Central nervous system involvement following diagnosis ofnon-Hodgkin’s lymphoma: a risk model

Hollender, Åse; Kvaløy, Stein; Nome, Ole; Skovlund, Eva; Lote, Knut; Holte, Harald

doi:10.1093/annonc/mdf175

Cited by 247 publications

(255 citation statements)

References 42 publications

Supporting

Mentioning

240

Contrasting

Unclassified

Order By: Relevance

“…Previous series demonstrate a CNS recurrence risk of 2% to 8% in patients with DLBCL in general, [1][2][3]5,11 but none of these series were limited to high-risk patients, among whom the incidence of CNS recurrence is known to be significantly higher. Specific extranodal sites are highly associated with an elevated risk of CNS recurrence, perhaps due to differential expression of integrin or chemokine receptor profiles that allow colonization of these sites.…”

Section: Discussionmentioning

confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

207

159

View full text Add to dashboard Cite

BACKGROUND:The outcome of patients with systemic diffuse large B-cell lymphoma (DLBCL) had improved over the past decade with the addition of monoclonal antibody therapy. Unfortunately, approximately 5% of these patients still developed a secondary central nervous system (CNS) recurrence followed invariably by rapid death. This rate is substantially increased in patients with certain high-risk features. Although prophylaxis against CNS recurrence with either intrathecal or intravenous methotrexate is commonly used for such patients, to the authors' knowledge, there is no standard of care. Retrospectively evaluated was the role of high-dose systemic methotrexate combined with standard cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (R-CHOP) chemotherapy to decrease CNS recurrence in high-risk patients. METHODS: A total of 65 patients with DLBCL and CNS risk factors were identified at the study institution between 2000 and 2008 who received intravenous methotrexate as CNS prophylaxis concurrent with standard systemic therapy with curative intent. CNS recurrence rate, progression-free survival, and overall survival were calculated. RESULTS: Patients received a median of 3 cycles of methotrexate at a dose of 3.5 gm/m 2 with leucovorin rescue. The complete response rate was 86%, with 6% partial responses. At a median follow-up of 33 months, there were only 2 CNS recurrences (3%) in this high-risk population. The 3-year progression-free and overall survival rates were 76% and 78%, respectively. Complications associated with methotrexate therapy included transient renal dysfunction in 7 patients and a delay in systemic chemotherapy in 8 patients. CONCLUSIONS: Intravenous methotrexate can be safely administered concurrently with R-CHOP and is associated with a low risk of CNS recurrence in high-risk patients. Cancer 2010;116:4283-90.

show abstract

Section: Discussionmentioning

confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

207

159

View full text Add to dashboard Cite

show abstract

“…The presence of more than one involved extranodal site has been consistently identified as an independent risk factor for CNS relapse in several studies. 13,[24][25][26][27][28] CNS relapse occurred early after completion of primary systemic therapy and CNS involvement was also found in four patients at the time of diagnosis. Since staging lumbar puncture and brain imaging were not routinely performed on all patients, it is possible that a proportion may have had occult CNS disease at diagnosis.…”

Section: Clinical Factor Chop (N=12) R-chop (N=8)mentioning

confidence: 99%

Diffuse large B-cell lymphoma with involvement of the kidney: outcome and risk of central nervous system relapse

