The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas.

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.

• 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)
• 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