Spinal manifestations of diffuse large B-cell lymphoma.

Background context: Spinal diffuse large B-cell lymphoma (DLBCL) can be divided into two categories: primary non-Hodgkin's lymphoma (PNHL) and metastases from disseminated DLBCL. Prognostic factors of spinal DLBCL metastases seem to differ from those of other spine metastases and PNHL, although the data in the literature remains scarce.

Purpose: This study aims at investigating prognostic factors associated with overall survival (OS) in patients with spine DLBCL metastases.

Study design: a retrospective study PATIENT SAMPLE: 371 patients treated for DLBCL, including 62 cases of spine DLBCL metastases OUTCOME MEASURES: Patient demographics were collected with survival.

Methods: This study is based on consecutive prospective population of, between January 2015 and 2019.

Results: The median age of the 371 patients was 68.4 years (range 19.1 to 94.0 years) and 58.8% were males (218 patients). The median OS for our whole series was 82.06 months (SD 11.2.), and 53.0 months (SD 41.2, p=0.622) for the 62 patients with spine DLBCL metastases. The mean duration between DLBCL diagnosis and development of spine metastases (SpM) was 9.0 months (range 0.0-160.8 months). Cox multivariate proportional hazard model identified ECOG <2 [HR: 0.O59, 95 % CI 0.019-0.075; p< 0.0001], age <40 years [HR: 0.206, 95 % CI 0.08-0.506; p =0.001], and IPI score ≤ 2 [HR: 0.472, 95 % CI 0.03-2.104; p =0.001] as predictors of longer survival. In contrast, age >80 years [HR: 2.198, 95 % CI 1.481-3.261; p < 0.0001], IPI score > 4 [HR: 3.232, 95 % CI 1.765-4.654; p =0.008] were independent poor prognostic factors of survival.

Conclusion: Spinal lesions in DLBCL are metastatic in nature whereas spine PNHL, similar to multiple myeloma, appears to be a primary spinal malignancy. The main prognostic factors of DLBCL spine metastases are those of the primary disease itself, and should be considered before spinal surgery.