J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://www.thejh.org

Case Report

Volume 12, Number 2, April 2023, pages 75-81

Primary Diffuse Large B-Cell Lymphoma of the Bone

**Table 1.** Patient Characteristics
Patient	Age/sex	Diagnosis	Site of bone involvement	Stage	Chemoimmunotherapy	Radiotherapy	Follow-up	Outcome
F: female; M: male; DLBCL: diffuse large B-cell lymphoma; NOS: not otherwise specified; R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CEOP: cyclophosphamide, etoposide, prednisone, vincristine, and rituximab; CR: complete remission.
1	32/F	DLBCL, NOS	Sacrum, pelvis, and humerus	IV	R-CHOP × 6 cycles	30 Gy	60 months	Alive and remains in CR
2	34/F	DLBCL, NOS	Proximal femur	IIE	R-CHOP × 6 cycles	39.6 Gy in 22 fractions	50 months	Alive and remains in CR
3	83/M	DLBCL, NOS	Humerus	IIE	R-CEOP × 6 cycles	36 Gy in 18 fractions	32 months	Alive and remains in CR
4	64/F	DLBCL, NOS	Distal femur	IIE	R-CHOP × 6 cycles	30 Gy in 15 fractions	40 months	Alive and remains in CR

Table 1. Patient Characteristics

Patient

Age/sex

Diagnosis

Site of bone involvement

Stage

Chemoimmunotherapy

Radiotherapy

Follow-up

Outcome

F: female; M: male; DLBCL: diffuse large B-cell lymphoma; NOS: not otherwise specified; R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CEOP: cyclophosphamide, etoposide, prednisone, vincristine, and rituximab; CR: complete remission.

32/F

DLBCL, NOS

Sacrum, pelvis, and humerus

R-CHOP × 6 cycles

30 Gy

60 months

Alive and remains in CR

34/F

DLBCL, NOS

Proximal femur

IIE

R-CHOP × 6 cycles

39.6 Gy in 22 fractions

50 months

Alive and remains in CR

83/M

DLBCL, NOS

Humerus

IIE

R-CEOP × 6 cycles

36 Gy in 18 fractions

32 months

Alive and remains in CR

64/F

DLBCL, NOS

Distal femur

IIE

R-CHOP × 6 cycles

30 Gy in 15 fractions

40 months

Alive and remains in CR

**Table 2.** Studies of PBL
Author	Study	N	DLBCL, n	Treatment	Outcome
PBL: primary bone lymphoma; CMT: combined modality therapy; DFS: disease-free survival; RFS: relapse-free survival; RT: radiotherapy; DLBCL: diffuse large B-cell lymphoma; NA: not available; PFS: progression-free survival; OS: overall survival.
Catlett et al, 2008 [22]	Single-center retrospective	30	26	21	3	5	OS favored CMT over either modality alone (P = 0.02)
Tao et al, 2015 [23]	Single-center retrospective	102	102	67	NA	NA	5-year PFS (63% without vs. 88% with RT) and OS (68% vs. 91%) P = 0.0064
Fidias et al, 1999 [24]	Case-control	37	24	35		37 (doxorubicin containing regimen in 33)	5-year DFS with CMT: 78% vs. 42% with RT alone (P = 0.0008); 5-year OS (91% vs. 50%), P = 0.0001
Rathmell et al, 1992 [17]	Single-center retrospective	27	NA	9	15	NA	5-year RFS (89% with CMT vs. 27% with RT alone), P = 0.01
Beal et al, 2006 [19]	Single-center retrospective	101	80	57	14	30	5-year OS for CMT vs. single modality therapy (95% vs. 78%), P = 0.013
Cai et al, 2012 [25]	Multicenter retrospective	116		87	13	14	Lymphoma-specific survival superior with CMT vs. those without RT (P = 0.01)

Table 2. Studies of PBL

Author

Study

DLBCL, n

Treatment

Outcome

CMT, n

RT only, n

Chemotherapy only, n

PBL: primary bone lymphoma; CMT: combined modality therapy; DFS: disease-free survival; RFS: relapse-free survival; RT: radiotherapy; DLBCL: diffuse large B-cell lymphoma; NA: not available; PFS: progression-free survival; OS: overall survival.

Catlett et al, 2008 [22]

Single-center retrospective

OS favored CMT over either modality alone (P = 0.02)

Tao et al, 2015 [23]

Single-center retrospective

102

5-year PFS (63% without vs. 88% with RT) and OS (68% vs. 91%) P = 0.0064

Fidias et al, 1999 [24]

Case-control

37 (doxorubicin containing regimen in 33)

5-year DFS with CMT: 78% vs. 42% with RT alone (P = 0.0008); 5-year OS (91% vs. 50%), P = 0.0001

Rathmell et al, 1992 [17]

Single-center retrospective

5-year RFS (89% with CMT vs. 27% with RT alone), P = 0.01

Beal et al, 2006 [19]

Single-center retrospective

101

5-year OS for CMT vs. single modality therapy (95% vs. 78%), P = 0.013

Cai et al, 2012 [25]

Multicenter retrospective

116

Lymphoma-specific survival superior with CMT vs. those without RT (P = 0.01)

