K Miyazaki1, M Yamaguchi2, R Suzuki3, Y Kobayashi4, A M Maeshima5, N Niitsu6, D Ennishi7, J-I Tamaru8, K Ishizawa9, M Kashimura10, Y Kagami11, K Sunami12, H Yamane13, M Nishikori14, H Kosugi15, T Yujiri16, R Hyo3, N Katayama1, T Kinoshita17, S Nakamura18. 1. Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu. 2. Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu. Electronic address: waniwani@clin.medic.mie-u.ac.jp. 3. Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Nagoya. 4. Hematology and Stem Cell Transplantation Division. 5. Clinical Laboratory Division, National Cancer Center Hospital, Tokyo. 6. Department of Hematology, International Medical Center, Saitama Medical University, Hidaka. 7. Department of Medical Oncology, Cancer Institute Hospital, Tokyo. 8. Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe. 9. Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai. 10. Department of Hematology, Matsudo City Hospital, Matsudo. 11. Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya. 12. Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama. 13. Division of Clinical Oncology, Sumitomo-Besshi Hospital Cancer Center, Niihama. 14. Department of Hematology and Oncology, Kyoto University, Kyoto. 15. Department of Hematology, Ogaki Municipal Hospital, Ogaki. 16. Department of Hematology, Yamaguchi University, Yamaguchi. 17. Departments of Hematology and Oncology. 18. Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Abstract
BACKGROUND: CD5-positive (CD5+) diffuse large B-cell lymphoma (DLBCL) shows poor prognosis and frequent central nervous system (CNS) relapses under anthracycline-containing chemotherapy. The aim of this study was to determine the prognosis and CNS relapse incidence of CD5+ DLBCL in the rituximab era. PATIENTS AND METHODS: We analyzed 337 patients with CD5+ DLBCL who received chemotherapy with (R-chemotherapy group; n = 184) or without (chemotherapy group; n = 153) rituximab. RESULTS: No significant difference was found in clinical background comparisons between the two groups. In the R-chemotherapy group, 60% of the patients were older than 65 years at diagnosis. Both the complete response rate and overall survival (OS) were significantly better in the R-chemotherapy group (P = 0.0003 and P = 0.002, respectively). Multivariate analysis confirmed that chemotherapy without rituximab was associated with unfavorable OS. However, the probability of CNS relapse did not differ between the two groups (P = 0.89). The CNS relapse was strongly associated with short OS (P < 0.0001). In the R-chemotherapy group, 83% of patients who experienced CNS relapse had parenchymal disease. CONCLUSIONS: Our results indicate that rituximab improves the OS of patients with CD5+ DLBCL but does not decrease the CNS relapse rate. More effective treatments with CNS prophylaxis are needed for CD5+ DLBCL patients.
BACKGROUND:CD5-positive (CD5+) diffuse large B-cell lymphoma (DLBCL) shows poor prognosis and frequent central nervous system (CNS) relapses under anthracycline-containing chemotherapy. The aim of this study was to determine the prognosis and CNS relapse incidence of CD5+ DLBCL in the rituximab era. PATIENTS AND METHODS: We analyzed 337 patients with CD5+ DLBCL who received chemotherapy with (R-chemotherapy group; n = 184) or without (chemotherapy group; n = 153) rituximab. RESULTS: No significant difference was found in clinical background comparisons between the two groups. In the R-chemotherapy group, 60% of the patients were older than 65 years at diagnosis. Both the complete response rate and overall survival (OS) were significantly better in the R-chemotherapy group (P = 0.0003 and P = 0.002, respectively). Multivariate analysis confirmed that chemotherapy without rituximab was associated with unfavorable OS. However, the probability of CNS relapse did not differ between the two groups (P = 0.89). The CNS relapse was strongly associated with short OS (P < 0.0001). In the R-chemotherapy group, 83% of patients who experienced CNS relapse had parenchymal disease. CONCLUSIONS: Our results indicate that rituximab improves the OS of patients with CD5+ DLBCL but does not decrease the CNS relapse rate. More effective treatments with CNS prophylaxis are needed for CD5+ DLBCL patients.
Authors: Lapo Alinari; Alejandro Gru; Carl Quinion; Ying Huang; Arletta Lozanski; Gerard Lozanski; Jacqueline Poston; Girish Venkataraman; Eunhye Oak; Friederike Kreisel; Steven I Park; Stephanie Matthews; Jeremy S Abramson; Hana Iris Lim; Peter Martin; Jonathon B Cohen; Andrew Evens; Zeina Al-Mansour; Arun Singavi; Timothy S Fenske; Kristie A Blum Journal: Am J Hematol Date: 2016-06 Impact factor: 10.047