Villa¹,

Connors²,

Sehn³

et al. 2011

Haematologica

View full text Add to dashboard Cite

BackgroundRenal involvement is uncommon in diffuse large B-cell lymphoma. Recent data suggest that it is an independent risk factor for central nervous system relapse. We reviewed the clinical features, risk of central nervous system involvement, and survival of patients with diffuse large Bcell lymphoma with involvement of the kidney at diagnosis. Design and MethodsAll patients with diffuse large B-cell lymphoma and renal involvement diagnosed from January 1, 1982 to December 31, 2008 at the British Columbia Cancer Agency were retrospectively identified in the Lymphoid Cancer Database. Patients were included if they were 16 years old or over, had advanced stage disease [stage III /IV, or stage I/II with B symptoms or bulky mass (>10 cm)] and were treated with curative intent. Central nervous system involvement was diagnosed by cerebrospinal fluid cytology, radiology or clinically. ResultsWe identified 55/2656 (2%) patients with diffuse large B-cell lymphoma and renal involvement at diagnosis. The male to female ratio was 2:1. The patients' median age was 58 years. Bilateral renal involvement was present in 24 (44%) and stage IV disease in 50 (91%). The International Prognostic Index score was 3, 4 or 5 in 52 (95%), the glomerular filtration rate was less than 30 mL/min/m 2 in 9 (16%) and elevated lactate dehydrogenase was recorded in 46 (84%). Twentyfive (46%) patients received CHOP plus rituximab and 30 (54%) received CHOP-like regimens without rituximab. In total, 20 (36%) patients had central nervous system involvement: four at the time of diagnosis and 16 at relapse. The median time to central nervous system relapse was 5.6 months (range, 1.2 months-4.6 years), and was not affected by the addition of rituximab (P=0.547). The 5-year overall and progression-free survival rates for the whole cohort were 29% and 25%, respectively. In patients who received rituximab, there were trends towards improved 5-year overall survival (43% versus 18%, P=0.071) and progression-free survival (40% versus 13%, P=0.057). ConclusionsThere is an exceptionally high incidence of central nervous system relapse in patients with diffuse large B-cell lymphoma and kidney involvement at diagnosis. The addition of rituximab may improve overall survival in this poor-risk population, likely through improved control of systemic disease.

show abstract

“…The incidence of leptomeningeal disease at diagnosis ranges from 3.7% to 25%, and it is related to several factors, such as the different histological subtypes, the involvement of particular sites of disease (ie, testis, bone marrow, Waldeyer ring, or retroperitoneal masses), and an increased serum lactate dehydrogenase (LDH) level. [1][2][3][4][5][6][7][8][9][10][11] Moreover, the overall incidence of CNS recurrence with or without intrathecal prophylaxis is around 5%. 3,[12][13][14][15] Since the beginning of the acquired immune deficiency syndrome (AIDS) epidemic, a close association between human immunodeficiency virus (HIV) infection and high-grade NHL has been reported.…”

mentioning

confidence: 99%

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Spina

Chimienti

Martellotta

et al. 2010

Cancer

View full text Add to dashboard Cite

BACKGROUND:Patients with aggressive non-Hodgkin lymphoma (NHL) develop central nervous system (CNS) progression or recurrence during the course of their disease. Patients with human immunodeficiency virus (HIV)-NHL often develop CNS progression despite the use of prophylaxis. Liposomal cytarabine (DepoCyte) has shown activity in lymphomatous meningitis, but there are limited data for prophylaxis. METHODS: Between May 2006 and December 2008, a phase 2 study of intrathecal liposomal cytarabine was performed at the dose of 50 mg in 30 patients with HIV-NHL, with the aim of evaluating feasibility and activity for prophylaxis. RESULTS: Liposomal cytarabine was well tolerated, with headache grade I to III being the most frequent side effect in 40% of patients. With a median followup of 10.5 months, only 1 (3%) patient developed a combined systemic and meningeal recurrence. The use of liposomal cytarabine allowed significant reduction of the number of lumbar injections in comparison to the standard schedules (around 50%), improving the quality of life of patients and reducing the professional exposure risk. CONCLUSIONS: In this first study on prophylaxis of lymphomatous meningitis in HIV-NHL, liposomal cytarabine seems safe and active; it reduces by approximately 50% the number of lumbar punctures, and exposure risk for health staff as well.

show abstract

Central nervous system involvement following diagnosis ofnon-Hodgkin’s lymphoma: a risk model

Cited by 247 publications

References 42 publications

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Diffuse large B-cell lymphoma with involvement of the kidney: outcome and risk of central nervous system relapse

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Contact Info

Product

Resources

About