ANALYSIS OF THE TOXICITY AND EFFICACY OF LIPOSOMAL CYTARABINE IN THE PROPHYLAXIS AND TREATMENT OF CNS LYMPHOMATOSIS: THE BALEARIC LYMPHOMA GROUP EXPERIENCE.
(Abstract release date: 05/19/16)
EHA Library. Garcia-Recio M. 06/09/16; 134633; PB1733
Dr. Marta Garcia-Recio
Contributions
Contributions
Abstract
Abstract: PB1733
Type: Publication Only
Background
CNS lymphomatosis is a generally fatal complication of aggressive NHL. Without specific CNS prophylaxis the risk of CNS relapse is higher (20-30%) in patients with very aggressive NHL such as burkitt or lymphoblastic lymphoma/leukemia. DLBCL has a lower risk (around 5%) but several factors have been identified that increase the incidence of CNS relapse to levels similar to very aggressive NHL. All above mentioned patients are candidates for CNS prophylaxis. However there is no consensus about which is the best way of administering CNS prophylaxis. Best results seem to be associated to the use of intravenous (iv) high-dose methotrexate (HDMTX) but with significant toxicity. Other options are intrathecal (IT) administration of MTX, cytarabine or liposomal cytarabine (ITLC). However no randomized trial has been performed to test which is the best option in terms of tolerance and efficacy.
Aims
We aim to analyse the experience of the centres of the Balearic Lymphoma Group about the tolerance, toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis.
Methods
We retrospectively reviewed all cases treated with ITLC in Son Espases and Son Llatzer Hospitals. Standard diagnostic, response assessment and follow-up data was obtained from medical records. All cerebrospinal fluid (CSF) samples were evaluated through 8-colours flow cytometry. Survival analysis was done using Kaplan-Meier curves and the Log-rank test.
Results
From 2005 to 2015, 58 patients received ITLC. They received a total of 180 ITLC injections. Toxicity was as follows: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n=26) with a median follow-up of 55 months (17-81) only 3 CNS relapses (11%) were observed in a testicular DLBCL, Burkitt and plasmablastic lymphoma. This represents a cumulative incidence of CNS relapse of 8%, 14% and 20%, respectively for DLBCL, Burkit/lymphoblastic and plasmablastic lymphoma. In the treatment cohort (n=32), complete clearance of CSF was obtained in 77% of cases (86%, 62% and 100% of respectively DLBCL, Burkit/lymphoblastic lymphoma and Primary CNS lymphoma). Median OS was 6 months (0-16). Causes of death were lymphoma progression in 19 patients (79%), treatment toxicity in 2 and other non-related in 3 (12%).
Conclusion
The toxicity profile was good especially when concomitant IT and oral dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse was low in the DLBCL group similar to previously reported for iv HDMTX and much better than IT MTX. ITLC may be a good alternative for CNS prophylaxis but randomized clinical trials are needed. Patients in treatment cohort had a high rate of clearance of CSF but survival is still poor in CNS lymphomatosis.
Session topic: E-poster
Keyword(s): CNS lymphoma, Cytarabine, Lymphoma therapy, Prophylaxis
Type: Publication Only
Background
CNS lymphomatosis is a generally fatal complication of aggressive NHL. Without specific CNS prophylaxis the risk of CNS relapse is higher (20-30%) in patients with very aggressive NHL such as burkitt or lymphoblastic lymphoma/leukemia. DLBCL has a lower risk (around 5%) but several factors have been identified that increase the incidence of CNS relapse to levels similar to very aggressive NHL. All above mentioned patients are candidates for CNS prophylaxis. However there is no consensus about which is the best way of administering CNS prophylaxis. Best results seem to be associated to the use of intravenous (iv) high-dose methotrexate (HDMTX) but with significant toxicity. Other options are intrathecal (IT) administration of MTX, cytarabine or liposomal cytarabine (ITLC). However no randomized trial has been performed to test which is the best option in terms of tolerance and efficacy.
Aims
We aim to analyse the experience of the centres of the Balearic Lymphoma Group about the tolerance, toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis.
Methods
We retrospectively reviewed all cases treated with ITLC in Son Espases and Son Llatzer Hospitals. Standard diagnostic, response assessment and follow-up data was obtained from medical records. All cerebrospinal fluid (CSF) samples were evaluated through 8-colours flow cytometry. Survival analysis was done using Kaplan-Meier curves and the Log-rank test.
