Central nervous system prophylaxis in patients with aggressive diffuse large B cell lymphoma: An analysis of 3,258 patie
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ORIGINAL PAPER
Central nervous system prophylaxis in patients with aggressive diffuse large B cell lymphoma: An analysis of 3,258 patients in a single center Agustin Avile´s • M. Jesu´s Nambo • Natividad Neri
Received: 17 January 2013 / Accepted: 20 February 2013 / Published online: 1 March 2013 Springer Science+Business Media New York 2013
Abstract Central nervous system (CNS) relapse continues to be a frequent and usually fatal complication in patients with diffuse large B cell lymphoma (DLBCL). Multiple factors identify the possibility of relapse and justify neurological prophylaxis; however, most of these have not been confirmed. Thus, the use of prophylaxis has not been defined. From 1988 to 2008, 3,258 patients with DLBCL with higher clinical risks and multiple extranodal involvement that have been treated with standard anthracycline-based chemotherapy: CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or CHOP-R (CHOP plus rituximab) and that achieve complete response were retrospectively analyzed to assess the efficacy of CNS prophylaxis. One thousand five patients received different schedules for CNS prophylaxis, and 2,253 patients did not receive CNS prophylaxis. CNS relapse was similar in patients who receive prophylaxis (6 %) compared to patients who did not receive prophylaxis (5.9 %). Overall survival of patients who either receive or did not receive prophylaxis was not statistically significant: 49 % versus 53 % (p = 0.802). Thus, it seems that CNS prophylaxis did not improve outcome in this special setting of patients, and no prognostic factors to predict the presence of CNS relapse were identified. It is evident that multicentric studies are necessary to define the role of prophylaxis in order to prevent CNS relapse and that the therapeutic procedure will be carefully revised. A. Avile´s (&) Oncology Research Oncology Diseases, Ave. Cuauhtemoc 330, Colonia Doctores, 06725 Mexico, D.F., Mexico e-mail: [email protected] M. Jesu´s Nambo N. Neri Department of Hematology, Oncology Hospital, National Medical Center, IMSS, Mexico, D.F., Mexico
Keywords Malignant lymphoma Central nervous system relapse Central nervous system prophylaxis Prognostic factors
Introduction Central nervous system (CNS) relapse in patients with diffuse large B cell lymphoma (DLBCL) has been reported to be between 1.1 and 10.4 %. Although relatively uncommon, it is a serious and mostly fatal complication [1–7]. Multiple attempts have been performed to identify the patients who are considered at risk and who should receive prophylaxis [8–16]. However, no uniform criteria have been developed, and the efficacy of different forms of CNS prophylaxis has never been formally demonstrated. Recently, the use of systemic therapy with higher doses of methotrexate (MTX) or cytosine arabinoside, or with the addition of rituximab to standard chemotherapy, has been advocated as useful to prevent CNS relapse, but contradictory results have been reported [17–20]. Controlled clinical trials are clinically and ethica
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