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Lung

, Volume 197, Issue 1, pp 47–51 | Cite as

Pleural Effusions in Diffuse Large B-Cell Lymphoma: Clinical and Prognostic Significance

  • José M. PorcelEmail author
  • Irene Cuadrat
  • Tomás García-Cerecedo
  • Marina Pardina
  • Silvia Bielsa
PLEURAL DISEASE
  • 44 Downloads

Abstract

Purpose

Pleural effusion (PEs) may complicate diffuse large B-cell lymphomas (DLBCL). However, their real prevalence and prognostic significance have seldom been approached systematically.

Methods

Retrospective single-center evaluation of consecutive patients with DLBCL was conducted. Baseline characteristics, PEs on CT imaging, pleural fluid analyses, and outcome until death or censoring date were collected.

Results

Of 185 DLBCL patients, 55 (30%) had PEs, of which 27 (49%) were analyzed. Most tapped PEs were malignant (n = 24) and cytological and/or flow cytometric analyses provided the diagnosis in about 70% of the cases. Malignant PEs were exudates with adenosine deaminase levels > 35 U/L in 35% of the cases. More than one-third of lymphomatous PEs required definitive pleural procedures for symptomatic relief. PEs greater than 200 mL on CT scans were an independent predictor of poor survival in Cox regression modeling (hazard ratio 1.9).

Conclusions

PEs are common in DLBCL and foreshadow a poor prognosis.

Keywords

Pleural effusion Diffuse large B-cell lymphoma Survival Indwelling pleural catheter Pleurodesis Adenosine deaminase Chylothorax 

Notes

Author Contributions

Conception and design: JMP and SB; Acquisition, analysis and interpretation of data: IC, TGC, MP, SB, and JMP; and drafting the manuscript: JMP All authors gave final approval.

Compliance with Ethical Standards

Conflict of interest

None of the authors has any conflicts of interest to declare in relation to this work.

