Abstract: FR-PO195
Kidney Intravascular Large B-Cell Lymphoma: A Multi-Institutional Experience
Session Information
- Onconephrology: Clinical and Research Advances - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Rastogi, Prerna, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
- Alrwashdeh, Audai A., The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
- Obeidat, Mohammad, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
- Lin, Mercury Y., Cedars-Sinai Medical Center, Los Angeles, California, United States
- Larsen, Christopher Patrick, Arkana Laboratories, Little Rock, Arkansas, United States
- Dai, Dao-Fu, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
Background
Intravascular large B-cell lymphoma (IVLBCL) is an aggressive variant of large B-cell lymphoma, with growth of neoplastic cells within the blood vessels. Kidney involvement is rare. Prognostic features from a multi-institutional retrospective review are presented here.
Methods
Kidney biopsies with a diagnosis of kidney IVLBCL were reviewed till Dec 2021. We identified 17 cases with mean age of 64.7±7.9 years with 52.9% (9/17) ♂ and 53 more (total 70) from literature review with mean age 61.1±11.4 (50% ♂). Findings included fever, anemia, acute kidney injury, 88% of our 17 cases, 69% for all, proteinuria in 65% of our cases, 83.3% for all, hematuria in 35.3% of our patients, unclear in others & Nephrotic range proteinuria in 11.7% of our patients & 27.2% of all cases.
Results
Of 40 patients with available data, the median & interquartile range of serum creatinine was 1.75 [1.17, 3.25] mg/dL. Biopsy showed glomerular infiltration by neoplastic lymphoid cells (yellow → Fig 1) in 84.6% cases, cells in the tubulointerstitium (56.7%) and peritubular capillaries. Arteries or veins were involved by neoplastic lymphoid cells in 13.11%. Of 58 cases with data 43.1% showed infiltration into bone marrow, liver, spleen, CNS, lungs & skin. IVLBCL expresses mature B-cell antigens, such as CD20, CD79a, PAX-5 & non-germinal center immunophenotype with CD10- and MUM1+. Follow-up data available in 48 patients showed median survival of ~20 months after diagnosis, of which 6 (12.5%) were post-mortem, with extensive extra-renal involvement. Multivariate Cox regression analysis showed extrarenal involvement is a significant predictor of mortality, with HR: 5.97 (95% CI:1.72, 20.7, p=0.005), but not serum Cre: 1.03 (.54, 1.97, p=0.9), after controlling for age gender.
Conclusion
Kidney IVLBCL is rare, presenting with fever, anemia, AKI, elevated serum creatinine & proteinuria. Median survival is 20 months & extrarenal involvement indicating extensive disease is associated with worse outcome.