Results
From 2005 to 2015, 58 patients received ITLC. They received a total of 180 ITLC injections. Toxicity was as follows: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n=26) with a median follow-up of 55 months (17-81) only 3 CNS relapses (11%) were observed in a testicular DLBCL, Burkitt and plasmablastic lymphoma. This represents a cumulative incidence of CNS relapse of 8%, 14% and 20%, respectively for DLBCL, Burkit/lymphoblastic and plasmablastic lymphoma. In the treatment cohort (n=32), complete clearance of CSF was obtained in 77% of cases (86%, 62% and 100% of respectively DLBCL, Burkit/lymphoblastic lymphoma and Primary CNS lymphoma). Median OS was 6 months (0-16). Causes of death were lymphoma progression in 19 patients (79%), treatment toxicity in 2 and other non-related in 3 (12%).
| Characteristics | Global group(n=58) | Prophylaxis cohort (n=26) | Treatment cohort(n=32) |
| Median age (range) | 53 (10-85) | 47 (12-85) | 55 (10-81) |
| Gender: | |||
| ·Male | 44 (76%) | 19 (73%) | 25 (78%) |
| ·Female | 14 (24%) | 7 (27%) | 7 (22%) |
| Diagnostic: | |||
| DLBCL | 31 (53%) | 17 (65%) | 14 (44%) |
| Lymphoblastic or Burkitt | 16 (27%) | 7 (27%) | 9 (28%) |
| Primary CNS Lymphoma | 6 (10%) | 1 (4%) | 5 (16%) |
| Mantle Cell Lymphoma | 3 (5%) | 1 (4%) | 2 (6%) |
| Peripheral T-cell lymphoma | 1 (2%) | 0 (0%) | 1 (3%) |
| Follicular Lymphoma | 1 (2%) | 0 (0%) | 1 (3%) |
| First line treatment: | |||
| ·Intensive treatment ALL-like | 14 (24%) | 7 (27%) | 7 (22%) |
| ·Intensive treatment for CNS | 11 (19%) | 1 (4%) | 10 (31%) |
| ·Conventional CHOP-like | 23 (40%) | 17 (65%) | 6 (19%) |
| Other | 10 (17%) | 1 (4%) | 9 (28%) |
Conclusion
The toxicity profile was good especially when concomitant IT and oral dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse was low in the DLBCL group similar to previously reported for iv HDMTX and much better than IT MTX. ITLC may be a good alternative for CNS prophylaxis but randomized clinical trials are needed. Patients in treatment cohort had a high rate of clearance of CSF but survival is still poor in CNS lymphomatosis.
Session topic: E-poster
Keyword(s): CNS lymphoma, Cytarabine, Lymphoma therapy, Prophylaxis
Abstract: PB1733
Type: Publication Only
Background
CNS lymphomatosis is a generally fatal complication of aggressive NHL. Without specific CNS prophylaxis the risk of CNS relapse is higher (20-30%) in patients with very aggressive NHL such as burkitt or lymphoblastic lymphoma/leukemia. DLBCL has a lower risk (around 5%) but several factors have been identified that increase the incidence of CNS relapse to levels similar to very aggressive NHL. All above mentioned patients are candidates for CNS prophylaxis. However there is no consensus about which is the best way of administering CNS prophylaxis. Best results seem to be associated to the use of intravenous (iv) high-dose methotrexate (HDMTX) but with significant toxicity. Other options are intrathecal (IT) administration of MTX, cytarabine or liposomal cytarabine (ITLC). However no randomized trial has been performed to test which is the best option in terms of tolerance and efficacy.
Aims
We aim to analyse the experience of the centres of the Balearic Lymphoma Group about the tolerance, toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis.
Methods
We retrospectively reviewed all cases treated with ITLC in Son Espases and Son Llatzer Hospitals. Standard diagnostic, response assessment and follow-up data was obtained from medical records. All cerebrospinal fluid (CSF) samples were evaluated through 8-colours flow cytometry. Survival analysis was done using Kaplan-Meier curves and the Log-rank test.
Results
From 2005 to 2015, 58 patients received ITLC. They received a total of 180 ITLC injections. Toxicity was as follows: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n=26) with a median follow-up of 55 months (17-81) only 3 CNS relapses (11%) were observed in a testicular DLBCL, Burkitt and plasmablastic lymphoma. This represents a cumulative incidence of CNS relapse of 8%, 14% and 20%, respectively for DLBCL, Burkit/lymphoblastic and plasmablastic lymphoma. In the treatment cohort (n=32), complete clearance of CSF was obtained in 77% of cases (86%, 62% and 100% of respectively DLBCL, Burkit/lymphoblastic lymphoma and Primary CNS lymphoma). Median OS was 6 months (0-16). Causes of death were lymphoma progression in 19 patients (79%), treatment toxicity in 2 and other non-related in 3 (12%).
