Survival of patients with localized diffuse histiocytic lymphoma

Abstract

Twenty-eight patients with previously untreated diffuse histiocytic lymphoma (DHL) were identified to be in pathologic stage (PS) I (11), I(E) (3), II (8), or II(E) (6) by exploratory laparotomy and splenectomy. Six patients were treated with total nodal radiotherapy; 14 with an extended mantle; 5 with an inverted Y or whole abdomen; and 3 with an involved field. Twenty-six patients achieved a complete remission (93%) and 2 patients had persistent local disease. The median survival and disease-free survival for the complete response group are 56 and 51.5 mth, respectively. Ten of the 11 stage I or I(E) patients had supradiaphragmatic lymph node disease. Patients with stage I or I(E) disease (n = 14) demonstrated a median survival of 72.5 mth and a median disease-free survival of 69.5 mth; there was 1 disease-related death. Patients with stage II or II(E) disease (n = 14) demonstrated a median survival of 33 mth and median disease-free survival of 29.5 mth; there were 10 relapses or deaths. Patients in stages I, I(E), II, or II(E) with infradiaphragmatic disease (n = 71) had a median survival of 36 mth, while patients with supradiaphragmatic presentation (n = 21) demonstrated median survival of 68 mth (p = 0.37). The data indicate that patients with diffuse histiocytic lymphoma with stage I supradiaphragmatic lymph node disease are curable using radiotherapy alone, achieving a 93% 11-yr actuarial disease-free survival. Patients with stage II or II(E) disease are not readily curable with radiation therapy alone, achieving a 33% 11-yr actuarial disease-free survival; radiotherapy with adjuvant chemotherapy or chemotherapy alone should be considered for this group.