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In Reply

Institute of Hematology and Oncology "Seràgnoli", University of Bologna, Bologna, Italy

Pietro Quaglino

Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Turin, Turin, Italy

Nicola Pimpinelli

Department of Dermatological Sciences, University of Florence, Florence, Italy

Emilio Berti

Department of Dermatology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Maggiore of Milan and University of Milan-Bicocca, Milan, Italy

Gianandrea Baliva

Institute of Dermatology "Immacolata", Rome, Italy

Serena Rupoli

University of Ancona, Ancona, Italy

Maurizio Martelli

Dipartimento Biotecnologie Cellulari ed Ematologia, University "La Sapienza", Rome, Italy

Mauro Alaibac

Unit of Dermatology, University of Padua, Padua, Italy

Giovanni Borroni

University of Pavia, Pavia, Italy

Sergio Chimenti

"Tor Vergata" University, Rome, Italy

Renato Alterini

University of Florence, Florence, Italy

Lapo Alinari

Institute of Hematology and Oncology "Seràgnoli", University of Bologna, Bologna, Italy

Maria Teresa Fierro

Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Turin, Turin, Italy

Nazario Cappello

Department of Genetics, Biology and Medical Chemistry, Section of Medical Statistics, University of Turin, Turin, Italy

Alessandro Pileri

Institute of Dermatology, University of Bologna, Bologna, Italy

Davide Soligo

Department of Hematology, Ospedale Maggiore and University of Milano, Milan, Italy

Marco Paulli

Anatomic Patology Section, Department of Human Pathology, University of Pavia and IRCCS Policlinico S. Matteo, Pavia, Italy

Stefano Pileri

Institute of Hematology and Oncology "Seràgnoli", University of Bologna, Bologna, Italy

Marco Santucci

Department of Human Pathology and Oncology, University of Florence, Italy

Maria Grazia Bernengo

Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Turin, Turin, Italy

We received with great interest the comments from Drs Wilson and Smith. We thank them for the punctual referencing of the article from Grange et al, published in the Journal of Clinical Oncology in 2001.¹ In fact, the latter represents a milestone in the appropriate classification of large cell cutaneous B-cell lymphoma (CBCL), now fully established in the consensus WHO-European Organisation for Research and Treatment of Cancer classification of primary cutaneous lymphomas.² However, the nosological dignity of CBCL characterized by de novo diffuse large round cell infiltration was already suggested and supported in the article published by the French group in 1999.³

Regarding the nice and interesting article published by Smith et al⁴ in the Journal of Clinical Oncology in 2005, which concerns a large series of nearly 1,000 patients, it is noteworthy to emphasize that it is based on data from Surveillance, Epidemiology and End Results registry. Although this study is of overall great epidemiologic value and suggests a temptative way of combining different features for the final prognostic evaluation (prognostic index), its results—claiming over 400 patients with diffuse large CBCL, which account for approximately 40% of the total—are possibly biased by a definition which is not necessarily adherent to that now clearly stated in the consensus WHO-European Organisation for Research and Treatment of Cancer classification (ie, diffuse infiltration by round, noncleaved cells, heavily expressing bcl-2 and MUM-1, and genetically characterized by an activated B-cell profile.) In our study, although a centralized histologic revision was not performed, the pathologists from each participating center were asked to review their cases strictly following the criteria which currently allow to them to separate diffuse large B-cell lymphoma, leg-type from follicular lymphoma patients with a diffuse large (cleaved) cell predominance. This method appears as substantially different from that followed by Smith et al⁴ in their study. However, there is no doubt that this latter has added an interesting piece of work to the diagnosis, classification, prognostic evaluation, and proper treatment planning of primary CBCL.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

ACKNOWLEDGMENTS

This study was supported in part by Sezione di Bologna dell’Associazione Italiana contro Leucemie, Linfomi e Mielomi (BolognAIL).

REFERENCES

1. Grange F, Bekkenk MW, Wechsler J, et al: Prognostic factors in primary cutaneous large B-cell lymphomas: A European multicenter study. J Clin Oncol 19:3602-3610, 2001[Abstract/Free Full Text]

2. Willemze R, Jaffe E, Burg G, al: WHO-EORTC classification of cutaneous lymphomas. Blood 105:3768-3785, 2005[Abstract/Free Full Text]

3. Grange F, Hedelin G, Joly P, et al: Prognostic factors in primary cutaneous lymphomas other than mycosis fungoides and the Sézary syndrome: The French Study Group on Cutaneous Lymphomas. Blood 93:3637-3642, 1999[Abstract/Free Full Text]

4. Smith BD, Smith GL, Cooper DL, et al: The cutaneous B-cell lymphoma prognostic index: A novel prognostic index derived from a population-based registry. J Clin Oncol 23:7246-7248, 2005[Free Full Text]

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