment Outcome
Vincristine* / administration & dosage
Vincristine* / therapeutic use

Substances

Rituximab
Cyclophosphamide
Prednisone
Methotrexate
Vincristine
Doxorubicin
R-CHOP protocol
Antibodies, Monoclonal, Murine-Derived