Originally published as JCO Early Release 10.1200/JCO.2006.07.5671 on October 16 2006

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Clinicopathologic Characteristics and Outcome of Diffuse Large B-Cell Lymphomas Presenting With an Associated Low-Grade Component at Diagnosis

Hervé Ghesquières, Françoise Berger, Pascale Felman, Evelyne Callet-Bauchu, Paul-André Bryon, Alexandra Traverse-Glehen, Catherine Thieblemont, Lucile Baseggio, Anne-Sophie Michallet, Bertrand Coiffier, Gilles Salles

From the Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Hématologie, Service d'Anatomie Pathologique, and Laboratoire d'Hématologie; Equipe d'Accueil, Pathologie des Cellules Lymphoïdes, Université Claude Bernard, Pierre-Bénite; Laboratoire d'Hématologie, Hôpital E. Herriot, Lyon, France

Address reprint requests to Gilles Salles, MD, PhD, Service d'Hématologie, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite, France; e-mail: gilles.salles{at}chu-lyon.fr

Purpose: Some diffuse large B-cell lymphomas (DLBCL) present at diagnosis with associated morphologic features of small B-cell non-Hodgkin's lymphoma (NHL) and may arise from the transformation of a previously unknown indolent low-grade lymphoma. The characteristics and prognosis of these particular DLBCL are not well known.

Patients and Methods: The strict morphologic review of consecutive DLBCL patients diagnosed over 12 years in our department (Hematology Department, Centre Hospitalier Lyon-Sud, Lyon, France) allowed to retrieve 60 DLBCL that could be have occurred from the transformation of marginal zone B-cell NHL (32 patients), follicular NHL (22 patients), and small lymphocytic NHL (6 patients). We compared them to 180 matched patients of de novo DLBCL.

Results: Patients median age was 55 years and presented the following clinical characteristics: poor performance status in 33%, disseminated disease in 97%, more than one extranodal site in 50%, and increased lactate dehydrogenase level in 55%. Complete remission with multidrug chemotherapy regimens was achieved in 60% of the patients, but 48% relapsed: 28% with aggressive and 20% with indolent histology, respectively. Overall survival (OS) and freedom-from-progression rates at 5 years were 57% and 33%, respectively. The matched-control analysis showed that patients with transformed NHL at diagnosis had lower complete response to chemotherapy (P = .004) and higher progression rate (P = .03), whereas no difference was observed in OS (P = .21).

Conclusion: Compared to de novo DLBCL, transformed NHL at diagnosis have similar overall survival but lower complete response to initial treatment and higher risk of indolent relapses.

published online ahead of print at www.jco.org on October 16, 2006.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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