The clinical features, management and prognostic effects of pathological fractures in a multicenter series of 373 patients with diffuse large B-cell lymphoma of the bone

S. Govi, D. Christie, C. Messina, M. Bruno Ventre, E. A. Gracia Medina, D. Porter, J. Radford, D. Seog Heo, Y. Park, G. Martinelli, E. Taylor, H. Lucraft, V. Ballova, E. Zucca, M. Gospodarowicz, Andrés J M Ferreri

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Pathological fractures (PFs) occur in 10%-20% of patients with diffuse large B-cell lymphoma (DLBCL) of the bone. The clinical features and the effects of this severe complication on management and prognosis have not been previously analyzed in a large series. Patients and methods: The effects of PF on management and prognosis were reviewed in an international retrospective series of 373 patients with newly diagnosed bone DLBCL, comparing 78 patients with PF at presentation (group 'PF-BL') and 295 patients without PF ('controls').Results: At a median follow-up of 53 months (range 3-246), PF-BL patients exhibited lower rates of overall response (ORR, 78%versus 85%; P = 0.17), 5-year progression-free survival (PFS, 53 ± 6% versus 61 ± 3%; P = 0.02) and 5-year overall survival (OS, 54 ± 6% versus 68 ± 3%, P = 0.008) than controls. Initial surgical stabilization of the PF did not change therapeutic outcome (5-year OS: 45 ± 9% versus 54 ± 10%; P = 0.20). PF-BL patients referred to irradiation of the fractured bone before chemotherapy exhibited a significantly poorer outcome than patients managed with the inverse sequence (ORR: 52% versus 92%, P = 0.0005; 5-year OS: 22 ± 14% versus 64 ± 9%, P = 0.007). Multivariate analysis confirmed the independent association between PF and worse survival and the negative effect of radiotherapy as initial therapy. Conclusion: Fracture is an independent, adverse prognostic event in patients with bone DLBCL. Anthracycline-based chemotherapy followed by radiotherapy seems to be the better treatment sequence. Initial fracture stabilization does not seem to improve outcome; it should be used to improve patient's quality of life only if chemotherapy delays can be avoided.

Original languageEnglish
Article numbermdt482
Pages (from-to)176-181
Number of pages6
JournalAnnals of Oncology
Volume25
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Spontaneous Fractures
Lymphoma, Large B-Cell, Diffuse
Bone and Bones
Drug Therapy
Radiotherapy
Survival
Anthracyclines
Disease-Free Survival
Therapeutics
Multivariate Analysis
Quality of Life

Keywords

  • Bone fixation
  • Bone lymphoma
  • Diffuse large B-cell lymphoma
  • Osteolymphoma
  • Pathological fractures
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

The clinical features, management and prognostic effects of pathological fractures in a multicenter series of 373 patients with diffuse large B-cell lymphoma of the bone. / Govi, S.; Christie, D.; Messina, C.; Bruno Ventre, M.; Gracia Medina, E. A.; Porter, D.; Radford, J.; Seog Heo, D.; Park, Y.; Martinelli, G.; Taylor, E.; Lucraft, H.; Ballova, V.; Zucca, E.; Gospodarowicz, M.; Ferreri, Andrés J M.

In: Annals of Oncology, Vol. 25, No. 1, mdt482, 2014, p. 176-181.

Research output: Contribution to journalArticle

Govi, S, Christie, D, Messina, C, Bruno Ventre, M, Gracia Medina, EA, Porter, D, Radford, J, Seog Heo, D, Park, Y, Martinelli, G, Taylor, E, Lucraft, H, Ballova, V, Zucca, E, Gospodarowicz, M & Ferreri, AJM 2014, 'The clinical features, management and prognostic effects of pathological fractures in a multicenter series of 373 patients with diffuse large B-cell lymphoma of the bone', Annals of Oncology, vol. 25, no. 1, mdt482, pp. 176-181. https://doi.org/10.1093/annonc/mdt482
Govi, S. ; Christie, D. ; Messina, C. ; Bruno Ventre, M. ; Gracia Medina, E. A. ; Porter, D. ; Radford, J. ; Seog Heo, D. ; Park, Y. ; Martinelli, G. ; Taylor, E. ; Lucraft, H. ; Ballova, V. ; Zucca, E. ; Gospodarowicz, M. ; Ferreri, Andrés J M. / The clinical features, management and prognostic effects of pathological fractures in a multicenter series of 373 patients with diffuse large B-cell lymphoma of the bone. In: Annals of Oncology. 2014 ; Vol. 25, No. 1. pp. 176-181.
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abstract = "Background: Pathological fractures (PFs) occur in 10{\%}-20{\%} of patients with diffuse large B-cell lymphoma (DLBCL) of the bone. The clinical features and the effects of this severe complication on management and prognosis have not been previously analyzed in a large series. Patients and methods: The effects of PF on management and prognosis were reviewed in an international retrospective series of 373 patients with newly diagnosed bone DLBCL, comparing 78 patients with PF at presentation (group 'PF-BL') and 295 patients without PF ('controls').Results: At a median follow-up of 53 months (range 3-246), PF-BL patients exhibited lower rates of overall response (ORR, 78{\%}versus 85{\%}; P = 0.17), 5-year progression-free survival (PFS, 53 ± 6{\%} versus 61 ± 3{\%}; P = 0.02) and 5-year overall survival (OS, 54 ± 6{\%} versus 68 ± 3{\%}, P = 0.008) than controls. Initial surgical stabilization of the PF did not change therapeutic outcome (5-year OS: 45 ± 9{\%} versus 54 ± 10{\%}; P = 0.20). PF-BL patients referred to irradiation of the fractured bone before chemotherapy exhibited a significantly poorer outcome than patients managed with the inverse sequence (ORR: 52{\%} versus 92{\%}, P = 0.0005; 5-year OS: 22 ± 14{\%} versus 64 ± 9{\%}, P = 0.007). Multivariate analysis confirmed the independent association between PF and worse survival and the negative effect of radiotherapy as initial therapy. Conclusion: Fracture is an independent, adverse prognostic event in patients with bone DLBCL. Anthracycline-based chemotherapy followed by radiotherapy seems to be the better treatment sequence. Initial fracture stabilization does not seem to improve outcome; it should be used to improve patient's quality of life only if chemotherapy delays can be avoided.",
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author = "S. Govi and D. Christie and C. Messina and {Bruno Ventre}, M. and {Gracia Medina}, {E. A.} and D. Porter and J. Radford and {Seog Heo}, D. and Y. Park and G. Martinelli and E. Taylor and H. Lucraft and V. Ballova and E. Zucca and M. Gospodarowicz and Ferreri, {Andr{\'e}s J M}",
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T1 - The clinical features, management and prognostic effects of pathological fractures in a multicenter series of 373 patients with diffuse large B-cell lymphoma of the bone

