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Br J Cancer. 2014 Sep 9;111(6):1072-9. doi: 10.1038/bjc.2014.405. Epub 2014 Jul 29.

A multicentre retrospective comparison of central nervous system prophylaxis strategies among patients with high-risk diffuse large B-cell lymphoma.

Author information

1
1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
2
1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia [3] Cabrini Medical Centre, Malvern, Victoria, Australia.
3
Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
4
1] Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia [2] University of Queensland, St Lucia, Queensland, Australia.
5
Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia.
6
Department of Haematology, Monash Health, Clayton, Victoria, Australia.
7
1] Department of Haematology, Monash Health, Clayton, Victoria, Australia [2] Department of Haematology, Monash University, Clayton, Victoria, Australia.
8
1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia [3] Cabrini Medical Centre, Malvern, Victoria, Australia [4] Department of Haematology, Monash University, Clayton, Victoria, Australia.

Abstract

BACKGROUND:

Central nervous system (CNS) relapse in diffuse large B-cell lymphoma (DLBCL) is a devastating complication; the optimal prophylactic strategy remains unclear.

METHODS:

We performed a multicentre, retrospective analysis of patients with DLBCL with high risk for CNS relapse as defined by two or more of: multiple extranodal sites, elevated serum LDH and B symptoms or involvement of specific high-risk anatomical sites. We compared three different strategies of CNS-directed therapy: intrathecal (IT) methotrexate (MTX) with (R)-CHOP 'group 1'; R-CHOP with IT MTX and two cycles of high-dose intravenous (IV) MTX 'group 2'; dose-intensive systemic antimetabolite-containing chemotherapy (Hyper-CVAD or CODOXM/IVAC) with IT/IV MTX 'group 3'.

RESULTS:

Overall, 217 patients were identified (49, 125 and 43 in groups 1-3, respectively). With median follow-up of 3.4 (range 0.2-18.6) years, 23 CNS relapses occurred (12, 10 and 1 in groups 1-3 respectively). The 3-year actuarial rates (95% CI) of CNS relapse were 18.4% (9.5-33.1%), 6.9% (3.5-13.4%) and 2.3% (0.4-15.4%) in groups 1-3, respectively (P=0.009).

CONCLUSIONS:

The addition of high-dose IV MTX and/or cytarabine was associated with lower incidence of CNS relapse compared with IT chemotherapy alone. However, these data are limited by their retrospective nature and warrant confirmation in prospective randomised studies.

PMID:
25072255
PMCID:
PMC4453849
DOI:
10.1038/bjc.2014.405
[Indexed for MEDLINE]
Free PMC Article

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