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. 2023 Feb 1;24(2):623-631.
doi: 10.31557/APJCP.2023.24.2.623.

The Outcomes of Diffuse Large B-cell Lymphoma Patients with Synchronous and Early Central Nervous System Involvement: A Single-Center Experience

Mubarak Al-Mansour  1   2 , Saif Ahmed Saif  2 , Ziyad Alharbi  2 , Abdulrhman Salem Alhwaity  2 , Ahmed Almasrahi  2 , Waleed Alnejadi  2 , Sarah Hussain  2 , Syed Sameer Aga  2 , Muhammad Anwar Khan  2 , Roula Almufti  2 , Ahmed Absi  2
Affiliations

The Outcomes of Diffuse Large B-cell Lymphoma Patients with Synchronous and Early Central Nervous System Involvement: A Single-Center Experience

Mubarak Al-Mansour et al. Asian Pac J Cancer Prev. .

Abstract

Background: Diffuse large B cell lymphoma (DLBCL) is the most commonly diagnosed subtype of non-Hodgkin's lymphoma (NHL). R-CHOP has significantly improved clinical outcomes in patients with DLBCL, however, its indication in the prevention of CNS relapse and recurrence is still inconsistent. Moreover, prophylactic methotrexate and/or cytarabine have been used prophylactically for DLBCL patients is at high risk of CNS relapse and to treat CNS DLBCL, however, their efficacy remains unclear.

Methods: The aim of our retrospective study was to determine the incidence of CNS in-volvement in patients with DLBCL and to describe its risk factors and survival outcomes.

Results: A total of 406 patients with DLBCL were identified, and 17 (4.2%) of DLBCL patients had CNS involvement i.e. 9 (2.2 %) at diagnosis and 8 (~2%) at relapse. The patients were younger, had advanced stage, high CNS-IPI, and had extra nodal involvement. Seven out of the 17 patients who survived received chemotherapy and a prophylactic methotrexate. Considering the CNS-IPI, of the 146 patients with high CNS-IPI at presentation, 18 received the prophylactic HDMTX and 3 (16.7%) of them had CNS relapse. Two (1.6%) out of 128 who did not receive the prophylactic HDMTX had CNS relapse. On the other hand, of the 223 patients with intermediate CNS-IPI, 25 received the prophylactic HDMTX and 2 (8%) of them had CNS relapse and in 198 patients who did not receive the prophylactic HDMTX, 2 (1.01%) had CNS relapse. The 5-year progression-free survival and overall survival rates for the entire cohort were 73% and 84%, respectively. The median OS for those who had CNS involvement was 17 months and the 2-year OS was 40%.

Conclusion: CNS involvement in DLBCL has a poor prognosis, thus, aggressive CNS-directed therapy should be considered, especially in young patients.

Keywords: Overall survival; Relapse; Synchronous; methotrexate; progression free survival.

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Conflict of interest statement

There is no conflict of interest in between the authors.

Figures

Figure 1
Figure 1
Progression Free Survival the Entire Cohort
Figure 2
Figure 2
Overall Survival of the EntireCohort
Figure 3
Figure 3
Overall survival of patients with CNS involvement and CNS relapse
See this image and copyright information in PMC

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