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

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  • 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 Gade
  • Maja 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
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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.

Original languageEnglish
JournalEuropean journal of cancer (Oxford, England : 1990)
Volume93
Pages (from-to)57-68
Number of pages12
ISSN0959-8049
DOIs
Publication statusPublished - 1 Apr 2018

ID: 54782366