First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOP, CNS prophylaxis, and contralateral testis irradiation: Final results of an international phase II trial

Umberto Vitolo, Annalisa Chiappella, Andrés J M Ferreri, Maurizio Martelli, Ileana Baldi, Monica Balzarotti, Chiara Bottelli, Annarita Conconi, Henry Gomez, Armando Lopez-Guillermo, Giovanni Martinelli, Francesco Merli, Domenico Novero, Lorella Orsucci, Vincenzo Pavone, Umberto Ricardi, Sergio Storti, Mary K. Gospodarowicz, Franco Cavalli, Andreas H. SarrisEmanuele Zucca

Research output: Contribution to journalArticle

Abstract

Purpose: Primary testicular lymphoma (PTL) has poor prognosis with failures in contralateral testis, CNS, and extranodal sites. To prevent these events, we designed an international phase II trial (International Extranodal Lymphoma Study Group 10 [IELSG-10]) that addressed feasibility and activity of conventional chemoimmunotherapy associated with CNS prophylaxis and contralateral testis irradiation. The trial was conducted by the IELSG and the Italian Lymphoma Foundation. Patients and Methods: Fifty-three patients (age 22 to 79 years) with untreated stage I or II PTL were treated with six to eight courses of rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) every 21 days (R-CHOP21); four doses of intrathecal methotrexate (IT-MTX) and radiotherapy (RT) to the contralateral testis (30 Gy) for all patients and to regional lymph nodes (30 to 36 Gy) for stage II disease. Results: All patients received R-CHOP21, 50 received CNS prophylaxis, and 47 received testicular RT. With a median follow-up of 65 months, 5-year progression-free survival and overall survival rates were 74% (95% CI, 59% to 84%) and 85% (95% CI, 71% to 92%), respectively. Ten patients relapsed or progressed: two in lymph nodes, five in extranodal organs, and three in the CNS. The 5-year cumulative incidence of CNS relapse was 6% (95% CI, 0% to 12%). No contralateral testis relapses occurred. Ten patients died: lymphoma (n = 6), secondary leukemia (n = 2), heart failure (n = 1), and gastric cancer (n = 1). Grade 3 to 4 toxicities were neutropenia, 28%; infections, 4%; and neurologic, 13%. No deaths occurred as a result of toxicity. Conclusion: This international prospective trial shows that combined treatment with R-CHOP21, IT-MTX, and testicular RT was associated with a good outcome in patients with PTL. RT avoided contralateral testis relapses, but CNS prophylaxis deserves further investigation.

Original languageEnglish
Pages (from-to)2766-2772
Number of pages7
JournalJournal of Clinical Oncology
Volume29
Issue number20
DOIs
Publication statusPublished - Jul 10 2011

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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    Vitolo, U., Chiappella, A., Ferreri, A. J. M., Martelli, M., Baldi, I., Balzarotti, M., Bottelli, C., Conconi, A., Gomez, H., Lopez-Guillermo, A., Martinelli, G., Merli, F., Novero, D., Orsucci, L., Pavone, V., Ricardi, U., Storti, S., Gospodarowicz, M. K., Cavalli, F., ... Zucca, E. (2011). First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOP, CNS prophylaxis, and contralateral testis irradiation: Final results of an international phase II trial. Journal of Clinical Oncology, 29(20), 2766-2772. https://doi.org/10.1200/JCO.2010.31.4187