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Kuitunen, H., Kaprio, E., Karihtala, P. et al. Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma. Ann Hematol 99, 1823–1831 (2020). https://doi.org/10.1007/s00277-020-04140-0

Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma

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Author: Kuitunen, Hanne1,2; Kaprio, Elina1,3; Karihtala, Peeter1,4;
Organizations: 1Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
2Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
3Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
4Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O. Box 100, FI-00029, Helsinki, Finland
5The North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
6Medical Research Center, Department of Pathology, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
7Department of Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
8Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2020091569508
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-09-15
Description:

Abstract

Although overall survival in diffuse large B cell lymphomas (DLBCL) has improved, central nervous system (CNS) relapse is still a fatal complication of DLBCL. For this reason, CNS prophylaxis is recommended for patients at high risk of CNS disease. However, no consensus exists on definition of high-risk patient and optimal CNS prophylaxis. Systemic high-dose methotrexate in combination with R-CHOP has been suggested as a potential prophylactic method, since methotrexate penetrates the blood-brain barrier and achieves high concentration in the CNS. In this retrospective analysis, we report treatment outcome of 95 high-risk DLBCL/FL grade 3B patients treated with R-CHOP or its derivatives with (N = 57) or without (N = 38) CNS prophylaxis. At a median follow-up time (51 months), CNS relapses were detected in twelve patients (12.6%). Ten out of twelve (83%) of CNS events were confined to CNS system only. Median overall survival after CNS relapse was 9 months. Five-year isolated CNS relapse rates were 5% in the prophylaxis group and 26% in the group without prophylaxis. These findings suggest that high-dose methotrexate-containing prophylaxis decreases the risk of CNS failure.

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Series: Annals of hematology
ISSN: 0939-5555
ISSN-E: 1432-0584
ISSN-L: 0939-5555
Volume: 99
Issue: 8
Pages: 1823 - 1831
DOI: 10.1007/s00277-020-04140-0
OADOI: https://oadoi.org/10.1007/s00277-020-04140-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Subjects:
Central nervous system prophylaxis
Central nervous system recurrence
Diffuse large B cell lymphoma
High-dose methotrexate
Article
Funding: Open access funding provided by University of Eastern Finland (UEF) including Kuopio University Hospital.
Copyright information: © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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