title: Central nervous system event in patients with diffuse large B-cell lymphoma in the rituximab era.
abstract: Central nervous system (CNS) events, including CNS relapse and progression to CNS, are known to be serious complications in the clinical course of patients with lymphoma. This study aimed to evaluate the risk of CNS events in patients with diffuse large B-cell lymphoma in the rituximab era. We performed a retrospective survey of Japanese patients diagnosed with diffuse large B-cell lymphoma who underwent primary therapy with R-CHOP chemoimmunotherapy between September 2003 and December 2006. Patients who had received any prophylactic CNS treatment were excluded. Clinical data from 1221 patients were collected from 47 institutions. The median age of patients was 64 years (range, 15-91 years). We noted 82 CNS events (6.7%) and the cumulative 5-year probability of CNS events was 8.4%. Patients with a CNS event demonstrated significantly worse overall survival (P < 0.001). The 2-year overall survival rate after a CNS event was 27.1%. In a multivariate analysis, involvement of breast (relative risk [RR] 10.5), adrenal gland (RR 4.6) and bone (RR 2.0) were identified as independent risk factors for CNS events. We conclude that patients with these risk factors, in addition to patients with testicular involvement in whom CNS prophylaxis has been already justified, are at high risk for CNS events in the rituximab era. The efficacy and manner of CNS prophylaxis in patients for each involvement site should be evaluated further.
authors: Bay-area Lymphoma Information Network, Tokyo, Japan. cavalier@ch-yamate.dlenet.com
authors: Naoto
authors: N
authors: Tomita
authors: Masahiro
authors: M
authors: Yokoyama
authors: Wataru
authors: W
authors: Yamamoto
authors: Reina
authors: R
authors: Watanabe
authors: Yutaka
authors: Y
authors: Shimazu
authors: Yasufumi
authors: Y
authors: Masaki
authors: Saburo
authors: S
authors: Tsunoda
authors: Chizuko
authors: C
authors: Hashimoto
authors: Kayoko
authors: K
authors: Murayama
authors: Takahiro
authors: T
authors: Yano
authors: Rumiko
authors: R
authors: Okamoto
authors: Ako
authors: A
authors: Kikuchi
authors: Kazuo
authors: K
authors: Tamura
authors: Kazuya
authors: K
authors: Sato
authors: Kazutaka
authors: K
authors: Sunami
authors: Hirohiko
authors: H
authors: Shibayama
authors: Rishu
authors: R
authors: Takimoto
authors: Rika
authors: R
authors: Ohshima
authors: Yoshihiro
authors: Y
authors: Hatta
authors: Yukiyoshi
authors: Y
authors: Moriuchi
authors: Tomohiro
authors: T
authors: Kinoshita
authors: Masahide
authors: M
authors: Yamamoto
authors: Ayumi
authors: A
authors: Numata
authors: Yoshiaki
authors: Y
authors: Ishigatsubo
authors: Kengo
authors: K
authors: Takeuchi
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001842:Bone and Bones / Q000473:pathology; D001940:Breast / Q000473:pathology; D002490:Central Nervous System / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000473:pathology*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D013737:Testis / Q000473:pathology; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone