Incidence and risk factors for central nervous system occurrencein elderly patients with diffuse large-B-cell lymphoma: influenceof rituximab

Feugier, Pierre; Virion, Jean Marc; Tilly, Hervé; Haı̈oun, Corinne; Marit, Gérald; Macro, Margaret; Bron, Dominique; Récher, Christian; Blanc, Michel; Molina, Thierry Jo; Léderlin, P.; Coiffier, Bertrand

doi:10.1093/annonc/mdh013

Cited by 231 publications

(215 citation statements)

References 13 publications

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“…However, when analysing the patient material with regard to the CNS relapse rate, no difference was recorded between the CHOP and rituximab/CHOP arms (28).…”

Section: Discussionmentioning

confidence: 94%

Testicular lymphoma A Retrospective, Population-based, Clinical and Immunohistochemical Study

Hasselblom¹,

Ridell²,

Wedel³

et al. 2004

Acta Oncologica

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“…However, when analysing the patient material with regard to the CNS relapse rate, no difference was recorded between the CHOP and rituximab/CHOP arms (28).…”

Section: Discussionmentioning

confidence: 94%

Testicular lymphoma A Retrospective, Population-based, Clinical and Immunohistochemical Study

Hasselblom¹,

Ridell²,

Wedel³

et al. 2004

Acta Oncologica

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“…The addition of rituximab to standard CHOP-21 appeared to have no influence on CNS recurrences in the landmark GELA trial of R-CHOP versus CHOP, with an overall 5% risk of CNS recurrence reported among elderly patients with DLBCL, regardless of treatment arm. 23 However, when the RICOVER-60 trial compared R-CHOP with CHOP in a dose-dense manner, there were modestly fewer recurrences in the rituximab-treated patients noted on univariate analysis Original Article (6.9% vs 4.1%), although this was not significant on multivariate analysis. A notable observation in both the GELA and RICOVER-60 trials was that CNS recurrences in R-CHOP-treated patients were predominantly parenchymal, not leptomeningeal, as had been reported before the introduction of rituximab.…”

Section: Discussionmentioning

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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“…The incidence of leptomeningeal disease at diagnosis ranges from 3.7% to 25%, and it is related to several factors, such as the different histological subtypes, the involvement of particular sites of disease (ie, testis, bone marrow, Waldeyer ring, or retroperitoneal masses), and an increased serum lactate dehydrogenase (LDH) level. [1][2][3][4][5][6][7][8][9][10][11] Moreover, the overall incidence of CNS recurrence with or without intrathecal prophylaxis is around 5%. 3,[12][13][14][15] Since the beginning of the acquired immune deficiency syndrome (AIDS) epidemic, a close association between human immunodeficiency virus (HIV) infection and high-grade NHL has been reported.…”

mentioning

confidence: 99%

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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Incidence and risk factors for central nervous system occurrencein elderly patients with diffuse large-B-cell lymphoma: influenceof rituximab

Cited by 231 publications

References 13 publications

Testicular lymphoma A Retrospective, Population-based, Clinical and Immunohistochemical Study

Testicular lymphoma A Retrospective, Population-based, Clinical and Immunohistochemical Study

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

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

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