title: Incidence and risk factors of central nervous system relapse in histologically aggressive non-Hodgkin's lymphoma uniformly treated and receiving intrathecal central nervous system prophylaxis: a GELA study on 974 patients. Groupe d'Etudes des Lymphomes de l'Adulte.
abstract: BACKGROUND
  Incidence of central nervous system (CNS) recurrence in patients with aggressive non-Hodgkin's lymphoma who did not receive meningeal prophylaxis is about 5%. Controversy remains regarding risk factors associated with such an event preventing a rational approach of prophylactic strategies.
  
  
  METHODS
  We analyzed a cohort of 974 patients with aggressive lymphoma in complete remission (CR). All the patients received a CNS prophylaxis consisting of intrathecal injections and intravenous high-dose methotrexate. The risk repartition on the basis of the international prognostic index (IPI) of these 974 CR-patients was low (L): 41%, low-intermediate (LI): 27%, high-intermediate (HI): 19%, high (H): 13%.
  
  
  RESULTS
  The incidence of isolated CNS relapse was 1.6%. In a first multivariate logistic regression analysis an increased LDH (P = 0.05, RR = 5) and the presence of more than one extranodal site (P = 0.05, RR = 3) were identified as independent risk factors for isolated CNS relapse. Another multivariate analysis incorporating IPI as a unique parameter showed that only IPI remained significantly associated with a higher risk of CNS relapse (L-LI: 0.6% vs. HI H: 4.1%, P = 0.002; RR = 7).
  
  
  CONCLUSIONS
  Prophylaxis notably reduces the risk of CNS recurrence in the higher risk patients. By contrast, we propose the deletion of prophylactic intrathecal injections in the lower risk patients.
authors.affiliation: Hôpital Henri Mondor-AP-HP, Créteil, France. corinne.haioun@hmn-ap-hop-paris
authors.forename: C
authors.initials: C
authors.lastname: Haioun
authors.forename: C
authors.initials: C
authors.lastname: Besson
authors.forename: E
authors.initials: E
authors.lastname: Lepage
authors.forename: C
authors.initials: C
authors.lastname: Thieblemont
authors.forename: D
authors.initials: D
authors.lastname: Simon
authors.forename: C
authors.initials: C
authors.lastname: Rose
authors.forename: H
authors.initials: H
authors.lastname: Tilly
authors.forename: A
authors.initials: A
authors.lastname: Sonet
authors.forename: P
authors.initials: P
authors.lastname: Lederlin
authors.forename: M
authors.initials: M
authors.lastname: Attal
authors.forename: J
authors.initials: J
authors.lastname: Brière
authors.forename: F
authors.initials: F
authors.lastname: Reyes
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D016015:Logistic Models; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D055502:Secondary Prevention; D016019:Survival Analysis
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate