Treatment strategies, outcomes and prognostic factors in 291 patients with secondary CNS involvement by diffuse large B-cell lymphoma
Autor: | Brian K. Link, Eldad J. Dann, Roopesh Kansara, Maja Bech Juul, Gita Thanarajasingam, Adir Shaulov, Umar Farooq, Michael Roost Clausen, Daniel J. Smith, Andrés J.M. Ferreri, Diego Villa, Joseph M. Connors, Michael Gilbertson, Chan Yoon Cheah, Tarec Christoffer El-Galaly, Thomas Stauffer Larsen, Carrie A. Thompson, Martin Hutchings, Inger Lise Gade, John F. Seymour, Neta Goldschmidt, Teresa Calimeri, Kerry J. Savage, Jakob Werner Hansen, Grzegorz S. Nowakowski, Stephen Opat, Mette Dahl Bendtsen, Laurie H. Sehn, Staffan Holmberg, N. George Mikhaeel, Matthew J. Maurer, C. Cecchetti, Tsofia Inbar, Sabrina Cordua |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Male
Oncology Cancer Research medicine.medical_treatment Central Nervous System Neoplasms 0302 clinical medicine Autologous stem-cell transplantation Antineoplastic Combined Chemotherapy Protocols Aged 80 and over Secondary CNS Diffuse large B-Cell lymphoma Neoplasms Second Primary Middle Aged Prognosis Survival Rate Lymphoma Large B-Cell Diffuse/drug therapy Neoplasm Recurrence Local/drug therapy 030220 oncology & carcinogenesis Female Rituximab Lymphoma Large B-Cell Diffuse medicine.drug Adult medicine.medical_specialty Neoplasms Second Primary/drug therapy Article Young Adult 03 medical and health sciences Internal medicine medicine Humans Survival rate Aged Retrospective Studies Chemotherapy Performance status business.industry Retrospective cohort study medicine.disease Transplantation Autologous stem cell transplant Central nervous system Central Nervous System Neoplasms/drug therapy Antineoplastic Combined Chemotherapy Protocols/therapeutic use Neoplasm Recurrence Local business Diffuse large B-cell lymphoma Follow-Up Studies 030215 immunology |
Zdroj: | El-Galaly, T C, Cheah, C Y, Bendtsen, M D, Nowakowski, G S, Kansara, R, Savage, K J, Connors, J M, Sehn, L H, Goldschmidt, N, Shaulov, A, Farooq, U, Link, B K, Ferreri, A J M, Calimeri, T, Cecchetti, C, Dann, E J, Thompson, C A, Inbar, T, Maurer, M J, Gade, I L, Juul, M B, Hansen, J W, Holmberg, S, Larsen, T S, Cordua, S, Mikhaeel, N G, Hutchings, M, Seymour, J F, Clausen, M R, Smith, D, Opat, S, Gilbertson, M, Thanarajasingam, G & Villa, D 2018, ' Treatment strategies, outcomes and prognostic factors in 291 patients with secondary CNS involvement by diffuse large B-cell lymphoma ', European Journal of Cancer, vol. 93, pp. 57-68 . https://doi.org/10.1016/j.ejca.2018.01.073 |
DOI: | 10.1016/j.ejca.2018.01.073 |
Popis: | PURPOSE: Secondary CNS involvement (SCNS) is a profoundly adverse complication of diffuse large B-cell lymphoma. Evidence from older series indicated a median overall survival (OS) < 6 months; however, data from the immunochemotherapy era are limited.METHODS: Patients diagnosed with SCNS during or after first-line immunochemotherapy were identified from databases and/or regional/national registries from three continents. Clinical information was retrospectively collected from medical records.RESULTS: In total, 291 patients with SCNS were included. SCNS occurred as part of first relapse in 254 (87%) patients and 113 (39%) had concurrent systemic relapse. With a median post-SCNS follow-up of 48 months, the median post-SCNS OS was 3.9 months and 2-year OS rate was 20% (95% CI: 15-25). In multivariable analysis of 173 patients treated with curative/intensive therapy (such as high-dose methotrexate [HDMTX] or platinum-containing regimens), age ≤60 years, performance status 0-1, absence of combined leptomeningeal and parenchymal involvement, and SCNS occurring after completion of first-line therapy were associated with superior outcomes. Patients ≤60 years with performance status 0-1 and treated with HDMTX-based regimens for isolated parenchymal SCNS had a 2-year OS of 62% (95% CI: 36-80). In patients with isolated SCNS, the addition of rituximab to HDMTX-based regimens was associated with improved OS. Amongst patients with isolated SCNS in CR following intensive treatment, high-dose chemotherapy and autologous stem cell transplantation did not improve OS (P = 0.9).CONCLUSIONS: In this large international cohort of patients treated with first-line immunochemotherapy, outcomes following SCNS remain poor. However, a moderate proportion of patients with isolated SCNS who received intensive therapies achieved durable remissions. |
Databáze: | OpenAIRE |
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