Abstract |
To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system ( CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patients who did not (P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study.
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Authors | Niels Murawski, Gerhard Held, Marita Ziepert, Barbara Kempf, Andreas Viardot, Mathias Hänel, Mathias Witzens-Harig, Rolf Mahlberg, Christian Rübe, Jochen Fleckenstein, Carsten Zwick, Bertram Glass, Norbert Schmitz, Samira Zeynalova, Michael Pfreundschuh |
Journal | Blood
(Blood)
Vol. 124
Issue 5
Pg. 720-8
(Jul 31 2014)
ISSN: 1528-0020 [Electronic] United States |
PMID | 24939657
(Publication Type: Clinical Trial, Phase I, Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © 2014 by The American Society of Hematology. |
Chemical References |
- Antibodies, Monoclonal, Murine-Derived
- Rituximab
- Methotrexate
|
Topics |
- Adolescent
- Adult
- Antibodies, Monoclonal, Murine-Derived
(administration & dosage)
- Antineoplastic Combined Chemotherapy Protocols
(administration & dosage)
- Central Nervous System Neoplasms
(mortality, prevention & control)
- Disease-Free Survival
- Facial Neoplasms
(mortality, therapy)
- Female
- Germany
- Humans
- Injections, Spinal
- Lymphoma, B-Cell
(mortality, therapy)
- Male
- Methotrexate
(administration & dosage)
- Middle Aged
- Radiotherapy
- Rituximab
- Skull Neoplasms
(mortality, therapy)
- Survival Rate
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