ANALYSIS OF RISK FACTORS FOR CENTRAL NERVOUS SYSTEM RELAPSE IN DIFFUSE LARGE B-CELL LYMPHOMA: THE EXPERIENCE OF A TERTIARY HOSPITAL
(Abstract release date: 05/19/16)
EHA Library. Vara Pampliega M. 06/09/16; 134632; PB1732
Mrs. M Vara Pampliega
Contributions
Contributions
Abstract
Abstract: PB1732
Type: Publication Only
Background
Central nervous system (CNS) relapse is an uncommon (5%) unfavorable complication of diffuse large B-cell lymphoma (DLBCL). Independent predictors at diagnosis have been described to establish higher-risk groups that benefit from CNS prophylaxis: IPI ≥3, elevated serum LDH levels, B symptoms, bulky mass, CD5+, MYC rearrangement, >1 extranodal involvement, ECOG >1 and absence of Rituximab in systemic treatment. Many studies have demonstrated that the frequency of CNS relapse varies from 10% to 50%, depending on risk factors.
Aims
Analyze triple intrathecal therapy to prevent CNS relapse in DLBCL with high risk factors.
Methods
We analyzed retrospectively, from 2009 to 2015, 75 patients with newly diagnosed DLBCL. The decision to administer them all triple intrathecal therapy (TIT) (metotrexate, cytarabine, hydrocortisone) was based on the CNS relapsing risk factors in DLBCL described above. Systemic therapy was CHOP-like. Qualitative variables are described in percentages and quantitative variables are described with means and standard deviations. We use Chi square test to compare different categorical variables with CNS relapse. The overall survival is tested with Kaplan-Meier tables.
Results
Of 75 patients, 41 were male. Median age at diagnosis was 62 years. 6 (8%) patients experienced CNS relapse. The mean Overall Survival (OS) was 62 months CI 95% (55-69). OS at 6 months was 90.4%, at 2 years 80.5% and at 5 years 72%.Table shows comparison between parameters described and CNS relapse.
Conclusion
Spanish GELTAMO group has recently published the Guideline for diagnosis, prevention and therapeutic management of CNS involvement in DLBCL. In our experience, TIT was effective to prevent CNS relapse (8% compare to 10-50% described in literature in high risk patients). However, patients with very high risk factors could benefit from combination therapy recommended by GELTAMO based on inmunochemotherapy + TIT + High Dose Metotrexate.
Session topic: E-poster
Keyword(s): CNS, DLBCL
Type: Publication Only
Background
Central nervous system (CNS) relapse is an uncommon (5%) unfavorable complication of diffuse large B-cell lymphoma (DLBCL). Independent predictors at diagnosis have been described to establish higher-risk groups that benefit from CNS prophylaxis: IPI ≥3, elevated serum LDH levels, B symptoms, bulky mass, CD5+, MYC rearrangement, >1 extranodal involvement, ECOG >1 and absence of Rituximab in systemic treatment. Many studies have demonstrated that the frequency of CNS relapse varies from 10% to 50%, depending on risk factors.
Aims
Analyze triple intrathecal therapy to prevent CNS relapse in DLBCL with high risk factors.
Methods
We analyzed retrospectively, from 2009 to 2015, 75 patients with newly diagnosed DLBCL. The decision to administer them all triple intrathecal therapy (TIT) (metotrexate, cytarabine, hydrocortisone) was based on the CNS relapsing risk factors in DLBCL described above. Systemic therapy was CHOP-like. Qualitative variables are described in percentages and quantitative variables are described with means and standard deviations. We use Chi square test to compare different categorical variables with CNS relapse. The overall survival is tested with Kaplan-Meier tables.
Results
Of 75 patients, 41 were male. Median age at diagnosis was 62 years. 6 (8%) patients experienced CNS relapse. The mean Overall Survival (OS) was 62 months CI 95% (55-69). OS at 6 months was 90.4%, at 2 years 80.5% and at 5 years 72%.Table shows comparison between parameters described and CNS relapse.
| Risk factors at diagnosis | Frequency (n) | CNS relapse (%) | P value |
| B symptoms (Yes/No) | 37/38 | 10.8/5.3 | 0.430 |
| Bulky mass (Yes/No) | 19/56 | 10.5/7.1 | 0.640 |
| Ann-Arbor Stage (I-II/III-IV) | 11/64 | 9.1/7.8 | 0.999 |
| Serum LDH levels (elevated/non-elevated) | 46/29 | 8.7/6.9 | 0.999 |
| Extranodal sites (0-1/>1) | 42/33 | 4.8/12.1 | 0.395 |
| IPI (0-2/3-5) | 30/35 | 6.7/8.9 | 0.999 |
| CNS involvement at diagnosis (Yes/No) | 2/73 | 50/6.8 | 0.155 |
| Rituximab (Yes/No) | 73/2 | 8.2/0 | 0.999 |
| CD5 (Positive/Negative) | 4/53 | 0/9.4 | 0.556 |
| MYC rearrangement (Negative/Not realized) | 6/69 | 16.7/7.2 | 0.405 |
Conclusion
Spanish GELTAMO group has recently published the Guideline for diagnosis, prevention and therapeutic management of CNS involvement in DLBCL. In our experience, TIT was effective to prevent CNS relapse (8% compare to 10-50% described in literature in high risk patients). However, patients with very high risk factors could benefit from combination therapy recommended by GELTAMO based on inmunochemotherapy + TIT + High Dose Metotrexate.
