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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

Schmitz, N.; Zeynalova, S.; Glass, B.; Kaiser, U.; Cavallin-Ståhl, Eva LU ; Wolf, M.; Haenel, M.; Loeffler, M.; Truemper, L. and Pfreundschuh, M. (2012) In Annals of Oncology 23(5). p.1267-1273
Abstract
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. 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. Fifty-six of 2196 patients (2.6%) developed CNS disease. It occurred early (median 7.0 months), median survival was 5.0 months. Patients... (More)
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. 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. 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. 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aggressive lymphoma, central nervous system relapse, DLBCL, rituximab
in
Annals of Oncology
volume
23
issue
5
pages
1267 - 1273
publisher
Oxford University Press
external identifiers
  • wos:000303336400027
  • scopus:84860448201
ISSN
1569-8041
DOI
10.1093/annonc/mdr440
language
English
LU publication?
yes
id
f17bc64f-8389-4a41-863b-609a94253fd4 (old id 2551557)
date added to LUP
2012-06-01 08:49:54
date last changed
2017-11-05 04:13:17
@article{f17bc64f-8389-4a41-863b-609a94253fd4,
  abstract     = {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. 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. 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. 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.},
  author       = {Schmitz, N. and Zeynalova, S. and Glass, B. and Kaiser, U. and Cavallin-Ståhl, Eva and Wolf, M. and Haenel, M. and Loeffler, M. and Truemper, L. and Pfreundschuh, M.},
  issn         = {1569-8041},
  keyword      = {aggressive lymphoma,central nervous system relapse,DLBCL,rituximab},
  language     = {eng},
  number       = {5},
  pages        = {1267--1273},
  publisher    = {Oxford University Press},
  series       = {Annals of Oncology},
  title        = {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},
  url          = {http://dx.doi.org/10.1093/annonc/mdr440},
  volume       = {23},
  year         = {2012},
}