title: Final results of a multicenter trial addressing role of CSF flow cytometric analysis in NHL patients at high risk for CNS dissemination.
abstract: This prospective study compared diagnostic and prognostic value of conventional cytologic (CC) examination and flow cytometry (FCM) of baseline samples of cerebrospinal fluid (CSF) in 174 patients with newly diagnosed aggressive non-Hodgkin lymphoma (NHL). FCM detected a neoplastic population in the CSF of 18 of 174 patients (10%), CC only in 7 (4%; P < .001); 11 patients (14%) were discordant (FCM(+)/CC(-)). At a median follow-up of 46 months, there were 64 systemic progressions and 10 CNS relapses, including 2 patients with both systemic and CNS relapses. Two-year progression-free and overall survival were significantly higher in patients with FCM(-) CSF (62% and 72%) compared with those FCM(+) CSF (39% and 50%, respectively), with a 2-year CNS relapse cumulative incidence of 3% (95% confidence interval [CI], 0-7) versus 17% (95% CI, 0-34; P = .004), respectively. The risk of CNS progression was significantly higher in FMC(+)/CC(-) versus FCM(-)/CC(-) patients (hazard ratio = 8.16, 95% CI, 1.45-46). In conclusion, FCM positivity in the CSF of patients with high-risk NHL is associated with a significantly higher CNS relapse risk and poorer outcome. The combination of IV drugs with a higher CNS bioavailability and intrathecal chemotherapy is advisable to prevent CNS relapses in FCM(+) patients.
authors.affiliation: Haematology 2 Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Benevolo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Stacchini
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: Marcella
authors.initials: M
authors.lastname: Arras
authors.forename: Laura
authors.initials: L
authors.lastname: Bellio
authors.forename: Barbara
authors.initials: B
authors.lastname: Botto
authors.forename: Pietro
authors.initials: P
authors.lastname: Bulian
authors.forename: Maria
authors.initials: M
authors.lastname: Cantonetti
authors.forename: Lorella
authors.initials: L
authors.lastname: Depaoli
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Renzo
authors.forename: Alice
authors.initials: A
authors.lastname: Di Rocco
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschetti
authors.forename: Laura
authors.initials: L
authors.lastname: Godio
authors.forename: Francesco
authors.initials: F
authors.lastname: Mannelli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pavone
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Pogliani
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003581:Cytodiagnosis; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000134:cerebrospinal fluid* / Q000473:pathology / Q000628:therapy; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid* / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors