The Outcomes of Diffuse Large B-cell Lymphoma Patients with Synchronous and Early Central Nervous System Involvement: A Single-Center Experience.
Overall survival
Relapse
Synchronous
methotrexate
progression free survival
Journal
Asian Pacific journal of cancer prevention : APJCP
ISSN: 2476-762X
Titre abrégé: Asian Pac J Cancer Prev
Pays: Thailand
ID NLM: 101130625
Informations de publication
Date de publication:
01 Feb 2023
01 Feb 2023
Historique:
received:
22
09
2022
entrez:
28
2
2023
pubmed:
1
3
2023
medline:
3
3
2023
Statut:
epublish
Résumé
Diffuse large B cell lymphoma (DLBCL) is the most commonly diagnosed subtype of non-Hodgkin's lymphoma (NHL). R-CHOP has significantly improved clinical outcomes in patients with DLBCL, however, its indication in the prevention of CNS relapse and recurrence is still inconsistent. Moreover, prophylactic methotrexate and/or cytarabine have been used prophylactically for DLBCL patients is at high risk of CNS relapse and to treat CNS DLBCL, however, their efficacy remains unclear. The aim of our retrospective study was to determine the incidence of CNS in-volvement in patients with DLBCL and to describe its risk factors and survival outcomes. A total of 406 patients with DLBCL were identified, and 17 (4.2%) of DLBCL patients had CNS involvement i.e. 9 (2.2 %) at diagnosis and 8 (~2%) at relapse. The patients were younger, had advanced stage, high CNS-IPI, and had extra nodal involvement. Seven out of the 17 patients who survived received chemotherapy and a prophylactic methotrexate. Considering the CNS-IPI, of the 146 patients with high CNS-IPI at presentation, 18 received the prophylactic HDMTX and 3 (16.7%) of them had CNS relapse. Two (1.6%) out of 128 who did not receive the prophylactic HDMTX had CNS relapse. On the other hand, of the 223 patients with intermediate CNS-IPI, 25 received the prophylactic HDMTX and 2 (8%) of them had CNS relapse and in 198 patients who did not receive the prophylactic HDMTX, 2 (1.01%) had CNS relapse. The 5-year progression-free survival and overall survival rates for the entire cohort were 73% and 84%, respectively. The median OS for those who had CNS involvement was 17 months and the 2-year OS was 40%. CNS involvement in DLBCL has a poor prognosis, thus, aggressive CNS-directed therapy should be considered, especially in young patients.
Sections du résumé
BACKGROUND
BACKGROUND
Diffuse large B cell lymphoma (DLBCL) is the most commonly diagnosed subtype of non-Hodgkin's lymphoma (NHL). R-CHOP has significantly improved clinical outcomes in patients with DLBCL, however, its indication in the prevention of CNS relapse and recurrence is still inconsistent. Moreover, prophylactic methotrexate and/or cytarabine have been used prophylactically for DLBCL patients is at high risk of CNS relapse and to treat CNS DLBCL, however, their efficacy remains unclear.
METHODS
METHODS
The aim of our retrospective study was to determine the incidence of CNS in-volvement in patients with DLBCL and to describe its risk factors and survival outcomes.
RESULTS
RESULTS
A total of 406 patients with DLBCL were identified, and 17 (4.2%) of DLBCL patients had CNS involvement i.e. 9 (2.2 %) at diagnosis and 8 (~2%) at relapse. The patients were younger, had advanced stage, high CNS-IPI, and had extra nodal involvement. Seven out of the 17 patients who survived received chemotherapy and a prophylactic methotrexate. Considering the CNS-IPI, of the 146 patients with high CNS-IPI at presentation, 18 received the prophylactic HDMTX and 3 (16.7%) of them had CNS relapse. Two (1.6%) out of 128 who did not receive the prophylactic HDMTX had CNS relapse. On the other hand, of the 223 patients with intermediate CNS-IPI, 25 received the prophylactic HDMTX and 2 (8%) of them had CNS relapse and in 198 patients who did not receive the prophylactic HDMTX, 2 (1.01%) had CNS relapse. The 5-year progression-free survival and overall survival rates for the entire cohort were 73% and 84%, respectively. The median OS for those who had CNS involvement was 17 months and the 2-year OS was 40%.
