CNS disease in younger patients with aggressive B-cell lymphoma: an analysis of patients treated on the Mabthera International Trial and trials of the German High-Grade Non-Hodgkin Lymphoma Study Group.

Abstract

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: N Schmitz, S Zeynalova, B Glass, U Kaiser, E Cavallin-Stahl, M Wolf, M Haenel, M Loeffler, L Truemper, M Pfreundschuh
• Journal: Annals of oncology : official journal of the European Society for Medical Oncology (Ann Oncol) Vol. 23 Issue 5 Pg. 1267-1273 (May 2012) ISSN: 1569-8041 [Electronic] England
• PMID: 21989328 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Rituximab
• Vincristine
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Prednisolone
• Prednisone
• Methotrexate

Topics

• Adolescent
• Adult
• Age of Onset
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Central Nervous System Neoplasms (drug therapy, epidemiology, secondary)
• Clinical Trials, Phase II as Topic (statistics & numerical data)
• Clinical Trials, Phase III as Topic (statistics & numerical data)
• Cyclophosphamide (administration & dosage, adverse effects, therapeutic use)
• Doxorubicin (administration & dosage, adverse effects, therapeutic use)
• Etoposide (administration & dosage, adverse effects, therapeutic use)
• Female
• Germany (epidemiology)
• Humans
• International Cooperation
• Lymphoma, B-Cell (drug therapy, epidemiology, pathology)
• Lymphoma, Non-Hodgkin (drug therapy, epidemiology, pathology)
• Male
• Medical Oncology (organization & administration)
• Methotrexate (administration & dosage, adverse effects)
• Middle Aged
• Multicenter Studies as Topic
• Neoplasm Grading
• Neoplasm Invasiveness
• Prednisolone (administration & dosage, adverse effects, therapeutic use)
• Prednisone (administration & dosage, adverse effects, therapeutic use)
• Rituximab
• Societies, Medical (organization & administration)
• Vincristine (administration & dosage, adverse effects, therapeutic use)
• Young Adult