Clinical Characteristics and Outcomes Of Waldeyer’s Ring Lymphoma: Nation-Wide Study In Korea

There has been published several papers that analyzed Waldeyer’s ring lymphoma. However, so far, Asian data was rare and WHO classification was not used for classifying subtype of malignant lymphoma.

328 patients who were diagnosed as non-Hodgkin’s lymphoma involved Waldeyer’s ring (WR-NHL) were analyzed retrospectively in Korea.

Male was slightly predominant compared to female. Low risk disease (low to low intermediate by International prognostic index) was 76.8% and localized disease was 64.9%. Most patients had normal level of serum lactate dehydrogenase (85.4%) and were not absent of B symptoms (85.1%). Bone marrow involvement was seen in only 30 patients (9.1%). Diffuse large B cell lymphoma (DLBCL) (73.2%) was most popular, and peripheral T cell lymphoma, NK/T cell lymphoma, and marginal zone B-cell lymphoma were also frequently involved Waldeyer’s ring. Almost subtype of lymphoma including DLBCL involved tonsil most frequently (199/328, 60.7%). Frequently involved extra-Waldeyer’s ring sites were bone marrow, G-I tract, lung/plerura/pericardium, and bone. In DLBCL, 169 patients (70.4%) received chemotherapy, 50 patients (20.8%) received chemotherapy plus radiotherapy, thirteen patients (5.4%) received surgical resection +/- chemotherapy or radiotherapy, and six patients (2.5%) received radiotherapy alone. Surgical resection showed improved PFS, DFS, and OS compared to chemotherapy +/- radiotherapy. In localized disease, all patients who received surgical resection still alive until now and chemotherapy or chemotherapy plus radiotherapy was better PFS and OS than radiotherapy alone (5-year PFS rates, 83.2% and 89.3% vs 66.7%; 5-year OS rates, 77.0% and 75.4% vs 58.9%). PFS, DFS and OS of B-cell lymphoma exhibited improved compared to T-cell lymphoma.

In conclusion, DLBCL was most frequent subtype and tonsil was frequently involved site of WR-NHL. In localized disease, surgical resection should be tried as possible for achieving long-term survival. Especially, in T-cell lymphoma patients, more aggressive treatment was required due to poor outcomes compared with B-cell lymphoma.