First-Line Treatment for Primary Breast Diffuse Large B-Cell Lymphoma Using Immunochemotherapy and Central Nervous System Prophylaxis: A Multicenter Phase 2 Trial

Yhim, Ho‐Young; Yoon, Dok Hyun; Kim, Seok Jin; Yang, Deok‐Hwan; Eom, Hyeon-Seok; Kim, Kyoung Ha; Park, Yong; Kim, Jin Seok; Kim, Hyo Jung; Suh, Cheolwon; Kim, Won Seog; Kwak, Jae‐Yong

doi:10.3390/cancers12082192

Cited by 16 publications

(21 citation statements)

References 33 publications

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“…Several studies have also reported that the involvement of specific extranodal sites, such as the testis or the breast, is associated with a high rate of CNS relapse. [7][8][9][10][11][12][13] In addition, specific biological features, such as double-hit lymphoma or double-expressor lymphoma, have been identified as high-risk factors for CNS relapse. [14][15][16] To reduce the incidence of CNS relapse in high-risk patients, prophylactic IV high-dose methotrexate (HD-MTX) has been considered an alternative to intrathecal methotrexate, because recent data have shown that intrathecal prophylaxis provides insufficient benefit.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of prophylactic high-dose MTX in high-risk DLBCL: a treatment intent–based analysis

et al. 2021

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Despite central nervous system (CNS) relapse occurring in >10% of high-risk diffuse large B-cell lymphoma (DLBCL) patients, the role of CNS-directed prophylaxis is controversial in the absence of randomized controlled trials. In this retrospective study, we aimed to evaluate the safety and efficacy of prophylactic high-dose methotrexate (HD-MTX) on CNS relapse and survival outcomes in 258 newly diagnosed R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)–treated high-risk DLBCL patients, based on the initial treatment intent (ITT) of the physician on the use of prophylactic HD-MTX. Patients were classified into an ITT HD-MTX group (n = 128) and a non-ITT HD-MTX group (n = 130). The CNS relapse rate was not significantly different between these groups, with 2-year CNS relapse rates of 12.4% and 13.9%, respectively (P = 0.96). Three-year progression-free survival and overall survival rates in the ITT HD-MTX and non-ITT HD-MTX groups were 62.4% vs 64.5% (P = 0.94) and 71.7% vs 71.4% (P = 0.7), respectively. Also, propensity score–matched analyses showed no significant differences in the time-to-CNS-relapse, progression-free survival, or overall survival. The ITT HD-MTX group showed a higher incidence of grade ≥ 3 oral mucositis and elevated alanine aminotransferase. Prophylactic HD-MTX does not improve CNS relapse rate or survival outcomes in high-risk DLBCL patients, and it is accompanied by increased toxicities.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of prophylactic high-dose MTX in high-risk DLBCL: a treatment intent–based analysis

et al. 2021

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“…Four patients relapsed in the CNS and 2 patients in the breasts. This study showed chemotherapy with rituximab and CNS prophylaxis without routine local radiation may be a sufficient approach (12).…”

Section: Definitive Diagnosis Is Based On Pathologic Featuresmentioning

confidence: 74%

Metachronous Diffuse Large B-Cell Lymphoma of the Breasts: A Case Report and Review of the Literature.

et al. 2021

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Introduction: PBL is a rare form of extranodal lymphoma. The most common pathology is diffuse large B cell lymphoma and most patients are diagnosed at stages 1 and 2. The therapeutic options undertaken so far include surgery, radiotherapy, and chemotherapy Case Presentation: The patient was a 54-year old woman with localized primary breast DLBCL. The patient underwent 6 courses of chemotherapy with an RCHOP regimen followed by radiotherapy of the breast and regional lymph nodes with a 40 Gy dose. The patient was in complete remission on PET scan 3 months later. Around one year after, the patient experienced relapse in the contralateral breast. Conclusions: In the pattern of relapse of patients, there is a tendency for extranodal relapse. In some studies maximum level of relapse occurring in CNS and some advocate CNS prophylaxis in these patients. The best outcome is for patients treated with chemotherapy including rituximab followed by radiation. We reviewed some studies in the aspect of treatment modalities and site of relapsed.

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“…The addition of rituximab to CHOP remains controversial and some studies have reported improved outcomes while most did not observe any benefit. [13][14][15]…”

Section: Discussionmentioning

confidence: 99%

Poor Prognosis of Diffuse Large B-Cell Lymphoma of the Breast: The Role of Dose-Dense Chemotherapy

Avilés

Silva²,

Cleto

2022

Arch Breast Cancer

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Background: The aim of the study was to define if the use of an intensive regimen (dose-dense) of chemotherapy may improve response rate and outcome in patients with primary breast lymphoma (PBL), whose is considered as lymphoma presentation with an worse prognosis. Methods: Patients with pathological confirmed diagnosis of diffuse large B-cell lymphoma with clinical presentation on breast (PBL) , > 18 years old, stage I and II, negative for immunodeficient syndrome, hepatitis A and B, previously untreated , with non-germinal center cell, were included in a open label clinical trial, phase II, were allocated to received an dose dense regimen of CHOP (cyclophosphamide , doxorubicine, vincristine and prednisone) Results: Between July 2006 to December 2016, seventy eight patients were enrolled in the study. Complete response was achieved in 76 (94.4%), patients. Five patients relapse , thus progression free survival at 5 years was 94.0% (95 % Confidence interval (CI): 87% to 98%%): three patients achieved a second response and are alive, overall survival at 5-years was : 95.3 (96%CI: 89% to 102%).Relapse at central nervous system has not been observed. Severe granulocytopenia was observed in 42.8 (93.0%) cycles, but no death associated to treatment were observed. Conclusion: The use a dose-dense regimen of chemotherapy improve outcome in this setting of patients; although severe acute toxicities were frequent , it well controlled. Relapse in central nervous system has not been observed. Thus, we considered that dose-dense chemotherapy will be employed in this setting of patients.

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First-Line Treatment for Primary Breast Diffuse Large B-Cell Lymphoma Using Immunochemotherapy and Central Nervous System Prophylaxis: A Multicenter Phase 2 Trial

Cited by 16 publications

References 33 publications

Efficacy and safety of prophylactic high-dose MTX in high-risk DLBCL: a treatment intent–based analysis

Efficacy and safety of prophylactic high-dose MTX in high-risk DLBCL: a treatment intent–based analysis

Metachronous Diffuse Large B-Cell Lymphoma of the Breasts: A Case Report and Review of the Literature.

Poor Prognosis of Diffuse Large B-Cell Lymphoma of the Breast: The Role of Dose-Dense Chemotherapy

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