**Table 3.** Outcomes in PBL
Study design	Author	Patients (n)	Treatment regimen	Response rate and clinical outcomes
PBL: primary bone lymphoma; SEER: Surveillance, Epidemiology and End Results; chemo-XRT: chemotherapy and radiation therapy; PFS: progression-free survival; OS: overall survival; CR: complete remission; ORR: overall response rate; NA: not available.
SEER data base study	Jawad et al, 2010 [5]	1,500	NA	5-year OS 58%, 10-year OS 45%
SEER data base study	Liu et al, 2020 [34]	2,558	Chemotherapy (75%), radiation (54%)	5-year OS 65.70%, 10-year OS 54.40%
Single-center retrospective (MSKCC)	Beal et al, 2006 [19]	82	14% with radiation alone, 30% with chemotherapy alone, 57% with combined chemotherapy and radiation	5-year OS, 78% for those treated with single modality, 95% for those with combined modality
Single-center retrospective (University of Miami)	Alencar et al, 2010 [27]	53	Radiation 6 (12%), chemotherapy 10 (21%), combined modality 30 (62%)	CR in 92% of treated patients, 4-year PFS 83%
Single-center retrospective	Demircay et al, 2013 [32]	119	36 patients had chemo-XRT, 15 patients had surgery, chemo-XRT	Disease-free 5-year survival 81%
Single-center retrospective study from China	Zhang et al, 2016 [36]	61	Chemotherapy alone (60%), chemo-XRT (39%)	ORR 87.7%, 56.1% CR, 5-year PFS 47%, OS 53.0%
Study from British Columbia cancer agency	Ramadan et al, 2007 [20]	131	Chemotherapy alone (57%), chemo-XRT (63%)	ORR 84%, 65% CR, 5-year OS 62%, 10-year OS 41%
Single-center retrospective study	Muller et al, 2020 [37]	109	Chemotherapy (81%), radiation (61%), combined chemo-XRT (47%)	5-year OS 66%
Multicenter retrospective review	Li et al, 2017 [12]	160	Chemotherapy (88%) and 55% consolidative radiotherapy	5-year PFS 80%, OS 93%
Multicenter retrospective study	Cai et al, 2012 [25]	116 (early stage)	Chemo-XRT in 87 patients	5-year OS 76%
International data base study	Ventre et al, 2014 [7]	161 (stage I - II)	Chemo-XRT in 125 (78%) patients	5-year PFS 68%, OS 75%
Prospective study	Christie et al, 2011 [38]	33	Three cycles of CHOP and radiation to a dose of 45 Gy	5-year OS 90%, local control 72%

Table 3. Outcomes in PBL

Study design

Author

Patients (n)

Treatment regimen

Response rate and clinical outcomes

PBL: primary bone lymphoma; SEER: Surveillance, Epidemiology and End Results; chemo-XRT: chemotherapy and radiation therapy; PFS: progression-free survival; OS: overall survival; CR: complete remission; ORR: overall response rate; NA: not available.

SEER data base study

Jawad et al, 2010 [5]

1,500

5-year OS 58%, 10-year OS 45%

SEER data base study

Liu et al, 2020 [34]

2,558

Chemotherapy (75%), radiation (54%)

5-year OS 65.70%, 10-year OS 54.40%

Single-center retrospective (MSKCC)

Beal et al, 2006 [19]

14% with radiation alone, 30% with chemotherapy alone, 57% with combined chemotherapy and radiation

5-year OS, 78% for those treated with single modality, 95% for those with combined modality

Single-center retrospective (University of Miami)

Alencar et al, 2010 [27]

Radiation 6 (12%), chemotherapy 10 (21%), combined modality 30 (62%)

CR in 92% of treated patients, 4-year PFS 83%

Single-center retrospective

Demircay et al, 2013 [32]

119

36 patients had chemo-XRT, 15 patients had surgery, chemo-XRT

Disease-free 5-year survival 81%

Single-center retrospective study from China

Zhang et al, 2016 [36]

Chemotherapy alone (60%), chemo-XRT (39%)

ORR 87.7%, 56.1% CR, 5-year PFS 47%, OS 53.0%

Study from British Columbia cancer agency

Ramadan et al, 2007 [20]

131

Chemotherapy alone (57%), chemo-XRT (63%)

ORR 84%, 65% CR, 5-year OS 62%, 10-year OS 41%

Single-center retrospective study

Muller et al, 2020 [37]

109

Chemotherapy (81%), radiation (61%), combined chemo-XRT (47%)

5-year OS 66%

Multicenter retrospective review

Li et al, 2017 [12]

160

Chemotherapy (88%) and 55% consolidative radiotherapy

5-year PFS 80%, OS 93%

Multicenter retrospective study

Cai et al, 2012 [25]

116 (early stage)

Chemo-XRT in 87 patients

5-year OS 76%

International data base study

Ventre et al, 2014 [7]

161 (stage I - II)

Chemo-XRT in 125 (78%) patients

5-year PFS 68%, OS 75%

Prospective study

Christie et al, 2011 [38]

Three cycles of CHOP and radiation to a dose of 45 Gy

5-year OS 90%, local control 72%