Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma

Autor: Esa Jantunen, Elina Kaprio, Milla E.L. Kuusisto, Ville Makkonen, Hanne Kuitunen, Outi Kuittinen, Saila Kauppila, Kirsi-Maria Haapasaari, Taina Turpeenniemi-Hujanen, Peeter Karihtala
Přispěvatelé: Department of Oncology, HUS Comprehensive Cancer Center, University of Helsinki, Helsinki University Hospital Area
Rok vydání: 2020
Předmět:
Male
INVOLVEMENT
Aggressive lymphoma
Gastroenterology
Central Nervous System Neoplasms
0302 clinical medicine
Recurrence
Antineoplastic Combined Chemotherapy Protocols
Medicine
CELL LYMPHOMA
ELDERLY-PATIENTS
Aged
80 and over
0303 health sciences
Hematology
Incidence
Incidence (epidemiology)
General Medicine
Middle Aged
3. Good health
medicine.anatomical_structure
High-dose methotrexate
Vincristine
030220 oncology & carcinogenesis
Female
Original Article
Lymphoma
Large B-Cell
Diffuse
Rituximab
medicine.drug
Adult
medicine.medical_specialty
3122 Cancers
Central nervous system
Diffuse large B cell lymphoma
03 medical and health sciences
INTRATHECAL CHEMOTHERAPY
Internal medicine
Humans
NON-HODGKINS-LYMPHOMA
CHEMOTHERAPY PLUS RITUXIMAB
Cyclophosphamide
Aged
RESPONSE CRITERIA
030304 developmental biology
AGGRESSIVE LYMPHOMA
MABTHERA INTERNATIONAL TRIAL
Central nervous system prophylaxis
business.industry
Central nervous system recurrence
INTERMEDIATE-GRADE
medicine.disease
Lymphoma
Methotrexate
Doxorubicin
Prednisone
business
Complication
Diffuse large B-cell lymphoma
Zdroj: Annals of Hematology
ISSN: 1432-0584
0939-5555
DOI: 10.1007/s00277-020-04140-0
Popis: Although overall survival in diffuse large B cell lymphomas (DLBCL) has improved, central nervous system (CNS) relapse is still a fatal complication of DLBCL. For this reason, CNS prophylaxis is recommended for patients at high risk of CNS disease. However, no consensus exists on definition of high-risk patient and optimal CNS prophylaxis. Systemic high-dose methotrexate in combination with R-CHOP has been suggested as a potential prophylactic method, since methotrexate penetrates the blood-brain barrier and achieves high concentration in the CNS. In this retrospective analysis, we report treatment outcome of 95 high-risk DLBCL/FL grade 3B patients treated with R-CHOP or its derivatives with (N = 57) or without (N = 38) CNS prophylaxis. At a median follow-up time (51 months), CNS relapses were detected in twelve patients (12.6%). Ten out of twelve (83%) of CNS events were confined to CNS system only. Median overall survival after CNS relapse was 9 months. Five-year isolated CNS relapse rates were 5% in the prophylaxis group and 26% in the group without prophylaxis. These findings suggest that high-dose methotrexate-containing prophylaxis decreases the risk of CNS failure.
Databáze: OpenAIRE
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