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
|Author:||Kuitunen, Hanne1,2; Kaprio, Elina1,3; Karihtala, Peeter1,4;|
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
|Online Access:||PDF Full Text (PDF, 0.5 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2020091569508
|Publish Date:|| 2020-09-15
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.
Annals of hematology
|Pages:||1823 - 1831|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
Open access funding provided by University of Eastern Finland (UEF) including Kuopio University Hospital.
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