Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders

Comparative Outcomes of MALT Versus Non-MALT Histologies

Binod Dhakal, Timothy S. Fenske, Sridevi Ramalingam, Jamie Shuff, Narendranath Epperla, Paul Hosking, Lisa Rein, Anjisnu Banerjee, Parameswaran Hari, Anita D'Souza, Nirav Shah, Malika Siker, Gregory J. Griepentrog, Gerald J. Harris, Timothy S. Wells, Beth A. Erickson, Mehdi Hamadani*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The efficacy of involved field radiotherapy (IFRT) in the outcomes of patients with different subtypes of ocular adnexal lymphoproliferative disorder is lacking. We retrospectively analyzed and compared the outcomes of patients with mucosa-associated lymphoid tissue (MALT) and non-MALT ocular adnexal lymphoproliferative disorder after being treated with IFRT. Our results reveal that IFRT provided excellent disease control with superior failure-free survival in the MALT cohort when compared with the non-MALT cohort. Introduction Ocular adnexal lymphoproliferative disorders (OALDs) are almost exclusively of B-cell origin, with the majority being extra-nodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT). The comparative efficacy of involved field radiation therapy (IFRT) in MALT vs. non-MALT OALDs is not known. Materials and Methods We present a single-center, large cohort, retrospective study of the efficacy of IFRT in OALDs. Failure-free survival (FFS), complete remission, and local, regional, and distant failure were determined for 112 patients with MALT OALDs (n = 71) and non-MALT OALDs (n = 41) cohorts. Results Fifty-six patients with MALT OALD and 26 patients with non-MALT OALD received IFRT only (without any planned concurrent or sequential systemic chemothereapy or chemo-immunotherapies). Among the OALD cohorts treated with only IFRT, complete remission was achieved in 49 (87.5%) patients in the MALT cohort and 23 (88.4%) in the non-MALT cohort (P = .99). Clinically, resolution of symptoms occurred in 83.3% and 93.3% of the patients in the MALT and non-MALT cohorts, respectively. Local failure occurred in 4 (7.1%) patients in the MALT cohort, compared with 4 (15.3%) patients in the non-MALT cohort (P = .24). Regional failure (or extra-orbital failure) occurred in 5 (8.9%) patients in the MALT cohort and in 3 (11.5%) patients in the non-MALT cohort (P = .71). Distant failure was reported in 1 (1.7%) and 2 patients (7.6%) in the MALT and non-MALT cohorts, respectively (P = .18). The median follow-up of survivors was 5.1 years (range, 0.1-22.5 years) in the MALT cohort and 3.9 years (range, 0.1-22.9 years) in the non-MALT cohort. The 5-year and 10-year FFS was 95% (95% confidence interval [CI], 88%-100%) and 83% (95% CI, 70%-98%) for the ocular MALT and 67% (95% CI, 48%-94%) and 56% (95% CI, 34%-91%) for the non-MALT cohorts, respectively (log rank for P = .025). On multivariate analyses, age (hazard ratio [HR], 1.06; 95% CI, 1.10-1.12; P = .03), presence of non-MALT histology (HR, 13.9; 95% CI, 2.05-94.4; P = .007), and radiation dose < 30.6 Gy (HR, 5.27; 95% CI, 1.14-24.3; P = .03) were associated with worse FFS. The 5-year and 10-year overall survival was 92% (95%, CI 83%-100%) and 80% (95% CI, 66%-96%) for the MALT and 78% (95% CI, 61%-100%) and 62% (95% CI, 38%-100%) for the non-MALT cohorts, respectively (P = .80). Conclusion Our results reveal that IFRT provided excellent disease control with superior FFS in the MALT cohort when compared with the non-MALT group.

Original languageEnglish (US)
Pages (from-to)305-311.e2
JournalClinical Lymphoma, Myeloma and Leukemia
Volume17
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Lymphoproliferative Disorders
Lymphoid Tissue
Histology
Mucous Membrane
Confidence Intervals
Radiotherapy
Survival

Keywords

  • Eye
  • IFRT
  • Non-Hodgkin lymphoma
  • OALD
  • Orbit lymphoma
  • Radiation

