Risk-tailored CNS prophylaxis in a mono-institutional series of 200 patients with diffuse large B-cell lymphoma treated in the rituximab era

Andrés J M Ferreri, Marta Bruno-Ventre, Giovanni Donadoni, Maurilio Ponzoni, Giovanni Citterio, Marco Foppoli, Alessandro Vignati, Lydia Scarfò, Marianna Sassone, Silvia Govi, Federico Caligaris-Cappio

Research output: Contribution to journalArticle

Abstract

Summary: The most effective strategy to prevent central nervous system (CNS) dissemination in diffuse large B-cell lymphoma (DLBCL) remains an important, unmet clinical need. Herein, we report a retrospective analysis of risk-tailored CNS prophylaxis in 200 human immunodeficiency virus-negative adults with DLBCL treated with rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or similar. High risk of CNS relapse was defined by involvement of specific extranodal organs, or simultaneous presence of advanced stage and high serum lactate dehydrogenase level; CNS prophylaxis with high-dose methotrexate ± intrathecal chemotherapy (IT) was routinely used in high-risk patients diagnosed after 2007. CNS relapse risk was low in 93 patients and high in 107; 40 high-risk patients received prophylaxis, which consisted of IT alone in 7. At a median follow-up of 60 months, one low-risk and nine high-risk patients (1% vs. 8%; P = 0·01) experienced CNS relapse. In the high-risk group, CNS relapses occurred in 8/67 (12%) patients who did not receive prophylaxis and in 1/40 (2·5%) patients who did; the latter occurred in a patient managed with IT alone. CNS relapse rate was 12% (9/74) for patients treated with "inadequate" prophylaxis (none or IT only) and 0% (0/33) for patients managed with intravenous prophylaxis (P = 0·03). In conclusion, high-dose methotrexate-based prophylaxis significantly reduces CNS failures in high-risk patients stratified by involvement of specific extranodal sites and International Prognostic Index.

Original languageEnglish
Pages (from-to)654-662
Number of pages9
JournalBritish Journal of Haematology
Volume168
Issue number5
DOIs
Publication statusPublished - Mar 1 2015

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Lymphoma, Large B-Cell, Diffuse
Central Nervous System
Recurrence
Drug Therapy
Methotrexate
Rituximab
Vincristine
Prednisone
L-Lactate Dehydrogenase
Doxorubicin
Cyclophosphamide
HIV

Keywords

  • Central nervous system prophylaxis
  • Diffuse large B-cell lymphoma
  • Intrathecal chemotherapy
  • Liposomal cytarabine
  • Methotrexate

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

Risk-tailored CNS prophylaxis in a mono-institutional series of 200 patients with diffuse large B-cell lymphoma treated in the rituximab era. / Ferreri, Andrés J M; Bruno-Ventre, Marta; Donadoni, Giovanni; Ponzoni, Maurilio; Citterio, Giovanni; Foppoli, Marco; Vignati, Alessandro; Scarfò, Lydia; Sassone, Marianna; Govi, Silvia; Caligaris-Cappio, Federico.

In: British Journal of Haematology, Vol. 168, No. 5, 01.03.2015, p. 654-662.

Research output: Contribution to journalArticle

Ferreri, AJM, Bruno-Ventre, M, Donadoni, G, Ponzoni, M, Citterio, G, Foppoli, M, Vignati, A, Scarfò, L, Sassone, M, Govi, S & Caligaris-Cappio, F 2015, 'Risk-tailored CNS prophylaxis in a mono-institutional series of 200 patients with diffuse large B-cell lymphoma treated in the rituximab era', British Journal of Haematology, vol. 168, no. 5, pp. 654-662. https://doi.org/10.1111/bjh.13194
Ferreri, Andrés J M ; Bruno-Ventre, Marta ; Donadoni, Giovanni ; Ponzoni, Maurilio ; Citterio, Giovanni ; Foppoli, Marco ; Vignati, Alessandro ; Scarfò, Lydia ; Sassone, Marianna ; Govi, Silvia ; Caligaris-Cappio, Federico. / Risk-tailored CNS prophylaxis in a mono-institutional series of 200 patients with diffuse large B-cell lymphoma treated in the rituximab era. In: British Journal of Haematology. 2015 ; Vol. 168, No. 5. pp. 654-662.
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AU - Bruno-Ventre, Marta

AU - Donadoni, Giovanni

AU - Ponzoni, Maurilio

AU - Citterio, Giovanni

AU - Foppoli, Marco

AU - Vignati, Alessandro

AU - Scarfò, Lydia

AU - Sassone, Marianna

AU - Govi, Silvia

AU - Caligaris-Cappio, Federico

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AB - Summary: The most effective strategy to prevent central nervous system (CNS) dissemination in diffuse large B-cell lymphoma (DLBCL) remains an important, unmet clinical need. Herein, we report a retrospective analysis of risk-tailored CNS prophylaxis in 200 human immunodeficiency virus-negative adults with DLBCL treated with rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or similar. High risk of CNS relapse was defined by involvement of specific extranodal organs, or simultaneous presence of advanced stage and high serum lactate dehydrogenase level; CNS prophylaxis with high-dose methotrexate ± intrathecal chemotherapy (IT) was routinely used in high-risk patients diagnosed after 2007. CNS relapse risk was low in 93 patients and high in 107; 40 high-risk patients received prophylaxis, which consisted of IT alone in 7. At a median follow-up of 60 months, one low-risk and nine high-risk patients (1% vs. 8%; P = 0·01) experienced CNS relapse. In the high-risk group, CNS relapses occurred in 8/67 (12%) patients who did not receive prophylaxis and in 1/40 (2·5%) patients who did; the latter occurred in a patient managed with IT alone. CNS relapse rate was 12% (9/74) for patients treated with "inadequate" prophylaxis (none or IT only) and 0% (0/33) for patients managed with intravenous prophylaxis (P = 0·03). In conclusion, high-dose methotrexate-based prophylaxis significantly reduces CNS failures in high-risk patients stratified by involvement of specific extranodal sites and International Prognostic Index.

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KW - Liposomal cytarabine

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