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

Cheah, C. Y., Herbert, K. E., O'Rourke, K., Kennedy, G. A., George, A., Fedele, P. L., Gilbertson, M., Tan, S. Y., Ritchie, D. S., Opat, S. S., Prince, H. M., Dickinson, M., Burbury, K., Wolf, M., Januszewicz, E. H., Tam, C. S., Westerman, D. A., Carney, D. A., Harrison, S. J. and Seymour, J. F. (2014) A multicentre retrospective comparison of central nervous system prophylaxis strategies among patients with high-risk diffuse large B-cell lymphoma. British Journal of Cancer, 111 6: 1072-1079. doi:10.1038/bjc.2014.405


Author Cheah, C. Y.
Herbert, K. E.
O'Rourke, K.
Kennedy, G. A.
George, A.
Fedele, P. L.
Gilbertson, M.
Tan, S. Y.
Ritchie, D. S.
Opat, S. S.
Prince, H. M.
Dickinson, M.
Burbury, K.
Wolf, M.
Januszewicz, E. H.
Tam, C. S.
Westerman, D. A.
Carney, D. A.
Harrison, S. J.
Seymour, J. F.
Title A multicentre retrospective comparison of central nervous system prophylaxis strategies among patients with high-risk diffuse large B-cell lymphoma
Journal name British Journal of Cancer   Check publisher's open access policy
ISSN 0007-0920
1532-1827
Publication date 2014-09-09
Year available 2014
Sub-type Article (original research)
DOI 10.1038/bjc.2014.405
Open Access Status DOI
Volume 111
Issue 6
Start page 1072
End page 1079
Total pages 8
Place of publication London, United Kingdom
Publisher Nature Publishing Group
Collection year 2015
Language eng
Formatted 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.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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