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Dhakal, Binod ; Fenske, Timothy S. ; Ramalingam, Sridevi ; Shuff, Jamie ; Epperla, Narendranath ; Hosking, Paul ; Rein, Lisa ; Banerjee, Anjisnu ; Hari, Parameswaran ; D'Souza, Anita ; Shah, Nirav ; Siker, Malika ; Griepentrog, Gregory J. ; Harris, Gerald J. ; Wells, Timothy S. ; Erickson, Beth A. ; Hamadani, Mehdi. / Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders : Comparative Outcomes of MALT Versus Non-MALT Histologies. In: Clinical Lymphoma, Myeloma and Leukemia. 2017 ; Vol. 17, No. 5. pp. 305-311.e2.
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abstract = "The efficacy of involved field radiotherapy (IFRT) in the outcomes of patients with different subtypes of ocular adnexal lymphoproliferative disorder is lacking. We retrospectively analyzed and compared the outcomes of patients with mucosa-associated lymphoid tissue (MALT) and non-MALT ocular adnexal lymphoproliferative disorder after being treated with IFRT. Our results reveal that IFRT provided excellent disease control with superior failure-free survival in the MALT cohort when compared with the non-MALT cohort. Introduction Ocular adnexal lymphoproliferative disorders (OALDs) are almost exclusively of B-cell origin, with the majority being extra-nodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT). The comparative efficacy of involved field radiation therapy (IFRT) in MALT vs. non-MALT OALDs is not known. Materials and Methods We present a single-center, large cohort, retrospective study of the efficacy of IFRT in OALDs. Failure-free survival (FFS), complete remission, and local, regional, and distant failure were determined for 112 patients with MALT OALDs (n = 71) and non-MALT OALDs (n = 41) cohorts. Results Fifty-six patients with MALT OALD and 26 patients with non-MALT OALD received IFRT only (without any planned concurrent or sequential systemic chemothereapy or chemo-immunotherapies). Among the OALD cohorts treated with only IFRT, complete remission was achieved in 49 (87.5{\%}) patients in the MALT cohort and 23 (88.4{\%}) in the non-MALT cohort (P = .99). Clinically, resolution of symptoms occurred in 83.3{\%} and 93.3{\%} of the patients in the MALT and non-MALT cohorts, respectively. Local failure occurred in 4 (7.1{\%}) patients in the MALT cohort, compared with 4 (15.3{\%}) patients in the non-MALT cohort (P = .24). Regional failure (or extra-orbital failure) occurred in 5 (8.9{\%}) patients in the MALT cohort and in 3 (11.5{\%}) patients in the non-MALT cohort (P = .71). Distant failure was reported in 1 (1.7{\%}) and 2 patients (7.6{\%}) in the MALT and non-MALT cohorts, respectively (P = .18). The median follow-up of survivors was 5.1 years (range, 0.1-22.5 years) in the MALT cohort and 3.9 years (range, 0.1-22.9 years) in the non-MALT cohort. The 5-year and 10-year FFS was 95{\%} (95{\%} confidence interval [CI], 88{\%}-100{\%}) and 83{\%} (95{\%} CI, 70{\%}-98{\%}) for the ocular MALT and 67{\%} (95{\%} CI, 48{\%}-94{\%}) and 56{\%} (95{\%} CI, 34{\%}-91{\%}) for the non-MALT cohorts, respectively (log rank for P = .025). On multivariate analyses, age (hazard ratio [HR], 1.06; 95{\%} CI, 1.10-1.12; P = .03), presence of non-MALT histology (HR, 13.9; 95{\%} CI, 2.05-94.4; P = .007), and radiation dose < 30.6 Gy (HR, 5.27; 95{\%} CI, 1.14-24.3; P = .03) were associated with worse FFS. The 5-year and 10-year overall survival was 92{\%} (95{\%}, CI 83{\%}-100{\%}) and 80{\%} (95{\%} CI, 66{\%}-96{\%}) for the MALT and 78{\%} (95{\%} CI, 61{\%}-100{\%}) and 62{\%} (95{\%} CI, 38{\%}-100{\%}) for the non-MALT cohorts, respectively (P = .80). Conclusion Our results reveal that IFRT provided excellent disease control with superior FFS in the MALT cohort when compared with the non-MALT group.",
keywords = "Eye, IFRT, Non-Hodgkin lymphoma, OALD, Orbit lymphoma, Radiation",
author = "Binod Dhakal and Fenske, {Timothy S.} and Sridevi Ramalingam and Jamie Shuff and Narendranath Epperla and Paul Hosking and Lisa Rein and Anjisnu Banerjee and Parameswaran Hari and Anita D'Souza and Nirav Shah and Malika Siker and Griepentrog, {Gregory J.} and Harris, {Gerald J.} and Wells, {Timothy S.} and Erickson, {Beth A.} and Mehdi Hamadani",
year = "2017",
month = "5",
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doi = "10.1016/j.clml.2017.02.002",
language = "English (US)",
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journal = "Clinical Lymphoma, Myeloma and Leukemia",
issn = "2152-2669",
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number = "5",

