A Rare Case of Primary Bone Follicular Lymphoma with Multiple Osteolytic Lesions: A Case Report and Review of the Literature

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

There is no WHO classification of lymphomas from 2013 or 2020 – please refer to lymphomas’ classification from 2016/17 and 2022

Lines 50-51 – English editing

Lines 54-56 – what about ALP? 

Line 80: large elements? Cells?

MUM1+ or -?

It is not clear how obinutuzumab was administered: cycle 1: days 1, 8, 15 and afterward only day 1, or day 1 only in each cycle + 2 maintenance cycles?

 

 

Discussion:

I would suggest providing the whole information on translocation + the information on the genes involved

I am not aware of FL transformation to HL; I would suggest leaving the information on transformation to LBCL

Line 126: there is no stage IVE

Line 166: I would not cite references concerning CNS prophylaxis from 2014; the CNS prophylaxis is among the hottest topics in hematology and in fact there is no evidence that any prophylaxis is successful

 

The discussion requires some modification -I personally would suggest discussing the issue of indications to treatment – the primary extranodal disease per se is not an indication; additionally discussing aggressive and indolent lymphomas together seems inappropriate – discussion should be clearly focused on indolent lymphomas, stressing however the possibility of transformation

The authors should also discuss the choice of first-line treatment

Comments on the Quality of English Language

English requires improvement

Author Response

Thank you for dedicating your time to review this manuscript, here are the corrections and responses made

There is no WHO classification of lymphomas from 2013 or 2020 – please refer to lymphomas’ classification from 2016/17 and 2022

Response: We were referring to the WHO regarding soft tissue and bone and therefore we corrected the manuscript 

Lines 50-51 – English editing

Response: we edited the english language

Lines 54-56 – what about ALP? 

Line 80: large elements? Cells?

MUM1+ or -?

Response: As you correctly pointed out we implemented the missing data

It is not clear how obinutuzumab was administered: cycle 1: days 1, 8, 15 and afterward only day 1, or day 1 only in each cycle + 2 maintenance cycles?

Response: we corrected the description of the administration of Obinutuzumab

 

The corrections regarding the discussion and conclusions were highly appreciated and we tried to significantly improve these passages trying to respond to the requests made.

Noneteheless we respectfully want to point out that due to the rarity there are no clear indications regarding treatment of indolent PBLs and the scarce data in literature is either pre-immunotherapy or heterogeneous and not uniformed.

 

Thanks again for your review

Reviewer 2 Report

Comments and Suggestions for Authors

Overall a well performed case report of a primary FL with multiple osteolytic lesions and integrated literature review. 

I have a few minor comments:

1. line 36: IELSG should be defined here and not later in the Discussion (line 118)

2.line 50. In the context of multifocal bone FL more detailed information about the seizure might be adequate. (follow-up brain MRI performed?, LP performed?)

3. line 81:  MUM1 nor precise (+or-) probably+

line 122: The authors mention low PFS and OS rates in a study evolving over many years. Probably this outcome is related to an era where modern immunotherapies were not yet available. It may improve the discussion including this aspect for the future.

Author Response

Thank you for dedicating the time to review this manuscript and we tried to improve the manuscript with your suggestions

line 36: IELSG should be defined here and not later in the Discussion (line 118)

response: as you correctly pointed out, we defined IELSG at line 36

2.line 50. In the context of multifocal bone FL more detailed information about the seizure might be adequate. (follow-up brain MRI performed?, LP performed?)

Response: we further described the neurologic episode

3. line 81:  MUM1 nor precise (+or-) probably+

Response: we implemented the description of MUM

line 122: The authors mention low PFS and OS rates in a study evolving over many years. Probably this outcome is related to an era where modern immunotherapies were not yet available. It may improve the discussion including this aspect for the future.

Response: as you suggested, we improbed the discussion regarding therapy in an era before immunotherapy.

 

Thanks again for your review

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Major issues: The discussion is in fact solely a review of the literature and there is no discussion in the manuscript 

Minor issues: Discussion – the translocation should be described in more detail; t(14;18)(q32;q21)

 

 

Comments on the Quality of English Language

minor changes required

Author Response

Thank you for your review, we aknowledged the issues adressed and improved the discussion as suggested

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

The names of the genes should  be written in italics

The order of the first two paragraphs in the discussion should be changed

Line 189 – what are low-grade NHLs – please use appropriate nomenclature

Lines 195-7 – please provide a reference; relapse and transformation are two different events – please correct the sentence

 

Conclusions represent summary and no conclusions – please modify; None of them are based on the reported case

Comments on the Quality of English Language

minor changes required

Author Response

Thanks for you thorough review, we corrected the minor issues

We rewrote the conclusions as requested

Thanks again