Treatment strategies, outcomes and prognostic factors in 291 patients with secondary CNS involvement by diffuse large B-cell lymphoma

Tarec Christoffer El-Galaly, Chan Yoon Cheah, Mette Dahl Bendtsen, Grzegorz S Nowakowski, Roopesh Kansara, Kerry J Savage, Joseph M Connors, Laurie H Sehn, Neta Goldschmidt, Adir Shaulov, Umar Farooq, Brian K Link, Andrés J M Ferreri, Teresa Calimeri, Caterina Cecchetti, Eldad J Dann, Carrie A Thompson, Tsofia Inbar, Matthew J Maurer, Inger Lise GadeMaja Bech Juul, Jakob W Hansen, Staffan Holmberg, Thomas S Larsen, Sabrina Cordua, N George Mikhaeel, Martin Hutchings, John F Seymour, Michael Roost Clausen, Daniel Smith, Stephen Opat, Michael Gilbertson, Gita Thanarajasingam, Diego Villa

    97 Citationer (Scopus)

    Abstract

    PURPOSE: Secondary CNS involvement (SCNS) is a profoundly adverse complication of diffuse large B-cell lymphoma. Evidence from older series indicated a median overall survival (OS) < 6 months; however, data from the immunochemotherapy era are limited.

    METHODS: Patients diagnosed with SCNS during or after first-line immunochemotherapy were identified from databases and/or regional/national registries from three continents. Clinical information was retrospectively collected from medical records.

    RESULTS: In total, 291 patients with SCNS were included. SCNS occurred as part of first relapse in 254 (87%) patients and 113 (39%) had concurrent systemic relapse. With a median post-SCNS follow-up of 48 months, the median post-SCNS OS was 3.9 months and 2-year OS rate was 20% (95% CI: 15-25). In multivariable analysis of 173 patients treated with curative/intensive therapy (such as high-dose methotrexate [HDMTX] or platinum-containing regimens), age ≤60 years, performance status 0-1, absence of combined leptomeningeal and parenchymal involvement, and SCNS occurring after completion of first-line therapy were associated with superior outcomes. Patients ≤60 years with performance status 0-1 and treated with HDMTX-based regimens for isolated parenchymal SCNS had a 2-year OS of 62% (95% CI: 36-80). In patients with isolated SCNS, the addition of rituximab to HDMTX-based regimens was associated with improved OS. Amongst patients with isolated SCNS in CR following intensive treatment, high-dose chemotherapy and autologous stem cell transplantation did not improve OS (P = 0.9).

    CONCLUSIONS: In this large international cohort of patients treated with first-line immunochemotherapy, outcomes following SCNS remain poor. However, a moderate proportion of patients with isolated SCNS who received intensive therapies achieved durable remissions.

    OriginalsprogEngelsk
    TidsskriftEuropean journal of cancer (Oxford, England : 1990)
    Vol/bind93
    Sider (fra-til)57-68
    Antal sider12
    ISSN0959-8049
    DOI
    StatusUdgivet - 1 apr. 2018

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