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
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