BACKGROUND: To describe incidence, risk factors, and influence of treatment on occurrence of central nervous system (CNS) relapse or progression in younger patients with aggressive B-cell lymphoma. PATIENTS AND METHODS: We analyzed 2210 patients with aggressive B-cell lymphoma treated on various studies for CNS relapse/progression. Treatment consisted of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) ± etoposide. Six hundred and twenty patients also received rituximab. CNS prophylaxis was intrathecal methotrexate on High-CHOEP and MegaCHOEP phase III studies if upper neck, head, bone marrow, or testes were involved. RESULTS: Fifty-six of 2196 patients (2.6%) developed CNS disease. It occurred early (median 7.0 months), median survival was 5.0 months. Patients with age-adjusted International Prognostic Index (aaIPI) 0 or 1 treated with rituximab showed a low risk for CNS disease (2-year rates: 0% or 0.5%), and rituximab decreased the risk (relative risk 0.3, 95% confidence interval 0.1-0.9, P = 0.029). Patients with aaIPI 2 or 3 showed a moderate risk (4.2%-9.7%) and no significant reduction of CNS disease with rituximab. CNS prophylaxis was of no significant benefit. CONCLUSIONS: In younger patients with aaIPI 0 or 1, CNS relapse/progression is very rare; in patients with aaIPI 2 or 3, the risk is higher (up to 10%) and requires new diagnostic strategies and treatment.
BACKGROUND: To describe incidence, risk factors, and influence of treatment on occurrence of central nervous system (CNS) relapse or progression in younger patients with aggressive B-cell lymphoma. PATIENTS AND METHODS: We analyzed 2210 patients with aggressive B-cell lymphoma treated on various studies for CNS relapse/progression. Treatment consisted of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) ± etoposide. Six hundred and twenty patients also received rituximab. CNS prophylaxis was intrathecal methotrexate on High-CHOEP and MegaCHOEP phase III studies if upper neck, head, bone marrow, or testes were involved. RESULTS: Fifty-six of 2196 patients (2.6%) developed CNS disease. It occurred early (median 7.0 months), median survival was 5.0 months. Patients with age-adjusted International Prognostic Index (aaIPI) 0 or 1 treated with rituximab showed a low risk for CNS disease (2-year rates: 0% or 0.5%), and rituximab decreased the risk (relative risk 0.3, 95% confidence interval 0.1-0.9, P = 0.029). Patients with aaIPI 2 or 3 showed a moderate risk (4.2%-9.7%) and no significant reduction of CNS disease with rituximab. CNS prophylaxis was of no significant benefit. CONCLUSIONS: In younger patients with aaIPI 0 or 1, CNS relapse/progression is very rare; in patients with aaIPI 2 or 3, the risk is higher (up to 10%) and requires new diagnostic strategies and treatment.
Authors: Wyndham H Wilson; Jacoline E C Bromberg; Maryalice Stetler-Stevenson; Seth M Steinberg; Lourdes Martin-Martin; Carmen Muñiz; Juan Manuel Sancho; Maria Dolores Caballero; Marjan A Davidis; Rik A Brooimans; Blanca Sanchez-Gonzalez; Antonio Salar; Eva González-Barca; Jose Maria Ribera; Margaret Shovlin; Armando Filie; Kieron Dunleavy; Thomas Mehrling; Michele Spina; Alberto Orfao Journal: Haematologica Date: 2014-04-11 Impact factor: 9.941
Authors: Francisco-Javier Peñalver; Juan-Manuel Sancho; Adolfo de la Fuente; María-Teresa Olave; Alejandro Martín; Carlos Panizo; Elena Pérez; Antonio Salar; Alberto Orfao Journal: Haematologica Date: 2016-10-20 Impact factor: 9.941
Authors: Agnieszka Korfel; Thomas Elter; Eckhard Thiel; Matthias Hänel; Robert Möhle; Roland Schroers; Marcel Reiser; Martin Dreyling; Jan Eucker; Christian Scholz; Bernd Metzner; Alexander Röth; Josef Birkmann; Uwe Schlegel; Peter Martus; Gerard Illerhaus; Lars Fischer Journal: Haematologica Date: 2012-12-14 Impact factor: 9.941
Authors: Stefan K Barta; Jitesh Joshi; Nicolas Mounier; Xiaonan Xue; Dan Wang; Josep-Maria Ribera; Jose-Tomas Navarro; Christian Hoffmann; Kieron Dunleavy; Richard F Little; Wyndham H Wilson; Michele Spina; Lionel Galicier; Ariela Noy; Joseph A Sparano Journal: Br J Haematol Date: 2016-04-07 Impact factor: 6.998