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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
Author(s) -
Guirguis Hany R.,
Cheung Matthew C.,
Mahrous Mervat,
Piliotis Eugenia,
Berinstein Neil,
Imrie Kevin R.,
Zhang Liying,
Buckstein Rena
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2012.09247.x
Subject(s) - medicine , rituximab , vincristine , diffuse large b cell lymphoma , prednisone , methotrexate , cyclophosphamide , lymphoma , chemotherapy , gastroenterology , surgery
Summary 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.