1100 - Liver involvement by lymphoma - indicator of poor response and mortality

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Lymphomas
Presenter SUSHEEL Kumar
Authors S. Kumar1, I.A. Muazzam2, N. Siddiqui3, N. Muzaffar2, K. Das2, U.E.K. Awan2
  • 1Medical Oncology, SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL & RESEARCH CENTRE, 54550 - LAHORE/PK
  • 2Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Reserch Centre (SKM), 54550 - Lahore/PK
  • 3Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Reserch Centre(SKM), PK-54550 - Lahore/PK

Abstract

Total = 46 Hodgkin' Lymphoma (n = 24) NonHodgkin's Lymphoma (n = 22)
Heptic (n = 12) Non-hepatic = 12 hepatic (n = 5) Non-hepatic (n= 17)
B-symptoms 9 (75%) 9 (75%) 3 (60%) 17 (77%)
Bulky 1 (8%) 1 (8%) 1 (20%) 7 (41%)
CR 8 (67%) 12 (100%) 4 (80%) 11 (64%)
PR 2 (16.5%) 0 (0) 1 (20%) 6 (36%)
PD 2 (16.5%) 0 (0) 0 (0) 0 (0)
ORR = CR + PR 83.5% 100% 100% 100%
Died 4 (33%) 0 (0) 1 (20% ) 6 (36%)

Introduction

Hepatic involvement is more common in Non-Hodgkin's as compared to Hodgkin's Lymphoma (HL) at presentation. It is a poor prognostic feature. We determined prognosis of our stage IV lymphoma patients who had liver involvement at baseline.

Material and method

In last 1 year, 70 patients presented in our lymphoma clinic with stage IV disease. Out of these, 46 had completed their treatment at the time of analysis. Diagnosis of lymphoma was confirmed on excision or core biopsy of a nodal site at presentation. PET/CT was done for staging before starting chemotherapy and response assessment was done after 2-4 cycles of planned chemotherapy. Histologic evaluation of any residual FDG-avid disease was made in patients who responded to chemotherapy at all the other sites. Response rate (RR) was calculated by adding percentage of patients in complete (CR) and partial (PR) remission.

Results

Out of these 46 patients, 24 had HL and intermediate-to-high grade NHL was diagnosed in 22 patients. Median age at diagnosis was 29.5 years (range 16 to 60). Secondary liver involvement was found in 17 patients (HL = 12/24; NHL = 5/22). More NHL patients presented with B-symptoms and bulky disease than HL. Presence of liver involvement predicted a lower response to initial therapy in patients with HL (RR 83.5%) as compared to NHL (RR 100%). Despite this initial response to treatment, one-third of advanced stage HL patients died before the completion of therapy. Such relationship was not observed in advanced stage NHL patients (see table).

Conclusion

Despite initial response to treatment, secondary liver involvement at presentation predicted higher mortality in stage IV HL patients. This effect should be further validated in larger studies.

Disclosure

All authors have declared no conflicts of interest.