CNS events in elderly patients with aggressive lymphoma treated with modern chemotherapy (CHOP-14) with or without rituximab: an analysis of patients treated in the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL)

Boehme, Volkmar; Schmitz, Norbert; Zeynalova, Samira; Loeffler, Markus; Pfreundschuh, Michael

doi:10.1182/blood-2008-10-182253

Cited by 286 publications

(290 citation statements)

References 33 publications

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“…Although every attempt has been made to identify patients who developed CNS relapse though database searches it is possible that patients may not have been discussed at the network MDT and therefore we acknowledge that, as a retrospective review, there maybe a degree of under-ascertainment. Although the CNS relapse rates seen here are lower than published data from the larger phase three trials, such as RICOVER-60 (Boehme et al, 2009), they are still consistent with published figures (Kumar et al, 2012). This is despite our conservative approach to CNS prophylaxis.…”

supporting

confidence: 88%

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Central nervous system prophylaxis in patients with diffuse large B cell lymphoma, are we treating ourselves? A response to the recent BCSH Guideline

et al. 2014

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supporting

confidence: 88%

“…Evidence collected in the rituximab era suggests a reduction in the frequency of CNS relapse, perhaps because of better initial disease control (Boehme et al, 2009;Guirguis et al, 2012).…”

mentioning

confidence: 99%

Central nervous system prophylaxis in patients with diffuse large B cell lymphoma, are we treating ourselves? A response to the recent BCSH Guideline

et al. 2014

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“…51 In our patients, the use of different regimens, in particular R-CODOX-M/IVAC, that include high-dose methotrexate and high-dose cytarabine may have influenced the positive outcome. Finally, the use of HAART could play a key role in the reduction of CNS involvement, both because it allows the use of more intensive regimens and because it is able to prolong the DFS.…”

mentioning

confidence: 81%

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Spina

Chimienti

Martellotta

et al. 2010

Cancer

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BACKGROUND:Patients with aggressive non-Hodgkin lymphoma (NHL) develop central nervous system (CNS) progression or recurrence during the course of their disease. Patients with human immunodeficiency virus (HIV)-NHL often develop CNS progression despite the use of prophylaxis. Liposomal cytarabine (DepoCyte) has shown activity in lymphomatous meningitis, but there are limited data for prophylaxis. METHODS: Between May 2006 and December 2008, a phase 2 study of intrathecal liposomal cytarabine was performed at the dose of 50 mg in 30 patients with HIV-NHL, with the aim of evaluating feasibility and activity for prophylaxis. RESULTS: Liposomal cytarabine was well tolerated, with headache grade I to III being the most frequent side effect in 40% of patients. With a median followup of 10.5 months, only 1 (3%) patient developed a combined systemic and meningeal recurrence. The use of liposomal cytarabine allowed significant reduction of the number of lumbar injections in comparison to the standard schedules (around 50%), improving the quality of life of patients and reducing the professional exposure risk. CONCLUSIONS: In this first study on prophylaxis of lymphomatous meningitis in HIV-NHL, liposomal cytarabine seems safe and active; it reduces by approximately 50% the number of lumbar punctures, and exposure risk for health staff as well.

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“…IT methotrexate has been most commonly used historically, 12 but evidence of benefit has been equivocal, with no protective benefit observed in 2 large randomized controlled treatment trials of DLBCL. 2,11,[13][14][15] By contrast, the combination of systemic and IT methotrexate has demonstrated effective reduction in CNS recurrence in DLBCL, 16 suggesting that intravenous methotrexate may be primarily responsible for the risk reduction; however, the protective benefit of intravenous high-dose methotrexate without concurrent IT chemotherapy has never been formally evaluated. In the current study, we present what to the best of our knowledge is the first report of high-dose systemic methotrexate combined with standard chemoimmunotherapy to decrease CNS recurrence in high-risk DLBCL patients.…”

mentioning

confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

210

159

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BACKGROUND:The outcome of patients with systemic diffuse large B-cell lymphoma (DLBCL) had improved over the past decade with the addition of monoclonal antibody therapy. Unfortunately, approximately 5% of these patients still developed a secondary central nervous system (CNS) recurrence followed invariably by rapid death. This rate is substantially increased in patients with certain high-risk features. Although prophylaxis against CNS recurrence with either intrathecal or intravenous methotrexate is commonly used for such patients, to the authors' knowledge, there is no standard of care. Retrospectively evaluated was the role of high-dose systemic methotrexate combined with standard cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (R-CHOP) chemotherapy to decrease CNS recurrence in high-risk patients. METHODS: A total of 65 patients with DLBCL and CNS risk factors were identified at the study institution between 2000 and 2008 who received intravenous methotrexate as CNS prophylaxis concurrent with standard systemic therapy with curative intent. CNS recurrence rate, progression-free survival, and overall survival were calculated. RESULTS: Patients received a median of 3 cycles of methotrexate at a dose of 3.5 gm/m 2 with leucovorin rescue. The complete response rate was 86%, with 6% partial responses. At a median follow-up of 33 months, there were only 2 CNS recurrences (3%) in this high-risk population. The 3-year progression-free and overall survival rates were 76% and 78%, respectively. Complications associated with methotrexate therapy included transient renal dysfunction in 7 patients and a delay in systemic chemotherapy in 8 patients. CONCLUSIONS: Intravenous methotrexate can be safely administered concurrently with R-CHOP and is associated with a low risk of CNS recurrence in high-risk patients. Cancer 2010;116:4283-90.

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CNS events in elderly patients with aggressive lymphoma treated with modern chemotherapy (CHOP-14) with or without rituximab: an analysis of patients treated in the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL)

Cited by 286 publications

References 33 publications

Central nervous system prophylaxis in patients with diffuse large B cell lymphoma, are we treating ourselves? A response to the recent BCSH Guideline

Central nervous system prophylaxis in patients with diffuse large B cell lymphoma, are we treating ourselves? A response to the recent BCSH Guideline

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

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