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Dhakal, B, Fenske, TS, Ramalingam, S, Shuff, J, Epperla, N, Hosking, P, Rein, L, Banerjee, A, Hari, P, D'Souza, A, Shah, N, Siker, M, Griepentrog, GJ, Harris, GJ, Wells, TS, Erickson, BA & Hamadani, M 2017, 'Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders: Comparative Outcomes of MALT Versus Non-MALT Histologies', Clinical Lymphoma, Myeloma and Leukemia, vol. 17, no. 5, pp. 305-311.e2. https://doi.org/10.1016/j.clml.2017.02.002

Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders : Comparative Outcomes of MALT Versus Non-MALT Histologies. / Dhakal, Binod; Fenske, Timothy S.; Ramalingam, Sridevi; Shuff, Jamie; Epperla, Narendranath; Hosking, Paul; Rein, Lisa; Banerjee, Anjisnu; Hari, Parameswaran; D'Souza, Anita; Shah, Nirav; Siker, Malika; Griepentrog, Gregory J.; Harris, Gerald J.; Wells, Timothy S.; Erickson, Beth A.; Hamadani, Mehdi.

In: Clinical Lymphoma, Myeloma and Leukemia, Vol. 17, No. 5, 01.05.2017, p. 305-311.e2.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders

T2 - Comparative Outcomes of MALT Versus Non-MALT Histologies

AU - Dhakal, Binod

AU - Fenske, Timothy S.

AU - Ramalingam, Sridevi

AU - Shuff, Jamie

AU - Epperla, Narendranath

AU - Hosking, Paul

AU - Rein, Lisa

AU - Banerjee, Anjisnu

AU - Hari, Parameswaran

AU - D'Souza, Anita

AU - Shah, Nirav

AU - Siker, Malika

AU - Griepentrog, Gregory J.

AU - Harris, Gerald J.

AU - Wells, Timothy S.

AU - Erickson, Beth A.

AU - Hamadani, Mehdi

PY - 2017/5/1

Y1 - 2017/5/1

N2 - The efficacy of involved field radiotherapy (IFRT) in the outcomes of patients with different subtypes of ocular adnexal lymphoproliferative disorder is lacking. We retrospectively analyzed and compared the outcomes of patients with mucosa-associated lymphoid tissue (MALT) and non-MALT ocular adnexal lymphoproliferative disorder after being treated with IFRT. Our results reveal that IFRT provided excellent disease control with superior failure-free survival in the MALT cohort when compared with the non-MALT cohort. Introduction Ocular adnexal lymphoproliferative disorders (OALDs) are almost exclusively of B-cell origin, with the majority being extra-nodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT). The comparative efficacy of involved field radiation therapy (IFRT) in MALT vs. non-MALT OALDs is not known. Materials and Methods We present a single-center, large cohort, retrospective study of the efficacy of IFRT in OALDs. Failure-free survival (FFS), complete remission, and local, regional, and distant failure were determined for 112 patients with MALT OALDs (n = 71) and non-MALT OALDs (n = 41) cohorts. Results Fifty-six patients with MALT OALD and 26 patients with non-MALT OALD received IFRT only (without any planned concurrent or sequential systemic chemothereapy or chemo-immunotherapies). Among the OALD cohorts treated with only IFRT, complete remission was achieved in 49 (87.5%) patients in the MALT cohort and 23 (88.4%) in the non-MALT cohort (P = .99). Clinically, resolution of symptoms occurred in 83.3% and 93.3% of the patients in the MALT and non-MALT cohorts, respectively. Local failure occurred in 4 (7.1%) patients in the MALT cohort, compared with 4 (15.3%) patients in the non-MALT cohort (P = .24). Regional failure (or extra-orbital failure) occurred in 5 (8.9%) patients in the MALT cohort and in 3 (11.5%) patients in the non-MALT cohort (P = .71). Distant failure was reported in 1 (1.7%) and 2 patients (7.6%) in the MALT and non-MALT cohorts, respectively (P = .18). The median follow-up of survivors was 5.1 years (range, 0.1-22.5 years) in the MALT cohort and 3.9 years (range, 0.1-22.9 years) in the non-MALT cohort. The 5-year and 10-year FFS was 95% (95% confidence interval [CI], 88%-100%) and 83% (95% CI, 70%-98%) for the ocular MALT and 67% (95% CI, 48%-94%) and 56% (95% CI, 34%-91%) for the non-MALT cohorts, respectively (log rank for P = .025). On multivariate analyses, age (hazard ratio [HR], 1.06; 95% CI, 1.10-1.12; P = .03), presence of non-MALT histology (HR, 13.9; 95% CI, 2.05-94.4; P = .007), and radiation dose < 30.6 Gy (HR, 5.27; 95% CI, 1.14-24.3; P = .03) were associated with worse FFS. The 5-year and 10-year overall survival was 92% (95%, CI 83%-100%) and 80% (95% CI, 66%-96%) for the MALT and 78% (95% CI, 61%-100%) and 62% (95% CI, 38%-100%) for the non-MALT cohorts, respectively (P = .80). Conclusion Our results reveal that IFRT provided excellent disease control with superior FFS in the MALT cohort when compared with the non-MALT group.

