Aggressive lymphomas with renal involvement: a study of 48 patients treated with the LNH-84 and LNH-87 regimens. Groupe d'Etude des Lymphomes de l'Adulte

• Published in: British journal of cancer Vol. 70; no. 1; pp. 154 - 159
• Main Authors: Morel, P, Dupriez, B, Herbrecht, R, Bastion, Y, Tilly, H, Delannoy, A, Haioun, C, Nouvel, C, Bouabdallah, K, Baumelou, E
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01-07-1994
• Subjects: Actuarial Analysis; Adolescent; Adult; Aged; Antibiotics, Antineoplastic - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - administration & dosage; Chi-Square Distribution; Creatinine - blood; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Humans; Kidney - physiopathology; Kidney Neoplasms - drug therapy; Kidney Neoplasms - physiopathology; Kidney Neoplasms - secondary; L-Lactate Dehydrogenase - blood; Lymphoma, Follicular - drug therapy; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large-Cell, Immunoblastic - drug therapy; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - pathology; Male; Methotrexate - administration & dosage; Methylprednisolone - administration & dosage; Middle Aged; Neoplasm Staging; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Prednisolone - administration & dosage; Prognosis; Proportional Hazards Models; Remission Induction; Survival Analysis; Survival Rate; Treatment Outcome; Vindesine - administration & dosage
• ISSN: 0007-0920; 1532-1827

In order to describe renal involvement in aggressive non-Hodgkin's lymphomas (NHLs) and its prognostic significance, we reviewed the outcome of 48 patients with renal involvement treated with the LNH-84 or LNH-87 regimen. Histology was diffuse large cell in 29 (60%) patients; immunoblastic, diffuse mixed cell and lymphoblastic in four each; follicular large cell, diffuse small cleaved cell and diffuse small non-cleaved cell in one each; and unclassified in four. Ann Arbor stage was IV in 44 patients, and IE or IIE in four. Tumour mass > or = 10 cm, performance status (ECOG scale) > 2 and increased LDH level were present in 69%, 20% and 76% of patients respectively. Fifteen patients (31%) had multiple intraparenchymal nodules, 14 (29%) had direct spread into the kidney from a perirenal mass, ten (21%) had a single intraparenchymal nodule and nine (19%) had diffuse infiltration. Twenty-one patients (43%) presented with bilateral lesions. Three patients (6%) presented with acute renal failure. Ten other patients (21%) had serum creatinine > 120 mumol l-1. In 12 of these 13 patients renal function was restored with chemotherapy. Twenty-eight patients (57%) achieved complete remission. Estimated 4 year disease-free survival was 39%. Disease-free survival and actuarial survival at 4 years were estimated to be 58% respectively. Two renal parameters had adverse prognostic significance for survival: renal hilum involvement (P = 0.02) and diffuse renal infiltration (P = 0.01). A Cox model identified only two independent prognostic factors for survival, namely performance status > or = 2 and tumour size > or = 10 cm. We conclude that alteration in renal function occurs in 27% of patients with renal involvement. Systemic chemotherapy improves renal function rapidly. Long-term outcome is similar to that expected in NHL patients presenting with the same prognostic factors.