Central nervous system event in patients with diffuse large B‐cell lymphoma in the rituximab era

Tomita, Naoto; Yokoyama, Masahiro; Yamamoto, Wataru; Watanabe, Reina; Shimazu, Yutaka; Yasukawa, Masaki; Tsunoda, Saburo; Hashimoto, Chizuko; Murayama, Kayoko; Yano, Takahiro; Okamoto, Rumiko; Kikuchi, Ako; Tamura, Kazuo; Sato, Kazuya; Sunami, Kazutaka; Shibayama, Hirohiko; Takimoto, Rishu; Ohshima, Rika; Hatta, Yoshihiro; Moriuchi, Yukiyoshi; Kinoshita, Tomohiro; Yamamoto, Masahide; Numata, Ayumi; Ishigatsubo, Yoshiaki; Takeuchi, Kengo

doi:10.1111/j.1349-7006.2011.02139.x

Cited by 76 publications

(62 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10,11 Presence of the blood-brain and blood-testicular barriers blocks the access of chemotherapy to lesions in these areas, reducing its efficacy and leading to a poor prognosis. In our recent study with the same patient cohort, 4 adrenal as well as testicular involvement was extracted as a risk factor for CNS involvement by multivariate analysis, which seemed to be a cause of poorer OS for patients with either of these 2 extranodal involvements. As for the proportion of CNS prophylaxis, we 12 have reported 407 consecutive DLBCL patients in our group with respect to CNS involvement, and only 7.1% (29 of 407) of the cases received CNS prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…All patients in this study were initially targeted to receive survey information from Bay-LINK (Bay-area Lymphoma Information Network) in Japan regarding central nervous system (CNS) events. 4 Data were collected by mail and e-mail for this purpose from October 2009 to June 2010. The data included patient data at diagnosis (IPIrelated data and presence/absence of each extranodal site), treatment (reduction of each drug, cycles of CHOP, addition of irradiation), and survival data (overall survival [OS], cause of death).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Takahashi

Tomita

Yokoyama

et al. 2011

Cancer

Self Cite

View full text Add to dashboard Cite

BACKGROUND:Extranodal involvement is considered a poor prognostic factor for patients with diffuse large B‐cell lymphoma (DLBCL); however, the prognostic impact of specific sites of involvement has not been fully elucidated.METHODS:The authors retrospectively analyzed 1221 patients treated uniformly with standard R‐CHOP therapy between 2003 and 2006. Patients with distinct forms of DLBCL such as intravascular lymphoma, primary effusion lymphoma, pyothorax‐associated lymphoma, primary central nervous system lymphoma, and intraocular lymphoma were also excluded. The authors evaluated 26 extranodal sites of involvement with respect to prognostic impact. The median age was 64 years (range, 15‐91 years).RESULTS:Univariate analysis revealed that patients with involvement of specific extranodal sites had significantly worse overall survival (OS) than did patients without such involvement; these sites included nasal cavity, paranasal sinus, lung, pleura, small intestine, peritoneum, liver, pancreas, stomach, spleen, adrenal gland, testis, bone, bone marrow, peripheral blood, skin, and subcutaneous tissue. Patients with Waldeyer ring involvement had significantly better OS. Multivariate analysis revealed that patients with the involvement of the pleura (P < .001), small intestine (P = .015), peritoneum (P = .002), adrenal gland (P < .001), testis (P = .005), bone marrow (P < .001), and peripheral blood (P = .002) had significantly worse OS, whereas those with Waldeyer ring involvement had significantly better OS (P = .038). Subgroup analysis with the nodal and/or Waldeyer patient group also showed prognostic impact of Waldeyer ring by multivariate analysis (relative risk, 0.3; P = .04).CONCLUSIONS:Extranodal involvement affects the prognosis of patients undergoing R‐CHOP therapy for DLBCL. Cancer 2012. © 2011 American Cancer Society.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Takahashi

Tomita

Yokoyama

et al. 2011

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…1,2,7,9,17,18 Accumulated evidence from studies of extranodal involvement have shown that testicular or breast involvement (particularly as primary lymphoma, but also as secondary involvement) is clearly associated with a higher rate of CNS relapse. 5,[19][20][21] A growing body of evidence indicates a higher CNS relapse rate among patients with renal involvement by lymphoma. Villa and colleagues 22 reported CNS involvement in 36% of patients with DLBCL with renal involvement.…”

