title: Rituximab is associated with improved survival for aggressive B cell CNS lymphoma.
abstract: BACKGROUND
  The optimal treatment strategy in patients with aggressive B cell central nervous system lymphoma suitable to receive intensive therapy is unknown. The benefit of incorporating rituximab in systemic therapy remains unclear. We performed a retrospective study examining the impact of rituximab in the context of concomitant therapies, including methotrexate, cytarabine, and radiotherapy, in patients treated with curative intent at 4 university teaching hospitals during 1996-2011.
  
  
  METHODS
  A retrospective study of CNS lymphoma cases treated at the participating institutions was performed in accordance with institutional ethical guidelines. Patients were included if they received a diagnosis of primary diffuse large B cell lymphoma of the CNS, were HIV negative, and were treated with curative intent.
  
  
  RESULTS
  One hundred twenty patients aged 21-81 years were identified. Rituximab recipients and nonrecipients were similar, except for rituximab recipients being more likely to have received a diagnosis after 2004. The median follow-up of surviving patients was 30 months. The 5-year overall survival was 46%. Univariate analysis revealed age ≤60 years, ECOG performance status ≤1, normal lactate dehydrogenase, diagnosis after 2004, and treatment with cytarabine and rituximab as predictive of favorable overall survival. Multivariate analysis identified age to be an independent predictor of overall survival, with a trend toward improved survival from the other variables that were significant in univariate analyses.
  
  
  CONCLUSIONS
  In this retrospective analysis, the addition of rituximab to high-dose methotrexate-based chemotherapy in patients with aggressive B cell CNS lymphoma was associated with improved overall survival. Further studies are underway to prospectively validate these findings.
authors.affiliation: Inter-hospital Multi-institution Project Alliance and Collaboration Taskforce, Monash Medical Centre, Clayton, Australia. gareth.gregory@petermac.org
authors.forename: Gareth
authors.initials: G
authors.lastname: Gregory
authors.forename: Ashwini
authors.initials: A
authors.lastname: Arumugaswamy
authors.forename: Teresa
authors.initials: T
authors.lastname: Leung
authors.forename: Kah-Lok
authors.initials: KL
authors.lastname: Chan
authors.forename: Melody
authors.initials: M
authors.lastname: Abikhair
authors.forename: Constantine
authors.initials: C
authors.lastname: Tam
authors.forename: Ashish
authors.initials: A
authors.lastname: Bajel
authors.forename: Lawrence
authors.initials: L
authors.lastname: Cher
authors.forename: Andrew
authors.initials: A
authors.lastname: Grigg
authors.forename: David
authors.initials: D
authors.lastname: Ritchie
authors.forename: Stephen
authors.initials: S
authors.lastname: Opat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D059248:Chemoradiotherapy; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; D008727:Methotrexate
keywords: CNS; immunotherapy; lymphoma; rituximab