Central nervous system relapse in patients with diffuse large B cell lymphoma: analysis of the risk factors and proposal of a new prognostic model

Abstract

Central nervous system (CNS) relapse in patients with diffuse large B cell lymphoma (DLBCL) is an uncommon event, and the outcome of patients with CNS relapse is poor. However, no reliable prediction models for CNS relapse have been developed. We retrospectively analyzed consecutive de novo DLBCL patients referred to our department between September 2004 and August 2015 and treated with R-CHOP or R-CHOP-like regimens. Of 413 patients analyzed in this study, a total of 27 patients (6.5 %) eventually developed CNS relapse. The 5-year probability of CNS relapse was 8.4 %. The median time from diagnosis of DLBCL to CNS relapse was 15 months, and the median survival after CNS relapse was 7 months. In univariate analysis, the risk factors significantly associated with CNS relapse were Ann Arbor stage 3 or 4, albumin level <3.2 mg/L, number of extranodal sites >1, and involvement of retroperitoneal lymph node. We developed a new prognostic model consisting of these four factors. The 5-year probability of CNS relapse was significantly higher in patients with at least three of these four factors than in those with two or fewer factors (26.4 vs. 3.0 %, P < 0.001). Using this model, we evaluated the incidence and the risk factors of CNS relapse in DLBCL patients. The new risk model consisting of the four factors demonstrated good risk stratification for CNS relapse, and could help to identify high-risk patients for whom CNS prophylaxis is warranted.

Selective contrast‐enhanced computed tomography is appropriate in diffuse large B‐cell lymphoma therapy response assessment

“…While 70% (n = 19) of these patients did not show new involvement compared to first diagnosis, 30% (n = 8) had new involvement sides. Half of these patients (2% of all analyzed patients) showed new central nervous system involvement, which is in line with previously reported data (2%‐8%) . Overall, the involvement of initially not affected sites at relapse in the current analysis indicates the necessity of a full imaging at relapse.…”

“…Half of these patients (2% of all analyzed patients) showed new central nervous system involvement, which is in line with previously reported data (2%-8%). 22,23 Overall, the involvement of initially not affected sites at relapse in the current analysis indicates the necessity of a full imaging at relapse. should be considered as an imaging modality in future studies.…”

Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma

“…IPI has remained the most commonly used tool for risk stratification. Several risk-scoring systems, which consider also some specific extra nodal involvements, have also been suggested to determine high-risk patients [11,16,34]. In spite of clinical presentation, lymphoma biology especially double hit genotype, non-GC phenotype or double expressor phenotype increases the risk for CNS recurrence [35][36][37].…”

Clinicopathologic consensus study of gray zone lymphoma with features intermediate between DLBCL and classical HL

“…This is a clinical factor that has been shown to be prognostic in HL as well as non-Hodgkin lymphomas. [32][33][34][35][36][37][38] However, the small number of patients and relative heterogeneity of therapy limit conclusions regarding prognostication.…”