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Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma.
- Source :
-
Annals of hematology [Ann Hematol] 2020 Aug; Vol. 99 (8), pp. 1823-1831. Date of Electronic Publication: 2020 Jun 23. - Publication Year :
- 2020
-
Abstract
- Although overall survival in diffuse large B cell lymphomas (DLBCL) has improved, central nervous system (CNS) relapse is still a fatal complication of DLBCL. For this reason, CNS prophylaxis is recommended for patients at high risk of CNS disease. However, no consensus exists on definition of high-risk patient and optimal CNS prophylaxis. Systemic high-dose methotrexate in combination with R-CHOP has been suggested as a potential prophylactic method, since methotrexate penetrates the blood-brain barrier and achieves high concentration in the CNS. In this retrospective analysis, we report treatment outcome of 95 high-risk DLBCL/FL grade 3B patients treated with R-CHOP or its derivatives with (Nā=ā57) or without (Nā=ā38) CNS prophylaxis. At a median follow-up time (51 months), CNS relapses were detected in twelve patients (12.6%). Ten out of twelve (83%) of CNS events were confined to CNS system only. Median overall survival after CNS relapse was 9 months. Five-year isolated CNS relapse rates were 5% in the prophylaxis group and 26% in the group without prophylaxis. These findings suggest that high-dose methotrexate-containing prophylaxis decreases the risk of CNS failure.
- Subjects :
- Adult
Aged
Aged, 80 and over
Central Nervous System Neoplasms mortality
Cyclophosphamide administration & dosage
Doxorubicin administration & dosage
Female
Humans
Incidence
Lymphoma, Large B-Cell, Diffuse mortality
Male
Middle Aged
Prednisone administration & dosage
Recurrence
Rituximab administration & dosage
Vincristine administration & dosage
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Central Nervous System Neoplasms prevention & control
Lymphoma, Large B-Cell, Diffuse prevention & control
Methotrexate administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1432-0584
- Volume :
- 99
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Annals of hematology
- Publication Type :
- Academic Journal
- Accession number :
- 32577843
- Full Text :
- https://doi.org/10.1007/s00277-020-04140-0