CONCLUSION
CONCLUSIONS
CNS involvement in DLBCL has a poor prognosis, thus, aggressive CNS-directed therapy should be considered, especially in young patients.
Identifiants
pubmed: 36853313
doi: 10.31557/APJCP.2023.24.2.623
pmc: PMC10162608
pii:
doi:
Substances chimiques
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
623-631Références
Leuk Lymphoma. 2015 Mar;56(3):725-9
pubmed: 24913502
Leuk Lymphoma. 2014 Oct;55(10):2228-40
pubmed: 24286262
Haematologica. 2015 Sep;100(9):1199-206
pubmed: 26185174
Leuk Lymphoma. 2014 Mar;55(3):509-14
pubmed: 23741977
J Clin Oncol. 2006 Jul 1;24(19):3121-7
pubmed: 16754935
Blood. 2016 May 19;127(20):2375-90
pubmed: 26980727
Ann Oncol. 2000 Jun;11(6):685-90
pubmed: 10942056
Lancet Oncol. 2011 Dec;12(13):1258-66
pubmed: 21933751
Blood. 1998 Feb 15;91(4):1178-84
pubmed: 9454747
Haematologica. 2013 May;98(5):808-13
pubmed: 23144196
Ann Oncol. 2012 May;23(5):1267-1273
pubmed: 21989328
Br J Haematol. 2019 Oct;187(2):174-184
pubmed: 31236941
J Clin Oncol. 1994 Nov;12(11):2415-22
pubmed: 7964958
Curr Treat Options Oncol. 2018 Jun 21;19(8):38
pubmed: 29931605
Ann Hematol. 2009 Mar;88(3):193-201
pubmed: 19050889
Biomark Res. 2021 May 6;9(1):32
pubmed: 33957995
Blood. 2019 Feb 28;133(9):919-926
pubmed: 30617197
Ann Oncol. 2007 Mar;18(3):541-5
pubmed: 17164228
J Clin Oncol. 2005 Aug 1;23(22):5027-33
pubmed: 15955905
Br J Haematol. 2009 Sep;146(5):489-503
pubmed: 19538530
J Clin Oncol. 2003 Jan 1;21(1):20-7
pubmed: 12506165
Crit Rev Oncol Hematol. 2014 Sep;91(3):292-303
pubmed: 24698003
Hematol Oncol Clin North Am. 2016 Dec;30(6):1277-1291
pubmed: 27888881
Blood. 2020 Jun 4;135(23):2041-2048
pubmed: 32232482
N Engl J Med. 2002 Jan 24;346(4):235-42
pubmed: 11807147
Ann Oncol. 2017 Oct 01;28(10):2511-2516
pubmed: 28961838
Blood. 2009 Apr 23;113(17):3896-902
pubmed: 19144985
Eur J Cancer. 2019 Aug;117:121-130
pubmed: 31279304
Lancet Haematol. 2016 May;3(5):e217-27
pubmed: 27132696
Eur J Cancer. 2017 Apr;75:195-203
pubmed: 28237865
Br J Haematol. 2013 Oct;163(2):168-81
pubmed: 24033102
Blood. 2008 Feb 1;111(3):1085-93
pubmed: 17962515
Eur J Haematol. 2010 Jul;85(1):6-10
pubmed: 20236301
Blood Cancer J. 2018 Jun 26;8(7):63
pubmed: 29946110
Ann Oncol. 2002 Jul;13(7):1099-107
pubmed: 12176790
Eur J Haematol. 2016 Aug;97(2):108-20
pubmed: 27096423