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Eur J Cancer. 2019 Jul;115:27-36. doi: 10.1016/j.ejca.2019.04.004. Epub 2019 May 10.

Intravenous but not intrathecal central nervous system-directed chemotherapy improves survival in patients with testicular diffuse large B-cell lymphoma.

Author information

1
Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
2
Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
3
Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
4
Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
5
Department of Oncology and Radiotherapy, Turku University Central Hospital, Turku, Finland.
6
Department of Oncology, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
7
Department of Pathology, Helsinki University Hospital, Helsinki, Finland.
8
Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland. Electronic address: sirpa.leppa@helsinki.fi.

Abstract

BACKGROUND:

Testicular lymphoma is a rare malignancy affecting mainly elderly men, the majority representing diffuse large B-cell lymphoma (DLBCL). Its relapse rate is higher than that of nodal DLBCL, often affecting the central nervous system (CNS) with dismal prognosis.

PATIENTS AND METHODS:

We searched for patients with testicular DLBCL (T-DLBCL) involvement from the pathology databases of Southern Finland University Hospitals and the Danish Lymphoma Registry. Clinical information was collected, and outcomes between treatment modalities were evaluated. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were assessed using Kaplan-Meier and Cox proportional hazards methods.

RESULTS:

We identified 235 patients; of whom, 192 were treated with curative anthracycline-based chemotherapy. Full survival data were available for 189 patients. In univariate analysis, intravenous CNS-directed chemotherapy, and irradiation or orchiectomy of the contralateral testis translated into favourable PFS, DSS and OS, particularly among the elderly patients (each p ≤ 0.023). Intrathecal chemotherapy had no impact outcome. In multivariate analyses, the advantage of intravenous CNS-directed chemotherapy (hazard ration [HR] for OS, 0.419; 95% confidence interval [CI], 0.256-0.686; p = 0.001) and prophylactic treatment of contralateral testis (HR for OS, 0.514; 95% CI, 0.338-0.782; p = 0.002) was maintained. Rituximab improved survival only among high-risk patients (International Prognostic Index≥3, p = 0.019). The cumulative risk of CNS progression was 8.4% and did not differ between treatment modalities.

CONCLUSION:

The results support the use of CNS-directed chemotherapy and prophylactic treatment of the contralateral testis in patients with T-DLBCL involvement. Survival benefit appears resulting from better control of systemic disease rather than prevention of CNS progression.

KEYWORDS:

CNS-directed therapy; Primary testicular lymphoma; Prophylactic testicular irradiation; Rituximab; Survival

PMID:
31082690
DOI:
10.1016/j.ejca.2019.04.004

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