Central nervous system relapse in younger patients with diffuse large B-cell lymphoma - a LYSA and GLA/ DSHNHL analysis

Author:

Thieblemont Catherine1,Altmann Bettina2,Frontzek Fabian3ORCID,Renaud Loïc4ORCID,Chartier Loic5,Ketterer Nicolas6,Recher Christian7,Poeschel Viola8,Fitoussi Olivier9,Held Gerhard10,Casasnovas René-Olivier11ORCID,Haioun Corinne12,Morschhauser Franck13,Glass Bertram14,Mounier Nicolas15,Tilly Hervé16,Rosenwald Andreas17,Ott German18,Lenz Georg3ORCID,Molina Thierry19,Ziepert Marita20,Schmitz Norbert3ORCID

Affiliation:

1. Hopital Saint-Louis, Paris Service Hemato-oncologie Chef de service

2. Institut für Medizinische informatik, Statistik und Epidemiologie

3. University Hospital Münster

4. Hopital Saint-Louis, Paris Service Hemato-oncologie

5. LYSARC Statistique

6. Lausanne Hospital

7. Cancer research center of Toulouse

8. Department of Internal Medicine

9. Polyclinique Bordeaux Nord

10. Westpfalz Klinikum

11. Centre Hospitalier Regional Universitaire De Dijon

12. AP-HP, Hopital Henri Mondor

13. Centre Hospitalier Universitaire de Lille

14. Helios Klinikum Berlin-Buch

15. University Hospital of Nice

16. Centre Henri Becquerel

17. University of Würzburg

18. Robert-Bosch-Hospital

19. Université de Paris, NF-kappaB, Différenciation et Cancer

20. Institute for Medical Informatics, Statistics and Epidemiology

Abstract

Abstract The majority of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with immunochemotherapy comprising rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Patients suffering progression or relapse in the central nervous system (CNS) face dismal outcomes. The impact of more aggressive regimens used in front-line therapy has not systematically been investigated in this context. To this end, we analyzed a large cohort of 2203 younger DLBCL patients treated on ten German and French prospective phase II and III trials following first-line therapy with R-CHOP, R-CHOEP (R-CHOP + etoposide), dose-escalated R-CHOEP followed by repetitive stem cell transplantation (R-MegaCHOEP), or rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycine, prednisone (R-ACVBP) followed by consolidation including multiple drugs crossing the blood-brain-barrier (BBB). DLBCL patients with age-adjusted International Prognostic Index (aaIPI) of 0–1 showed very low cumulative incidence (CI) rates of CNS relapse regardless of first-line therapy and CNS prophylaxis (3-year CI 0% − 1%). Younger high-risk patients with aaIPI of 2–3 had 3-year CI rates of 1.6% and 4% after R-ACVBP plus consolidation or R-(Mega)CHO(E)P, respectively (Hazard Ratio 2.4 (95% confidence interval: 0.8–7.4), p = 0.118). Thus, for younger high-risk patients, front-line regimens incorporating multiple agents crossing the BBB may reduce often fatal CNS relapse.

Publisher

Research Square Platform LLC

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3