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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



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



Annals of Oncology 23(5): 1267-1273



To describe incidence, risk factors, and influence of treatment on occurrence of central nervous system (CNS) relapse or progression in younger patients with aggressive B-cell lymphoma. We analyzed 221 patients with aggressive B-cell lymphoma treated on various studies for CNS relapse/progression. Treatment consisted of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) ± etoposide. Six hundred and twenty patients also received rituximab. CNS prophylaxis was intrathecal methotrexate on High-CHOEP and MegaCHOEP phase III studies if upper neck, head, bone marrow, or testes were involved. Fifty-six of 2196 patients (2.6%) developed CNS disease. It occurred early (median 7. months), median survival was 5. months. Patients with age-adjusted International Prognostic Index (aaIPI) or 1 treated with rituximab showed a low risk for CNS disease (2-year rates: % or .5%), and rituximab decreased the risk (relative risk .3, 95% confidence interval .1–.9, P = .29). Patients with aaIPI 2 or 3 showed a moderate risk (4.2%–9.7%) and no significant reduction of CNS disease with rituximab. CNS prophylaxis was of no significant benefit. In younger patients with aaIPI or 1, CNS relapse/progression is very rare; in patients with aaIPI 2 or 3, the risk is higher (up to 1%) and requires new diagnostic strategies and treatment.

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Accession: 036390079

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PMID: 21989328

DOI: 10.1093/annonc/mdr440



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