title: Isolated central nervous system relapses in primary mediastinal large B-cell lymphoma after CHOP-like chemotherapy with or without Rituximab.
abstract: Central nervous system (CNS) involvement in patients with primary mediastinal large B-cell (PMLBCL) lymphoma is a rare event, occurring in approximately 6% of patients, on the basis of the review of the literature prior to induction of Rituximab. The aim of this retrospective study was to describe the incidence of CNS relapse among 100 consecutive patients with PMLBCL who were treated with R-CHOP ± RT in comparison to patients treated with CHOP ± RT (n = 45) in 11 hospitals in Greece. Two patients experienced a CNS relapse, representing an overall frequency of 2.0% in R-CHOP treated patients and a 2-year actuarial incidence of 2.3%. Both patients had isolated CNS relapses. The incidence of CNS relapse after CHOP without Rituximab was 2/45 (4.4%) for a 2-year actuarial incidence of 7.5% (p = 0.29). Again, both patients had isolated CNS relapses. Parenchymal-only localizations accounted for 3/4 cases. Risk factors for CNS involvement could include leukocytosis, poor performance status and higher age-adjusted International Prognostic Index, although their impact was weakened by competing risk survival analysis. Both patients relapsing after R-CHOP required CNS radiotherapy to achieve a complete remission and be forwarded to high-dose therapy and autologous stem cell transplantation: They are both alive and disease-free 18 and 23 months after CNS relapse. Both cases relapsing after CHOP without Rituximab were salvaged by CNS radiotherapy (one also received intrathecal chemotherapy) entering long-term remissions. In conclusion, CNS relapses are rare in PMLBCL tending to be isolated in the CNS, probably reflecting the persistence of latent CNS disease than dissemination of resistant disease. The impact of Rituximab in reducing CNS relapses remains unknown. Established risk factors for CNS involvement in aggressive lymphomas may not be helpful in assessing the risk of CNS recurrence in this disease. Routine CNS prophylaxis is not probably required in PMLBCL.
authors.affiliation: Second Department of Internal Medicine, Propaedeutic, Hematology Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital 'Attikon', Haidari, Greece.
authors.forename: Sotirios G
authors.initials: SG
authors.lastname: Papageorgiou
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Diamantopoulos
authors.forename: Georgia
authors.initials: G
authors.lastname: Levidou
authors.forename: Maria K
authors.initials: MK
authors.lastname: Angelopoulou
authors.forename: Panagiota
authors.initials: P
authors.lastname: Economopoulou
authors.forename: Anna
authors.initials: A
authors.lastname: Efthimiou
authors.forename: Nikos
authors.initials: N
authors.lastname: Constantinou
authors.forename: Andreas
authors.initials: A
authors.lastname: Katsigiannis
authors.forename: Penelope
authors.initials: P
authors.lastname: Korkolopoulou
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Pappa
authors.forename: Christina
authors.initials: C
authors.lastname: Economopoulou
authors.forename: George
authors.initials: G
authors.lastname: Georgiou
authors.forename: Maria
authors.initials: M
authors.lastname: Dimou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsirigotis
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Kyrtsonis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kotsianidis
authors.forename: Christina
authors.initials: C
authors.lastname: Kalpadakis
authors.forename: Meletios-Athanassios
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: Photis
authors.initials: P
authors.lastname: Beris
authors.forename: John
authors.initials: J
authors.lastname: Meletis
authors.forename: Gerassimos A
authors.initials: GA
authors.lastname: Pangalis
authors.forename: John
authors.initials: J
authors.lastname: Dervenoulas
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Panayiotidis
authors.forename: Theodoros P
authors.initials: TP
authors.lastname: Vassilakopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002066:Busulfan / Q000008:administration & dosage; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000473:pathology*; D008727:Methotrexate / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D013852:Thiotepa / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D013852:Thiotepa; D002066:Busulfan; D002330:Carmustine; D011241:Prednisone; D008775:Methylprednisolone; D008727:Methotrexate