Central nervous system prophylaxis with intrathecal liposomal cytarabine in diffuse large B-cell lymphomas.
BACKGROUND
Central nervous system (CNS) involvement is a serious and potentially fatal complication in patients with lymphoma because it is associated with a particularly poor prognosis (median progression‑free survival [PFS] of 4-6 months). Although CNS prophylaxis is considered necessary, there are no clear guidelines on identifying high‑risk patients or selecting treatment regimen.


OBJECTIVE
The aim of the study was to assess the safety and efficacy of CNS prophylaxis with intrathecal liposomal cytarabine.


METHODS
We analyzed the data of 79 patients (46 men and 33 women; median age, 48.5 years [20-79]) with diffuse large B‑cell lymphoma (83.5% of the patients) and primary mediastinal large B‑cell lymphoma (16.5%). Patients were treated in the departments of hematology in Kraków and Wrocław, Poland, between the years 2009-2012. They were considered to be at a high risk of developing CNS involvement associated with a lymphoma.


RESULTS
Adverse reactions after intrathecal liposomal cytarabine were reported in 59 patients (74.7%); in 7 cases, the reactions were severe. The most common side effect was headache (67.1%). During antilymphoma therapy and prophylaxis, the functional status assessed by the Karnofsky score improved in 56 patients (70.9%) and remained unchanged in the remaining cases. A median follow‑up time did not exceed 28 months (range, 1.4-52.1); during follow‑up, neither median overall survival (OS) nor PFS were reached (projected OS and PFS at 48 months are 86.1% and 90.1%, respectively).


CONCLUSIONS
Our results encourage the use of intrathecal liposomal cytarabine in CNS prophylaxis in patients with lymphoma.
Katarzyna
K
Krawczyk
Wojciech
W
Jurczak
Monika
M
Długosz-Danecka
Agnieszka
A
Zauska-Giza
Justyna
J
Dzietczenia
Tomasz
T
Wróbel
Aleksander B
AB
Skotnicki
D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002493:Central Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage*; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004337:Drug Carriers / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D008081:Liposomes / Q000008:administration & dosage; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic; D004337:Drug Carriers; D008081:Liposomes; C571759:R-CHOP protocol; D003561:Cytarabine; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone