TY - JOUR
T1 - Treatment strategies, outcomes and prognostic factors in 291 patients with secondary CNS involvement by diffuse large B-cell lymphoma
AU - El-Galaly, Tarec Christoffer
AU - Cheah, Chan Yoon
AU - Bendtsen, Mette Dahl
AU - Nowakowski, Grzegorz S
AU - Kansara, Roopesh
AU - Savage, Kerry J
AU - Connors, Joseph M
AU - Sehn, Laurie H
AU - Goldschmidt, Neta
AU - Shaulov, Adir
AU - Farooq, Umar
AU - Link, Brian K
AU - Ferreri, Andrés J M
AU - Calimeri, Teresa
AU - Cecchetti, Caterina
AU - Dann, Eldad J
AU - Thompson, Carrie A
AU - Inbar, Tsofia
AU - Maurer, Matthew J
AU - Gade, Inger Lise
AU - Juul, Maja Bech
AU - Hansen, Jakob W
AU - Holmberg, Staffan
AU - Larsen, Thomas S
AU - Cordua, Sabrina
AU - Mikhaeel, N George
AU - Hutchings, Martin
AU - Seymour, John F
AU - Clausen, Michael Roost
AU - Smith, Daniel
AU - Opat, Stephen
AU - Gilbertson, Michael
AU - Thanarajasingam, Gita
AU - Villa, Diego
N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - 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.
AB - 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.
U2 - 10.1016/j.ejca.2018.01.073
DO - 10.1016/j.ejca.2018.01.073
M3 - Journal article
C2 - 29477102
SN - 0959-8049
VL - 93
SP - 57
EP - 68
JO - European journal of cancer (Oxford, England : 1990)
JF - European journal of cancer (Oxford, England : 1990)
ER -