CNS disease in younger patients with aggressive B-cell lymphoma: an analysis of patients treated on the Mabthera International Trial and trials of the German High-Grade Non-Hodgkin Lymphoma Study Group

Abstract

In younger patients with aaIPI 0 or 1, CNS relapse/progression is very rare; in patients with aaIPI 2 or 3, the risk is higher (up to 10%) and requires new diagnostic strategies and treatment.

Detection and outcome of occult leptomeningeal disease in diffuse large B-cell lymphoma and Burkitt lymphoma

“…25,26 The benefit of intrathecal therapy is controversial in DLBCL. 9,13,24,27 The reasons for this controversy are multifactorial. To help address this question, we first looked at patients with pre-treatment occult CSF involvement who in the absence of FCM analysis would have been clinically considered for prophylactic treatment.…”

“…The effect of systemic rituximab on the risk of CNS relapse is also controversial. [9][10][11][12][13] To assess this, we looked at the effect of rituximab on survival and freedom from CNS relapse. Within all patients with DLBCL, systemic rituximab was associated with a significant reduction in CNS relapse suggesting it may treat established CNS disease.…”

“…2 However, several retrospective rituximab-era studies in DLBCL did not find a benefit of intrathecal prophylaxis. 9,10,13,27 Two studies from the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL) reported that CNS prophylaxis was of no significant benefit in high-risk young patients or elderly patients with aggressive B-cell lymphoma. 13,27 The conclusions are confounded by two methodological problems.…”

“…9,10,13,27 Two studies from the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL) reported that CNS prophylaxis was of no significant benefit in high-risk young patients or elderly patients with aggressive B-cell lymphoma. 13,27 The conclusions are confounded by two methodological problems. First, patients were designated to receive intrathecal prophylaxis based on clinical criteria that were inconsistent with the authors' own optimal risk model for CNS disease.…”

“…Indeed, multiple retrospective studies have examined the effect of systemic rituximab and intrathecal 'prophylaxis' on the risk of CNS recurrence in DLBCL and have reported inconsistent results. [9][10][11][12][13] To help address these questions, we conducted an analysis of untreated patients with DLBCL The benefit of intrathecal therapy and systemic rituximab on the outcome of diffuse large B-cell lymphoma at risk of central nervous system disease is controversial. Furthermore, the effect of intrathecal treatment and rituximab in diffuse large B-cell and Burkitt lymphoma with occult leptomeningeal disease detected by flow cytometry at diagnosis is unknown.…”