Disease status at autologous stem cell transplantation and the cell of origin phenotype are important predictors of outcome in patients with neurologic (central nervous system) relapse of diffuse large B-cell lymphoma undergoing autologous stem cell transplantation.
Neurologic relapse of systemic diffuse large B-cell lymphoma (DLBCL) is associated with poor outcome. The existing literature about this specific entity is very limited. We present a retrospective analysis of patients with neurological relapse of DLBCL and correlate the outcome according to the disease stage at autologous stem cell transplantation (ASCT) and the cell of origin phenotype. Totally, 11 patients with neurologic relapse of DLBCL underwent ASCT, seven in complete remission (CR) and four with active disease. The conditioning regimens included LACE (six), BEAM (two), and Bu/Mel (three). Ten patients relapsed after ASCT. All patients with CNS relapse died of progressive disease. Patients with systemic relapse were salvaged by further treatment. The median disease free survival (DFS) and overall survival (OS) for patients in CR at ASCT is far superior than those with active disease at ASCT (24 and 33 months versus 3 and 5 months, respectively). For patients undergoing ASCT in CR, the germinal centre (GC) phenotype is associated with a superior DFS and OS as compared to non GC phenotype (36 and 40 months versus 3.5 months and 5 months, respectively). Patients with neurological relapse of DLBCL have a poor outcome after ASCT; the outcome is worse for patients with non-GC phenotype irrespective of the disease stage at ASCT.
The Department of Malignant Haematology and Stem Cell Transplantation, Monash University, The Alfred Hospital, Melbourne, Australia. s.patil@alfred.org.au
Sushrut
S
Patil
Andrew
A
Spencer
Anthony
A
Schwarer
Sharon
S
Avery
David
D
Ritchie
Stephen
S
Opat
Andrew
A
Wei
Catriona
C
McLean
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000187:drug effects / Q000473:pathology*; D002490:Central Nervous System / Q000473:pathology*; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D018858:Germinal Center / Q000187:drug effects / Q000473:pathology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D033581:Stem Cell Transplantation / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D003561:Cytarabine; D008727:Methotrexate