Norbert Schmitz1, Samira Zeynalova2, Maike Nickelsen2, Roopesh Kansara2, Diego Villa2, Laurie H Sehn2, Bertram Glass2, David W Scott2, Randy D Gascoyne2, Joseph M Connors2, Marita Ziepert2, Michael Pfreundschuh2, Markus Loeffler2, Kerry J Savage2. 1. Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. n.schmitz@asklepios.com. 2. Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Abstract
PURPOSE: To develop and validate a risk score for relapse in the CNS in patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS: A total of 2,164 patients (18 to 80 years old) with aggressive B-cell lymphomas (80% DLBCL) treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-like chemotherapy, who were enrolled in studies from the German High-Grade Non-Hodgkin Lymphoma Study Group and the MabThera International Trial, were analyzed for occurrence of relapse/progression in the CNS. The resulting risk model was validated in an independent data set of 1,597 patients with DLBCL identified in the British Columbia Cancer Agency Lymphoid Cancer database. RESULTS: The risk model consists of the International Prognostic Index (IPI) factors in addition to involvement of kidneys and/or adrenal glands (CNS-IPI). In a three-risk group model, the low-risk group (46% of all patients analyzed), the intermediate-risk group (41%), and the high-risk group (12%) showed 2-year rates of CNS disease of 0.6% (CI, 0% to 1.2%), 3.4% (CI, 2.2% to 4.4%), and 10.2% (CI, 6.3% to 14.1%), respectively. Patients from the validation British Columbia Cancer Agency data set showed similar rates of CNS disease for low-risk (0.8%; CI, 0.0% to 1.6%), intermediate-risk (3.9%; CI, 2.3% to 5.5%), and high-risk (12.0%; CI, 7.9% to 16.1%) groups. CONCLUSION: The CNS-IPI is a robust, highly reproducible tool that can be used to estimate the risk of CNS relapse/progression in patients with DLBCL treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Close to 90% of patients with DLBCL belong to the low- and intermediate-risk groups and have a CNS relapse risk < 5%; they may be spared any diagnostic and therapeutic intervention. In contrast, those in the high-risk group have a > 10% risk of CNS relapse and should be considered for CNS-directed investigations and prophylactic interventions.
PURPOSE: To develop and validate a risk score for relapse in the CNS in patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS: A total of 2,164 patients (18 to 80 years old) with aggressive B-cell lymphomas (80% DLBCL) treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-like chemotherapy, who were enrolled in studies from the German High-Grade Non-Hodgkin Lymphoma Study Group and the MabThera International Trial, were analyzed for occurrence of relapse/progression in the CNS. The resulting risk model was validated in an independent data set of 1,597 patients with DLBCL identified in the British Columbia Cancer Agency Lymphoid Cancer database. RESULTS: The risk model consists of the International Prognostic Index (IPI) factors in addition to involvement of kidneys and/or adrenal glands (CNS-IPI). In a three-risk group model, the low-risk group (46% of all patients analyzed), the intermediate-risk group (41%), and the high-risk group (12%) showed 2-year rates of CNS disease of 0.6% (CI, 0% to 1.2%), 3.4% (CI, 2.2% to 4.4%), and 10.2% (CI, 6.3% to 14.1%), respectively. Patients from the validation British Columbia Cancer Agency data set showed similar rates of CNS disease for low-risk (0.8%; CI, 0.0% to 1.6%), intermediate-risk (3.9%; CI, 2.3% to 5.5%), and high-risk (12.0%; CI, 7.9% to 16.1%) groups. CONCLUSION: The CNS-IPI is a robust, highly reproducible tool that can be used to estimate the risk of CNS relapse/progression in patients with DLBCL treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Close to 90% of patients with DLBCL belong to the low- and intermediate-risk groups and have a CNS relapse risk < 5%; they may be spared any diagnostic and therapeutic intervention. In contrast, those in the high-risk group have a > 10% risk of CNS relapse and should be considered for CNS-directed investigations and prophylactic interventions.
Authors: Matthew R Wilson; Toby A Eyre; Nicolas Martinez-Calle; Matthew Ahearne; Katrina E Parsons; Gavin Preston; Jahanzaib Khwaja; Jeremy Schofield; Johnathon Elliot; Almurtadha Mula Kh; Nimish Shah; Cheuk-Kie Cheung; Matthew A Timmins; Thomas Creasey; Kim Linton; Jeffery Smith; Christopher P Fox; Fiona Miall; Kate Cwynarski; Pamela McKay Journal: Blood Adv Date: 2020-08-11
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: Magdalena Klanova; Laurie H Sehn; Isabelle Bence-Bruckler; Federica Cavallo; Jie Jin; Maurizio Martelli; Douglas Stewart; Umberto Vitolo; Francesco Zaja; Qingyuan Zhang; Federico Mattiello; Gila Sellam; Elizabeth A Punnoose; Edith Szafer-Glusman; Christopher R Bolen; Mikkel Z Oestergaard; Guenter R Fingerle-Rowson; Tina Nielsen; Marek Trneny Journal: Blood Date: 2019-01-07 Impact factor: 22.113