References

  1. 1.
    Porcel JM, Esquerda A, Vives M, Bielsa S (2014) Etiology of pleural effusions: analysis of more than 3000 consecutive thoracenteses. Arch Bronconeumol 50:161–165.  https://doi.org/10.1016/j.arbres.2013.11.007 CrossRefGoogle Scholar
  2. 2.
    Elis A, Blickstein D, Mulchanov I, Manor Y, Radnay J, Shapiro H, Lishner M (1998) Pleural effusion in patients with non-Hodgkin’s lymphoma: a case-controlled study. Cancer 83:1607–1611CrossRefGoogle Scholar
  3. 3.
    Chen YP, Huang HY, Lin KP, Medeiros LJ, Chen TY, Chang KC (2015) Malignant effusions correlate with poorer prognosis in patients with diffuse large B-cell lymphoma. Am J Clin Pathol 143:707–715.  https://doi.org/10.1309/AJCP6LXA2LKFZAMC CrossRefGoogle Scholar
  4. 4.
    Laurent C, Do C, Gourraud PA, de Paiva GR, Valmary S, Brousset P (2015) Prevalence of common non-Hodgkin lymphomas and subtypes of Hodgkin lymphoma by nodal site of Involvement: a systematic retrospective review of 938 cases. Medicine 94:e987.  https://doi.org/10.1097/MD.0000000000000987 CrossRefGoogle Scholar
  5. 5.
    Porcel JM, Pardina M, Alemán C, Pallisa E, Light RW, Bielsa S (2017) Computed tomography scoring system for discriminating between parapneumonic effusions eventually drained and those cured only with antibiotics. Respirology 22:1199–1204.  https://doi.org/10.1111/resp.13040 CrossRefGoogle Scholar
  6. 6.
    Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ET, Tobin CL, Medford AR, Harvey JE, van den Heuvel MM, Lee YC, Maskell NA (2014) Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 69:1098–1104.  https://doi.org/10.1136/thoraxjnl-2014-205285 CrossRefGoogle Scholar
  7. 7.
    Lu CS, Chen JH, Huang TC, Wu YY, Chang PY, Dai MS, Chen YC, Ho CL (2015) Diffuse large B-cell lymphoma: sites of extranodal involvement are a stronger prognostic indicator than number of extranodal sites in the rituximab era. Leuk Lymphoma 56:2047–2055.  https://doi.org/10.3109/10428194.2014.982636 CrossRefGoogle Scholar
  8. 8.
    Mian M, Wasle I, Gritsch S, Willenbacher W, Fiegl M (2015) B cell lymphoma with lung involvement: what is it about? Acta Haematol 133:221–225.  https://doi.org/10.1159/000365778 CrossRefGoogle Scholar
  9. 9.
    Nitta H, Gotoh A, Tanaka M, Sekiguchi Y, Ota Y, Noguchi M, Komatsu N (2018) Pleural effusion at diagnosis predicts extremely poor outcomes in patients with diffuse large B-cell lymphoma harbouring MYC rearrangement. Br J Haematol.  https://doi.org/10.1111/bjh.15431 Google Scholar
  10. 10.
    Ahmed S, Shahid RK, Rimawi R, Siddiqui AK, Rossoff L, Sison CP, Steinberg H, Rai KR (2005) Malignant pleural effusions in lymphoproliferative disorders. Leuk Lymphoma 46:1039–1044CrossRefGoogle Scholar
  11. 11.
    Chen HJ, Huang KY, Tseng GC, Chen LH, Bai LY, Liang SJ, Tu CY, Light RW (2015) Diagnostic pitfalls of discriminating lymphoma-associated effusions. Medicine 94(17):e800.  https://doi.org/10.1097/MD.0000000000000800 CrossRefGoogle Scholar
  12. 12.
    Arnold DT, De Fonseka D, Perry S, Morley A, Harvey JE, Medford A, Brett M, Maskell NA (2018) Investigating unilateral pleural effusions: the role of cytology. Eur Respir J.  https://doi.org/10.1183/13993003.01254-2018 Google Scholar
  13. 13.
    Porcel JM (2017) Persistent benign pleural effusion. Rev Clin Esp 217:336–341.  https://doi.org/10.1016/j.rce.2017.03.008 CrossRefGoogle Scholar
  14. 14.
    Porcel JM, Esquerda A, Bielsa S (2010) Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. Eur J Intern Med 21:419–423.  https://doi.org/10.1016/j.ejim.2010.03.011 CrossRefGoogle Scholar
  15. 15.
    Yao CW, Wu BR, Huang KY, Chen HJ (2014) Adenosine deaminase activity in pleural effusions of lymphoma patients. QJM 107:887–893.  https://doi.org/10.1093/qjmed/hcu106 CrossRefGoogle Scholar
  16. 16.
    Fysh ETH, Bielsa S, Budgeon CA, Read CA, Porcel JM, Maskell NA, Lee YCG (2015) Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion. Chest 147:1629–1634.  https://doi.org/10.1378/chest.14-1701 CrossRefGoogle Scholar
  17. 17.
    Bairey O, Bar-Natan M, Shpilberg O (2013) Early death in patients diagnosed with non-Hodgkin’s lymphoma. Ann Hematol 92:345–350CrossRefGoogle Scholar
  18. 18.
    Porcel JM, Gasol A, Bielsa S, Civit C, Light RW, Salud A (2015) Clinical features and survival of lung cancer patients with pleural effusions. Respirology 20:654–659.  https://doi.org/10.1111/resp.12496 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pleural Medicine Unit, Department of Internal MedicineArnau de Vilanova University Hospital, IRBLleidaLleidaSpain
  2. 2.Service of HematologyArnau de Vilanova University HospitalLleidaSpain
  3. 3.Department of RadiologyArnau de Vilanova University HospitalLleidaSpain

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