ABCL-165 primary testicular diffuse large B-Cell lymphoma: outcome with uniform treatment protocol

Abstract

Context: Primary testicular lymphoma (PTL) accounts for 1% to 5% of all testicular malignancies and diffuse large B-cell lymphoma (DLBCL) is the most common subtype in 70% to 80% of total PTL cases. Primary testicular DLBCL (PT-DLBCL) has a relatively aggressive course, poor prognosis, and its relapse in the central nervous system (CNS) is a major concern. Objective: This study aimed to evaluate the clinicopathological profile and outcome of PT-DLBCL with uniform multimodality treatment protocol at an Indian tertiary care centre. Design and Setting This was a retrospective study of consecutive cases of PT-DLBCL registered at All India Institute of Medical Sciences between May 1, 2013 and April 30, 2023 and treated with a uniform protocol including orchiectomy, chemoimmunotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone [CHOP] +rituximab), CNS prophylaxis with intrathecal methotrexate, and prophylactic radiation to the contralateral testis and scrotum. Patients: The patients were classified as germinal center B-cell-like or activated B-cell (ABC) type using the Hans classification. Results: Overall, 15 patients were identified with the median age at diagnosis being 55 years (range, 28-72 years) and the median symptoms duration was 4 months. Unilateral testicular involvement (right=8, left=5) was observed in 13 patients. Seven patients had stage I, 6 had stage II, and 2 had stage IV disease. Data regarding the cell of origin were available in 12 patients, and 9 (75%) were ABC in origin. Low, intermediate, and high-risk International Prognostic Index (IPI) was seen in 6 (40%), 7 (46.6%), and 2 (13.3%) patients, respectively. The median number of chemotherapy cycles was 5 (4-6) and rituximab was used in 13 (86.7%) cases. The complete response rate was 86.6%. At a median follow-up of 39 months (range, 10-120 months), the 3-year progression-free survival and overall survival rates were 78% and 89%, respectively. Two patients relapsed (1 systemic + CNS and 1 CNS) within 18 months after completion of treatment. Conclusion: Multimodality treatment (chemoimmunotherapy + radiation) can result in good survival with PT-DLBCL but adding high-dose methotrexate to the existing protocol, especially in stage IV and /or high IPI disease, needs further exploration.