AU - Govi, S.

AU - Christie, D.

AU - Messina, C.

AU - Bruno Ventre, M.

AU - Gracia Medina, E. A.

AU - Porter, D.

AU - Radford, J.

AU - Seog Heo, D.

AU - Park, Y.

AU - Martinelli, G.

AU - Taylor, E.

AU - Lucraft, H.

AU - Ballova, V.

AU - Zucca, E.

AU - Gospodarowicz, M.

AU - Ferreri, Andrés J M

PY - 2014

Y1 - 2014

N2 - Background: Pathological fractures (PFs) occur in 10%-20% of patients with diffuse large B-cell lymphoma (DLBCL) of the bone. The clinical features and the effects of this severe complication on management and prognosis have not been previously analyzed in a large series. Patients and methods: The effects of PF on management and prognosis were reviewed in an international retrospective series of 373 patients with newly diagnosed bone DLBCL, comparing 78 patients with PF at presentation (group 'PF-BL') and 295 patients without PF ('controls').Results: At a median follow-up of 53 months (range 3-246), PF-BL patients exhibited lower rates of overall response (ORR, 78%versus 85%; P = 0.17), 5-year progression-free survival (PFS, 53 ± 6% versus 61 ± 3%; P = 0.02) and 5-year overall survival (OS, 54 ± 6% versus 68 ± 3%, P = 0.008) than controls. Initial surgical stabilization of the PF did not change therapeutic outcome (5-year OS: 45 ± 9% versus 54 ± 10%; P = 0.20). PF-BL patients referred to irradiation of the fractured bone before chemotherapy exhibited a significantly poorer outcome than patients managed with the inverse sequence (ORR: 52% versus 92%, P = 0.0005; 5-year OS: 22 ± 14% versus 64 ± 9%, P = 0.007). Multivariate analysis confirmed the independent association between PF and worse survival and the negative effect of radiotherapy as initial therapy. Conclusion: Fracture is an independent, adverse prognostic event in patients with bone DLBCL. Anthracycline-based chemotherapy followed by radiotherapy seems to be the better treatment sequence. Initial fracture stabilization does not seem to improve outcome; it should be used to improve patient's quality of life only if chemotherapy delays can be avoided.

AB - Background: Pathological fractures (PFs) occur in 10%-20% of patients with diffuse large B-cell lymphoma (DLBCL) of the bone. The clinical features and the effects of this severe complication on management and prognosis have not been previously analyzed in a large series. Patients and methods: The effects of PF on management and prognosis were reviewed in an international retrospective series of 373 patients with newly diagnosed bone DLBCL, comparing 78 patients with PF at presentation (group 'PF-BL') and 295 patients without PF ('controls').Results: At a median follow-up of 53 months (range 3-246), PF-BL patients exhibited lower rates of overall response (ORR, 78%versus 85%; P = 0.17), 5-year progression-free survival (PFS, 53 ± 6% versus 61 ± 3%; P = 0.02) and 5-year overall survival (OS, 54 ± 6% versus 68 ± 3%, P = 0.008) than controls. Initial surgical stabilization of the PF did not change therapeutic outcome (5-year OS: 45 ± 9% versus 54 ± 10%; P = 0.20). PF-BL patients referred to irradiation of the fractured bone before chemotherapy exhibited a significantly poorer outcome than patients managed with the inverse sequence (ORR: 52% versus 92%, P = 0.0005; 5-year OS: 22 ± 14% versus 64 ± 9%, P = 0.007). Multivariate analysis confirmed the independent association between PF and worse survival and the negative effect of radiotherapy as initial therapy. Conclusion: Fracture is an independent, adverse prognostic event in patients with bone DLBCL. Anthracycline-based chemotherapy followed by radiotherapy seems to be the better treatment sequence. Initial fracture stabilization does not seem to improve outcome; it should be used to improve patient's quality of life only if chemotherapy delays can be avoided.

KW - Bone fixation

KW - Bone lymphoma

KW - Diffuse large B-cell lymphoma

KW - Osteolymphoma

KW - Pathological fractures

KW - Radiotherapy

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