Conclusion
The toxicity profile was good especially when concomitant IT and oral dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse was low in the DLBCL group similar to previously reported for iv HDMTX and much better than IT MTX. ITLC may be a good alternative for CNS prophylaxis but randomized clinical trials are needed. Patients in treatment cohort had a high rate of clearance of CSF but survival is still poor in CNS lymphomatosis.
Session topic: E-poster
Keyword(s): CNS lymphoma, Cytarabine, Lymphoma therapy, Prophylaxis
Type: Publication Only
Background
CNS lymphomatosis is a generally fatal complication of aggressive NHL. Without specific CNS prophylaxis the risk of CNS relapse is higher (20-30%) in patients with very aggressive NHL such as burkitt or lymphoblastic lymphoma/leukemia. DLBCL has a lower risk (around 5%) but several factors have been identified that increase the incidence of CNS relapse to levels similar to very aggressive NHL. All above mentioned patients are candidates for CNS prophylaxis. However there is no consensus about which is the best way of administering CNS prophylaxis. Best results seem to be associated to the use of intravenous (iv) high-dose methotrexate (HDMTX) but with significant toxicity. Other options are intrathecal (IT) administration of MTX, cytarabine or liposomal cytarabine (ITLC). However no randomized trial has been performed to test which is the best option in terms of tolerance and efficacy.
Aims
We aim to analyse the experience of the centres of the Balearic Lymphoma Group about the tolerance, toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis.
Methods
We retrospectively reviewed all cases treated with ITLC in Son Espases and Son Llatzer Hospitals. Standard diagnostic, response assessment and follow-up data was obtained from medical records. All cerebrospinal fluid (CSF) samples were evaluated through 8-colours flow cytometry. Survival analysis was done using Kaplan-Meier curves and the Log-rank test.
Results
From 2005 to 2015, 58 patients received ITLC. They received a total of 180 ITLC injections. Toxicity was as follows: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n=26) with a median follow-up of 55 months (17-81) only 3 CNS relapses (11%) were observed in a testicular DLBCL, Burkitt and plasmablastic lymphoma. This represents a cumulative incidence of CNS relapse of 8%, 14% and 20%, respectively for DLBCL, Burkit/lymphoblastic and plasmablastic lymphoma. In the treatment cohort (n=32), complete clearance of CSF was obtained in 77% of cases (86%, 62% and 100% of respectively DLBCL, Burkit/lymphoblastic lymphoma and Primary CNS lymphoma). Median OS was 6 months (0-16). Causes of death were lymphoma progression in 19 patients (79%), treatment toxicity in 2 and other non-related in 3 (12%).
| Characteristics | Global group(n=58) | Prophylaxis cohort (n=26) | Treatment cohort(n=32) |
| Median age (range) | 53 (10-85) | 47 (12-85) | 55 (10-81) |
| Gender: | |||
| ·Male | 44 (76%) | 19 (73%) | 25 (78%) |
| ·Female | 14 (24%) | 7 (27%) | 7 (22%) |
| Diagnostic: | |||
| DLBCL | 31 (53%) | 17 (65%) | 14 (44%) |
| Lymphoblastic or Burkitt | 16 (27%) | 7 (27%) | 9 (28%) |
| Primary CNS Lymphoma | 6 (10%) | 1 (4%) | 5 (16%) |
| Mantle Cell Lymphoma | 3 (5%) | 1 (4%) | 2 (6%) |
| Peripheral T-cell lymphoma | 1 (2%) | 0 (0%) | 1 (3%) |
| Follicular Lymphoma | 1 (2%) | 0 (0%) | 1 (3%) |
| First line treatment: | |||
| ·Intensive treatment ALL-like | 14 (24%) | 7 (27%) | 7 (22%) |
| ·Intensive treatment for CNS | 11 (19%) | 1 (4%) | 10 (31%) |
| ·Conventional CHOP-like | 23 (40%) | 17 (65%) | 6 (19%) |
| Other | 10 (17%) | 1 (4%) | 9 (28%) |
Conclusion
The toxicity profile was good especially when concomitant IT and oral dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse was low in the DLBCL group similar to previously reported for iv HDMTX and much better than IT MTX. ITLC may be a good alternative for CNS prophylaxis but randomized clinical trials are needed. Patients in treatment cohort had a high rate of clearance of CSF but survival is still poor in CNS lymphomatosis.
Session topic: E-poster
Keyword(s): CNS lymphoma, Cytarabine, Lymphoma therapy, Prophylaxis
{{ help_message }}
{{filter}}