Central nervous system relapse of diffuse large B-cell lymphoma in the rituximab era: Results of the UK NCRI R-CHOP-14 versus 21 trial

68Citations
Citations of this article
107Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Background: Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is associated with a dismal prognosis. Here, we report an analysis of CNS relapse for patients treated within the UK NCRI phase III R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) 14 versus 21 randomised trial. Patients and methods: The R-CHOP 14 versus 21 trial compared R-CHOP administered two- versus three weekly in previously untreated patients aged ≥ 18 years with bulky stage I-IV DLBCL (n=1080). Details of CNS prophylaxis were retrospectively collected from participating sites. The incidence and risk factors for CNS relapse including application of the CNS-IPI were evaluated. Results: 177/984 patients (18.0%) received prophylaxis (intrathecal (IT) methotrexate (MTX) n=163, intravenous (IV) MTX n=2, prophylaxis type unknown n=11 and IT MTX and cytarabine n=1). At a median follow-up of 6.5 years, 21 cases of CNS relapse (isolated n=11, with systemic relapse n=10) were observed, with a cumulative incidence of 1.9%. For patients selected to receive prophylaxis, the incidence was 2.8%. Relapses predominantly involved the brain parenchyma (81.0%) and isolated leptomeningeal involvement was rare (14.3%). Univariable analysis demonstrated the following risk factors for CNS relapse: performance status 2, elevated lactate dehydrogenase, IPI,>1 extranodal site of disease and presence of a 'high-risk' extranodal site. Due to the low number of events no factor remained significant in multivariate analysis. Application of the CNS-IPI revealed a high-risk group (4-6 risk factors) with a 2- and 5-year incidence of CNS relapse of 5.2% and 6.8%, respectively. Conclusion: Despite very limited use of IV MTX as prophylaxis, the incidence of CNS relapse following R-CHOP was very low (1.9%) confirming the reduced incidence in the rituximab era. The CNS-IPI identified patients at highest risk for CNS recurrence.

Cite

CITATION STYLE

APA

Gleeson, M., Counsell, N., Cunningham, D., Chadwick, N., Lawrie, A., Hawkes, E. A., … Linch, D. (2017). Central nervous system relapse of diffuse large B-cell lymphoma in the rituximab era: Results of the UK NCRI R-CHOP-14 versus 21 trial. Annals of Oncology, 28(10), 2511–2516. https://doi.org/10.1093/annonc/mdx353

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free