title: Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: analyses with competing risk regression model.
abstract: Central nervous system (CNS) relapse is a challenging complication in patients with diffuse large B-cell lymphoma (DLBCL). Thus, identification of the high-risk population, in whom prophylactic treatment may play a significant role, is critical. We calculated the incidence of CNS relapse and evaluated the risk factors for CNS relapse using competing risk regression analysis. A total of 386 patients who received CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) with (n = 203) or without (n = 183) rituximab were analyzed. The 5-year cumulative incidence of CNS relapse was 6.7%. Multivariate analysis identified three independent risk factors: bulky disease (subhazard ratio [SHR] 3.34, 95% confidence interval [1.45-7.66], p = 0.004), absolute lymphocyte count <1.0 × 10(9)/L (SHR 2.38 [1.05-5.39], p = 0.037) and extranodal involvement (SHR 2.90 [1.01-8.33], p = 0.047). Patients with three risk factors represented 6% of patients, in whom the 5-year cumulative incidence was 26%. Larger scale studies are needed to validate our results. A better management strategy in patients with high-risk disease is critically needed.
authors: Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors: Dai
authors: D
authors: Chihara
authors: Yasuhiro
authors: Y
authors: Oki
authors: Keitaro
authors: K
authors: Matsuo
authors: Hiroshi
authors: H
authors: Onoda
authors: Hirofumi
authors: H
authors: Taji
authors: Kazuhito
authors: K
authors: Yamamoto
authors: Yasuo
authors: Y
authors: Morishima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents