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Ann Hematol. 2017 Jan;96(1):57-64. doi: 10.1007/s00277-016-2848-y. Epub 2016 Oct 18.

Secondary central nervous system relapse in diffuse large B cell lymphoma in a resource limited country: result from the Thailand nationwide multi-institutional registry.

Author information

1
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV road Pathumwan, Bangkok, Thailand. kwudhikarn@hotmail.com.
2
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV road Pathumwan, Bangkok, Thailand.
3
Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand.
4
Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
5
Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
6
Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand.
7
Department of Internal Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
8
Department of Internal Medicine, Thammasart University, Bangkok, Thailand.
9
Department of Internal Medicine, Khon Kaen University, Khon Kaen, Thailand.
10
Department of Internal Medicine, Naresuan University, Phitsanulok, Thailand.
11
Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
12
Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand.
13
Department of Internal Medicine, Khonkaen Regional Hospital, Khon Kaen, Thailand.
14
Department of Internal Medicine, Chulabhorn Hospital, Bangkok, Thailand.

Abstract

Secondary central nervous system (CNS) relapse is a serious and fatal complication of diffuse large B cell lymphoma (DLBCL). Data on secondary CNS (SCNS) relapse were mostly obtained from western countries with limited data from developing countries. We analyzed the data of 2034 newly diagnosed DLBCL patients enrolled into the multi-center registry under Thai Lymphoma Study Group from setting. The incidence, September 2006 to December 2013 to represent outcome from a resource limited pattern, management, and outcome of SCNS relapse were described. The 2-year cumulative incidence (CI) of SCNS relapse was 2.7 %. A total of 729, 1024, and 281 patients were classified as low-, intermediate-, and high-risk CNS international prognostic index (CNS-IPI) with corresponding 2-year CI of SCNS relapse of 1.5, 3.1, and 4.6 %, respectively (p < 0.001). Univariate analysis demonstrated advance stage disease, poor performance status, elevated lactate dehydrogenase, presence of B symptoms, more than one extranodal organ involvement, high IPI, and high CNS-IPI group as predictive factors for SCNS relapse. Rituximab exposure and intrathecal chemoprophylaxis offered no protective effect against SCNS relapse. At the time of analysis, six patients were alive. Median OS in SCNS relapsed patients was significantly shorter than relapsed patients without CNS involvement (13.2 vs 22.6 months) (p < 0.001). Primary causes of death were progressive disease (n = 35, 63.6 %) and infection (n = 9, 16.7 %). In conclusion, although the incidence of SCNS relapse in our cohort was low, the prognosis was dismal. Prophylaxis for SCNS involvement was underused even in high-risk patients. Novel approaches for SCNS relapse prophylaxis and managements are warranted.

KEYWORDS:

CNS prophylaxis; CNS-IPI; Diffuse large B cell lymphoma; Secondary CNS relapse

PMID:
27752821
DOI:
10.1007/s00277-016-2848-y
[Indexed for MEDLINE]

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