title: Lack of benefit of central nervous system prophylaxis for diffuse large B-cell lymphoma in the rituximab era: findings from a large national database.
abstract: BACKGROUND
  Little is known about the utility of central nervous system (CNS) prophylaxis for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. The objective of this study was to characterize patterns of CNS prophylaxis for patients who received combined rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy using the National Comprehensive Cancer Network Non-Hodgkin Lymphoma Outcomes Database, a prospective cohort study that collects clinical and outcomes data for patients at 7 participating centers.
  
  
  METHODS
  Patients who were eligible for this analysis presented with newly diagnosed DLBCL between January 2001 and July 2008, had no evidence of baseline CNS disease, and had received R-CHOP within 180 days of diagnosis. The authors assessed incidence and covariates of prophylaxis, prophylaxis modality, and, using propensity score analysis, outcomes such as overall survival.
  
  
  RESULTS
  Of 989 eligible patients, 117 received CNS prophylaxis (11.8%), most intrathecally (71.8%). Involvement of bone marrow, other high-risk site, >1 extranodal site, higher International Prognostic Index score, and higher stage were associated individually with the receipt of prophylaxis (all P < .0001). At a median follow-up of 2.5 years, there were 20 CNS recurrences (2% [95% confidence interval, 1.1%-2.9%]) among all patients, and overall survival was not affected by prophylaxis.
  
  
  CONCLUSIONS
  Given the overall low rate of CNS recurrence and lack of prophylaxis-associated survival benefit, the current data called into question the practice of CNS prophylaxis in the rituximab era.
authors: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Anita
authors: A
authors: Kumar
authors: Ann
authors: A
authors: Vanderplas
authors: Ann S
authors: AS
authors: LaCasce
authors: Maria A
authors: MA
authors: Rodriguez
authors: Allison L
authors: AL
authors: Crosby
authors: Eva
authors: E
authors: Lepisto
authors: Myron S
authors: MS
authors: Czuczman
authors: Auayporn
authors: A
authors: Nademanee
authors: Joyce
authors: J
authors: Niland
authors: Leo I
authors: LI
authors: Gordon
authors: Michael
authors: M
authors: Millenson
authors: Andrew D
authors: AD
authors: Zelenetz
authors: Jonathan W
authors: JW
authors: Friedberg
authors: Gregory A
authors: GA
authors: Abel
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000517:prevention & control*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone