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Clinical Trial
. 2020 Aug;99(8):1823-1831.
doi: 10.1007/s00277-020-04140-0. Epub 2020 Jun 23.

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

Hanne Kuitunen  1   2 , Elina Kaprio  3   4 , Peeter Karihtala  1   5 , Ville Makkonen  1   6 , Saila Kauppila  2   7 , Kirsi-Maria Haapasaari  2   7 , Milla Kuusisto  1   6 , Esa Jantunen  8 , Taina Turpeenniemi-Hujanen  1   2 , Outi Kuittinen  1   2   9   10
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Clinical Trial

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

Hanne Kuitunen et al. Ann Hematol. 2020 Aug.

Abstract

Although overall survival in diffuse large B cell lymphomas (DLBCL) has improved, central nervous system (CNS) relapse is still a fatal complication of DLBCL. For this reason, CNS prophylaxis is recommended for patients at high risk of CNS disease. However, no consensus exists on definition of high-risk patient and optimal CNS prophylaxis. Systemic high-dose methotrexate in combination with R-CHOP has been suggested as a potential prophylactic method, since methotrexate penetrates the blood-brain barrier and achieves high concentration in the CNS. In this retrospective analysis, we report treatment outcome of 95 high-risk DLBCL/FL grade 3B patients treated with R-CHOP or its derivatives with (N = 57) or without (N = 38) CNS prophylaxis. At a median follow-up time (51 months), CNS relapses were detected in twelve patients (12.6%). Ten out of twelve (83%) of CNS events were confined to CNS system only. Median overall survival after CNS relapse was 9 months. Five-year isolated CNS relapse rates were 5% in the prophylaxis group and 26% in the group without prophylaxis. These findings suggest that high-dose methotrexate-containing prophylaxis decreases the risk of CNS failure.

Keywords: Central nervous system prophylaxis; Central nervous system recurrence; Diffuse large B cell lymphoma; High-dose methotrexate.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Progression-free survival (PFS) (p = 0.044) and b five-year overall survival (OS) according to GC phenotypes: GCB in red and non-GC phenotype in blue
Fig. 2
Fig. 2
Kaplan-Meier estimate of overall survival (OS) of the patient after the detection of central nervous system (CNS) relapse
Fig. 3
Fig. 3
Kaplan-Meier estimate of isolated central nervous system (CNS) relapse rate based on prophylaxis group. Full prophylaxis group in blue, inadequate prophylaxis groups in red and no prophylaxis group in green
Fig. 4
Fig. 4
Five-year isolated CNS relapse rates based on actualized prophylaxis (p = 0.016). Full and inadequate prophylaxis group in blue and no prophylaxis group in red
See this image and copyright information in PMC

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