Central nervous system prophylaxis with intrathecal liposomal cytarabine in diffuse large B-cell lymphomas

Abstract

INTRODUCTION: Central nervous system (CNS) involvement is a serious and potentially fatal complication in patients with lymphoma because it is associated with a particularly poor prognosis (median progression-free survival [PFS] of 4-6 months). Although CNS prophylaxis is considered necessary, there are no clear guidelines on identifying high-risk patients or selecting treatment regimen. OBJECTIVES: The aim of the study was to assess the safety and efficacy of CNS prophylaxis with intrathecal liposomal cytarabine. PATIENTS AND METHODS: We analyzed the data of 79 patients (46 men and 33 women; median age, 48.5 years [20-79]) with diffuse large B-cell lymphoma (83.5% of the patients) and primary mediastinal large B-cell lymphoma (16.5%). Patients were treated in the departments of hematology in Kraków and Wrocław, Poland, between the years 2009-2012. They were considered to be at a high risk of developing CNS involvement associated with a lymphoma. RESULTS: Adverse reactions after intrathecal liposomal cytarabine were reported in 59 patients (74.7%); in 7 cases, the reactions were severe. The most common side effect was headache (67.1%). During antilymphoma therapy and prophylaxis, the functional status assessed by the Karnofsky score improved in 56 patients (70.9%) and remained unchanged in the remaining cases. A median follow-up time did not exceed 28 months (range, 1.4-52.1); during follow-up, neither median overall survival (OS) nor PFS were reached (projected OS and PFS at 48 months are 86.1% and 90.1%, respectively). CONCLUSIONS: Our results encourage the use of intrathecal liposomal cytarabine in CNS prophylaxis in patients with lymphoma. Copyright by Medycyna Praktyczna, 2013.