| Purpose: To investigate the clinical features,efficacy evaluation and prognostic factors of primary breast diffuse large B-cell lymphoma(PB-DLBCL)and primary breast high-grade B-cell lymphoma(PB-HGBCL).Methods: We retrospectively analyzed 36 patients who were newly diagnosed with PB-DLBCL or PB-HGBCL and received treatment from January 2008 to December 2018 in four large medical centers,including the Affiliated Hospital of Qingdao University,Qingdao Central Hospital,and so on.All patients were followed up until December 1,2018.According to the evaluation criteria of WHO neoplasms,they were divided into complete remission(CR)and partial remission(PR),stable disease(SD),progressive disease(PD).The total effective rate was calculated by CR to compare the efficacy,side effects,central nervous system recurrence rate between two chemical groups.The Kaplan-Meier analysis predicted 5-year overall survival(OS)and progression-free survival(PFS)rates for all patients.Cox proportional hazards model revealed the risk factors influencing long-term prognosis of patients.Result: A total of 36 patients with PB-DLBCL or PB-HGBCL from January 2008 to December 2018 were retrospectively analyzed.35 female patients and 1 male patient were included in the study.12 patients had succumbed to the disease until the last follow-up.Among the 36 patients,there were 29 PB-DLBCL patients and 7 PB-HGBCL patients.(1)The 5-year OS for PB-DLBCL and PB-HGBCL was 75.9% and 28.6%,respectively.The 5-year PFS for PB-DLBCL and PB-HGBCL was 69.0% and 14.3%,respectively.(2)The R-DAEPOCH regimen was significantly more effective in PB-DLBCL patients than the R-CHOP regimen(5-year OS: 78.9% vs 62.5%,P=0.024;5-year PFS: 73.7% vs 50.0%,P=0.037),but the grade 3/4 myelosuppression in the R-DAEPOCH group was stronger than that in the R-CHOP group,with statistically significant differences based on Fisher’s exact test(79.0% vs 25.0%,P=0.025).The other AEs,such as gastrointestinal reactions and cardiotoxicity,were mild and controllable,with no significant differences between treatment groups.In seven PB-HGBCL patients,the median OS of three patients who received the R-DAEPOCH regimen was 36.0months(95% CI 25.7-46.3 months),and the median OS in the R-CHOP group was 31.0months(95% CI 2.6-59.4 months).R-DAEPOCH showed a tendency for improved outcomes in PB-HGBCL,but this needs to be confirmed by more clinical data.(3)The rate of CNS relapse among PB-DLBCL patients was 17.2%,whereas that among PB-HGBCL patients was 28.6%;the difference was not significant(P=0.602).Among the PB-DLBCL patients,CNS relapse occurred in 15.79% of the patients in the R-DAEPOCH group,which was lower than that in the R-CHOP group,but no statistically significant differences were observed by Fisher’s exact test(15.8% vs 25.0%,P=0.616).Prophylactic CNS chemotherapy was administered to 28 PB-DLBCL patients(96.6%)and all PB-HGBCL patients(100.0%).The number of intrathecal injections had no significant effect on survival(P=0.275).The R-DAEPOCH regimen did not predominantly reduce CNS recurrence as expected(P=0.616).Univariate analysis by the log-rank test demonstrated that double expression,triple expression,Ann Arbor staging,and risk stratification were closely related to long-term prognosis,while age(P=0.660),tumour size(P=0.270),chromosomal abnormalities(P=0.645),surgical treatment(P=0.314),radiotherapy(P=0.600),and prophylactic intrathecal injection(P=0.295)had no relationship with PFS or OS.The Cox proportional hazards model revealed that high-intermediate and high risk and triple expression were adverse prognostic factors for patients(HR=7.9,P=0.039;HR=16.3,P=0.042).Conclusions:(1)Among PB-DLBCL patients,R-DAEPOCH regimen was significantly superior to the R-CHOP regimen in 5-year OS and PFS,but bone marrow suppression was more severe.(2)The other adverse effects,such as gastrointestinal reactions and cardiotoxicity,were mild and controllable,with no significant differences between treatment groups.R-DAEPOCH showed a tendency for improved outcomes in PB-HGBCL,but this needs to be confirmed by more clinical data.(3)In Cox proportional hazards model,triple expression and risk stratification were independent prognostic factors.High-intermediate and high risk and triple expression were adverse prognostic factors for patients.(4)Compared with PB-DLBCL patients,PB-HGBCL patients were more likely to have CNS recurrence.R-DAEPOCH and intrathecal chemotherapy did not significantly reduce CNS recurrence as expected.This recommendation of CNS prophylaxis was stronger if potential high-risk features for CNS involvement are present,such as tumour > 5 cm,stage IIE,stage-modified IPI score > 2 or bilateral breast involvement.Thus,multicentre prospective studies are still warranted to explore the optimal strategy for CNS prophylaxis and to develop more effective treatment regimens for patients. |
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