Session topic: E-poster
Keyword(s): CNS, DLBCL
Abstract: PB1732
Type: Publication Only
Background
Central nervous system (CNS) relapse is an uncommon (5%) unfavorable complication of diffuse large B-cell lymphoma (DLBCL). Independent predictors at diagnosis have been described to establish higher-risk groups that benefit from CNS prophylaxis: IPI ≥3, elevated serum LDH levels, B symptoms, bulky mass, CD5+, MYC rearrangement, >1 extranodal involvement, ECOG >1 and absence of Rituximab in systemic treatment. Many studies have demonstrated that the frequency of CNS relapse varies from 10% to 50%, depending on risk factors.
Aims
Analyze triple intrathecal therapy to prevent CNS relapse in DLBCL with high risk factors.
Methods
We analyzed retrospectively, from 2009 to 2015, 75 patients with newly diagnosed DLBCL. The decision to administer them all triple intrathecal therapy (TIT) (metotrexate, cytarabine, hydrocortisone) was based on the CNS relapsing risk factors in DLBCL described above. Systemic therapy was CHOP-like. Qualitative variables are described in percentages and quantitative variables are described with means and standard deviations. We use Chi square test to compare different categorical variables with CNS relapse. The overall survival is tested with Kaplan-Meier tables.
Results
Of 75 patients, 41 were male. Median age at diagnosis was 62 years. 6 (8%) patients experienced CNS relapse. The mean Overall Survival (OS) was 62 months CI 95% (55-69). OS at 6 months was 90.4%, at 2 years 80.5% and at 5 years 72%.Table shows comparison between parameters described and CNS relapse.
Conclusion
Spanish GELTAMO group has recently published the Guideline for diagnosis, prevention and therapeutic management of CNS involvement in DLBCL. In our experience, TIT was effective to prevent CNS relapse (8% compare to 10-50% described in literature in high risk patients). However, patients with very high risk factors could benefit from combination therapy recommended by GELTAMO based on inmunochemotherapy + TIT + High Dose Metotrexate.
Session topic: E-poster
Keyword(s): CNS, DLBCL
Type: Publication Only
Background
Central nervous system (CNS) relapse is an uncommon (5%) unfavorable complication of diffuse large B-cell lymphoma (DLBCL). Independent predictors at diagnosis have been described to establish higher-risk groups that benefit from CNS prophylaxis: IPI ≥3, elevated serum LDH levels, B symptoms, bulky mass, CD5+, MYC rearrangement, >1 extranodal involvement, ECOG >1 and absence of Rituximab in systemic treatment. Many studies have demonstrated that the frequency of CNS relapse varies from 10% to 50%, depending on risk factors.
Aims
Analyze triple intrathecal therapy to prevent CNS relapse in DLBCL with high risk factors.
Methods
We analyzed retrospectively, from 2009 to 2015, 75 patients with newly diagnosed DLBCL. The decision to administer them all triple intrathecal therapy (TIT) (metotrexate, cytarabine, hydrocortisone) was based on the CNS relapsing risk factors in DLBCL described above. Systemic therapy was CHOP-like. Qualitative variables are described in percentages and quantitative variables are described with means and standard deviations. We use Chi square test to compare different categorical variables with CNS relapse. The overall survival is tested with Kaplan-Meier tables.
Results
Of 75 patients, 41 were male. Median age at diagnosis was 62 years. 6 (8%) patients experienced CNS relapse. The mean Overall Survival (OS) was 62 months CI 95% (55-69). OS at 6 months was 90.4%, at 2 years 80.5% and at 5 years 72%.Table shows comparison between parameters described and CNS relapse.
| Risk factors at diagnosis | Frequency (n) | CNS relapse (%) | P value |
| B symptoms (Yes/No) | 37/38 | 10.8/5.3 | 0.430 |
| Bulky mass (Yes/No) | 19/56 | 10.5/7.1 | 0.640 |
| Ann-Arbor Stage (I-II/III-IV) | 11/64 | 9.1/7.8 | 0.999 |
| Serum LDH levels (elevated/non-elevated) | 46/29 | 8.7/6.9 | 0.999 |
| Extranodal sites (0-1/>1) | 42/33 | 4.8/12.1 | 0.395 |
| IPI (0-2/3-5) | 30/35 | 6.7/8.9 | 0.999 |
| CNS involvement at diagnosis (Yes/No) | 2/73 | 50/6.8 | 0.155 |
| Rituximab (Yes/No) | 73/2 | 8.2/0 | 0.999 |
| CD5 (Positive/Negative) | 4/53 | 0/9.4 | 0.556 |
| MYC rearrangement (Negative/Not realized) | 6/69 | 16.7/7.2 | 0.405 |
Conclusion
Spanish GELTAMO group has recently published the Guideline for diagnosis, prevention and therapeutic management of CNS involvement in DLBCL. In our experience, TIT was effective to prevent CNS relapse (8% compare to 10-50% described in literature in high risk patients). However, patients with very high risk factors could benefit from combination therapy recommended by GELTAMO based on inmunochemotherapy + TIT + High Dose Metotrexate.
Session topic: E-poster
Keyword(s): CNS, DLBCL
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