Section: Guidelines For Diagnosis Prevention and Management Of Centrmentioning

confidence: 99%

Guidelines for diagnosis, prevention and management of central nervous system involvement in diffuse large B-cell lymphoma patients by the Spanish Lymphoma Group (GELTAMO)

et al. 2016

View full text Add to dashboard Cite

Several factors hinder the identification of risk factors for central nervous system (CNS) involvement in diffuse large B-cell lymphoma (DLBCL), including the retrospective nature of most studies, the relatively low frequency of CNS relapse in DLBCL, and the heterogeneity of CNS prophylaxis methods used in these studies. Moreover, the impact of newly developed diagnostic tools (such as multiparameter flow cytometry [FCM]) and new treatments introduced in the last decade, in particular rituximab, has still not been fully clarified.Several studies 4,5,[7][8][9][10] and a recent meta-analysis 1 have described a decrease in rates D iffuse large B-cell lymphoma patients have a 5% overall risk of central nervous system events (relapse or progression), which account for high morbidity and frequently fatal outcomes, 1 and shortened overall survival of <6 months.2 Early diagnosis of central nervous system events is critical for successful treatment and improved prognosis. Identification of patients at risk of central nervous system disease is critical to accurately identify candidates for central nervous system prophylaxis vs. therapy. [3][4][5] This report by the Spanish Lymphoma Group (GELTAMO) aims to provide useful guidelines and recommendations for the prevention, diagnosis, and treatment of central nervous system diffuse large B-cell lymphoma patients with, or at risk of, leptomeningeal and/or brain parenchyma lymphoma relapse. A panel of lymphoma experts working on behalf of GELTAMO reviewed all data published on these topics available in PubMed up to May 2016. Recommendations were classified according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. 6 A practical algorithm based on the proposed recommendations was then developed (Figure 1 have concluded that the incidence of CNS relapse decreased after the introduction of rituximab (Table 1). The identification of risk factors has been the major goal of many studies of CNS involvement. Several large retrospective studies conducted in the pre-rituximab era [12][13][14][15] reported higher rates of CNS relapse in patients with increased serum lactate dehydrogenase (LDH) levels and/or involvement of >1 extranodal site, although these factors failed to predict CNS relapse in more than half of all cases.12 In addition to the involvement of >1 extranodal site and increased LDH, International Prognostic Index (IPI) score was also identified as an independent predictor for CNS relapse in other studies.13,16 A post-rituximab era study of 399 DLBCL patients, randomized to R-CHOP or CHOP chemotherapy, 3 identified an age-adjusted IPI (aaIPI) >1 as the only risk factor for CNS involvement, although a high aaIPI score was recorded for more than 60% of the patients. When aaIPI was excluded from the analysis, elevated LDH and a poor performance status (PS >1) were identified as independent predictive factors for CNS relapse. Similarly, in the randomized RICOVER-60 trial, 4 the combination of increased LDH levels, the involvement of >1 ex...

show abstract

“…[54][55][56] Several clinical parameters, such as an elevated serum LDH level and extranodal or bone marrow involvement, have been established as risk factors for CNS relapse in DLBCL. [57][58][59] Testicular involvement of DLBCL is associated with a particularly high risk of CNS relapse. A phase II study by the International Extranodal Lymphoma Study Group (IELSG) reported that R-CHOP with intrathecal administration of MTX followed by contralateral testicular irradiation could reduce the incidence of CNS relapse in testicular DLBCL.…”

Section: Extranodal Involvementmentioning

confidence: 99%

Treatment of Diffuse Large B-Cell Lymphoma

Miyazaki

2016

JCEH

View full text Add to dashboard Cite

Diffuse large B-cell lymphoma (DLBCL) comprises a heterogeneous group with pathophysiological, genetic and clinical features. Many patients can be cured with R-CHOP therapy, which is the current standard regimen. Despite recent progress in improving patient survival, the 40% survival of DLBCL patients remains poor. Therefore, the most important issue for patients with DLBCL remains the development of a new front-line therapy. Several studies have reported that intensified chemotherapy with dose-adjusted EPOCH-R or R-ACVBP was superior to R-CHOP. Gene expression profiling has identified two distinct forms of DLBCL: activated B cell-like (ABC) and germinal center B-cell-like (GCB) types. ABC DLBCL exhibits a worse prognosis than GCB DLBCL by molecular diagnosis after R-CHOP therapy. Next-generation sequencing has identified unique oncogenic mechanisms and genetic complexity, which has provided rational therapeutic targets. There are also a number of biomarkers, including CD5, and prognostic factors. Efforts to distinguish many biomarkers will be crucial for individualized treatment in the future. 〔J Clin Exp Hematop 56(2):79-88, 2016〕

show abstract

Central nervous system event in patients with diffuse large B‐cell lymphoma in the rituximab era

Cited by 76 publications

References 28 publications

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Guidelines for diagnosis, prevention and management of central nervous system involvement in diffuse large B-cell lymphoma patients by the Spanish Lymphoma Group (GELTAMO)

Treatment of Diffuse Large B-Cell Lymphoma

Contact Info

Product

Resources

About