AGGRESSIVE LYMPHOMAS WITH RENAL INVOLVEMENT - A STUDY OF 48 PATIENTS TREATED WITH THE LNH-84 AND LNH-87 REGIMENS

In order to describe renal involvement in aggressive non-Hodgkin's lym phomas (NHLs) and its prognostic significance, we reviewed the outcome of 48 patients with renal involvement treated with the LNH-84 or LNH- 87 regimen. Histology was diffuse large cell in 29 (60%) patients; imm munoblastic, diffuse mixed cell and lymphoblastic in four each; follic ular large cell, diffuse small cleaved cell and diffuse small non-clea ved cell in one each; and unclassified in four. Ann Arbor stage was IV in 44 patients, and IE or IIE in four. Tumour mass greater than or eq ual to 10 cm, performance status (ECOG scale) > 2 and increased LDH le vel were present in 69%, 20% and 76% of patients respectively. Fifteen patients (31%) had multiple intraparenchymal nodules, 14 (29%) had di rect spread into the kidney from a perirenal mass, ten (21%) had a sin gle intraparenchymal nodule and nine (19%) had diffuse infiltration. T wenty-one patients (43%) presented with bilateral lesions. Three patie nts (6%) presented with acute renal failure. Ten other patients (21%) had serum creatinine > 120 mu mol l(-1). In 12 of these 13 patients re nal function was restored with chemotherapy. Twenty-eight patients (57 %) achieved complete remission. Estimated 4 year disease-free survival was 39%. Disease-free survival and actuarial survival at 4 years were estimated to be 58% respectively. Two renal parameters had adverse pr ognostic significance for survival: renal hilum involvement (P = 0.02) and diffuse renal infiltration (P = 0.01). A Cox model identified onl y two independent prognostic factors for survival, namely performance status greater than or equal to 2 and tumour size greater than or equa l to 10 cm. We conclude that alteration in renal function occurs in 27 % of patients with renal involvement. Systemic chemotherapy improves r enal function rapidly. Long-term outcome is similar to that expected i n NHL patients presenting with the same prognostic factors.