AB - The efficacy of involved field radiotherapy (IFRT) in the outcomes of patients with different subtypes of ocular adnexal lymphoproliferative disorder is lacking. We retrospectively analyzed and compared the outcomes of patients with mucosa-associated lymphoid tissue (MALT) and non-MALT ocular adnexal lymphoproliferative disorder after being treated with IFRT. Our results reveal that IFRT provided excellent disease control with superior failure-free survival in the MALT cohort when compared with the non-MALT cohort. Introduction Ocular adnexal lymphoproliferative disorders (OALDs) are almost exclusively of B-cell origin, with the majority being extra-nodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT). The comparative efficacy of involved field radiation therapy (IFRT) in MALT vs. non-MALT OALDs is not known. Materials and Methods We present a single-center, large cohort, retrospective study of the efficacy of IFRT in OALDs. Failure-free survival (FFS), complete remission, and local, regional, and distant failure were determined for 112 patients with MALT OALDs (n = 71) and non-MALT OALDs (n = 41) cohorts. Results Fifty-six patients with MALT OALD and 26 patients with non-MALT OALD received IFRT only (without any planned concurrent or sequential systemic chemothereapy or chemo-immunotherapies). Among the OALD cohorts treated with only IFRT, complete remission was achieved in 49 (87.5%) patients in the MALT cohort and 23 (88.4%) in the non-MALT cohort (P = .99). Clinically, resolution of symptoms occurred in 83.3% and 93.3% of the patients in the MALT and non-MALT cohorts, respectively. Local failure occurred in 4 (7.1%) patients in the MALT cohort, compared with 4 (15.3%) patients in the non-MALT cohort (P = .24). Regional failure (or extra-orbital failure) occurred in 5 (8.9%) patients in the MALT cohort and in 3 (11.5%) patients in the non-MALT cohort (P = .71). Distant failure was reported in 1 (1.7%) and 2 patients (7.6%) in the MALT and non-MALT cohorts, respectively (P = .18). The median follow-up of survivors was 5.1 years (range, 0.1-22.5 years) in the MALT cohort and 3.9 years (range, 0.1-22.9 years) in the non-MALT cohort. The 5-year and 10-year FFS was 95% (95% confidence interval [CI], 88%-100%) and 83% (95% CI, 70%-98%) for the ocular MALT and 67% (95% CI, 48%-94%) and 56% (95% CI, 34%-91%) for the non-MALT cohorts, respectively (log rank for P = .025). On multivariate analyses, age (hazard ratio [HR], 1.06; 95% CI, 1.10-1.12; P = .03), presence of non-MALT histology (HR, 13.9; 95% CI, 2.05-94.4; P = .007), and radiation dose < 30.6 Gy (HR, 5.27; 95% CI, 1.14-24.3; P = .03) were associated with worse FFS. The 5-year and 10-year overall survival was 92% (95%, CI 83%-100%) and 80% (95% CI, 66%-96%) for the MALT and 78% (95% CI, 61%-100%) and 62% (95% CI, 38%-100%) for the non-MALT cohorts, respectively (P = .80). Conclusion Our results reveal that IFRT provided excellent disease control with superior FFS in the MALT cohort when compared with the non-MALT group.

KW - Eye

KW - IFRT

KW - Non-Hodgkin lymphoma

KW - OALD

KW - Orbit lymphoma

KW - Radiation

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