Impact of central nervous system (CNS) prophylaxis on the incidence and risk factors for CNS relapse in patients with diffuse large B-cell lymphoma treated in the rituximab era: a single centre experience and review of the literature.

Abstract

Central nervous system (CNS) prophylaxis for diffuse large B-cell lymphoma (DLBCL) is controversial with even less evidence in the era of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. We reviewed the impact of CNS prophylaxis in DLBCL patients treated with R-CHOP at a tertiary care centre over a 7-year period. CNS prophylaxis was recommended for 'higher risk' patients and consisted of intrathecal methotrexate and/or high-dose methotrexate. Of 214 patients 12·6% received CNS prophylaxis. With a median follow-up of 27 months, eight patients (3·7%) developed CNS relapse (75% isolated to the CNS and 62·5% as parenchymal brain disease) at a median time of 17 months. Patients who did not receive CNS prophylaxis had lower events (2·7%) than those who did (11·1%). Half of the CNS relapses occurred in testicular lymphoma patients, 75% of whom had received CNS prophylaxis. In multivariate analysis, testicular involvement was the only significant prognostic factor for CNS relapse (hazard ratio 33·5, P < 0·001). In conclusion, CNS relapse in DLBCL appears to present as a later, more isolated parenchymal event and at a lower rate in the rituximab era compared with historical data. R-CHOP may negate the need for CNS prophylaxis with the exception of testicular lymphoma.

• Authors: Hany R Guirguis, Matthew C Cheung, Mervat Mahrous, Eugenia Piliotis, Neil Berinstein, Kevin R Imrie, Liying Zhang, Rena Buckstein
• Journal: British journal of haematology (Br J Haematol) Vol. 159 Issue 1 Pg. 39-49 (Oct 2012) ISSN: 1365-2141 [Electronic] England
• PMID: 22849793 (Publication Type: Journal Article, Review)
• Copyright: © 2012 Blackwell Publishing Ltd.

Chemical References

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

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Central Nervous System Neoplasms (drug therapy, pathology)
• Cyclophosphamide (administration & dosage, adverse effects)
• Doxorubicin (administration & dosage, adverse effects)
• Female
• Humans
• Incidence
• Lymphoma, Large B-Cell, Diffuse (drug therapy, pathology)
• Male
• Methotrexate (administration & dosage, adverse effects, therapeutic use)
• Middle Aged
• Prednisone (administration & dosage, adverse effects)
• Recurrence
• Retrospective Studies
• Risk Factors
• Rituximab
• Vincristine (administration & dosage, adverse effects)
• Young Adult