title: Management and prognosis of 66 patients with B-cell non-Hodgkin lymphoma presenting with initial spinal cord compression: a French retrospective multicenter study.
abstract: Initial spinal cord compression (ISCC) in B-cell non-Hodgkin lymphoma (NHL) is rarely present at diagnosis. We performed a multicenter retrospective analysis of 66 patients with ISCC, including diffuse large B-cell (DLBCL) (70%), follicular (20%), small lymphocytic (6%), marginal zone (2%) and B-cell unclassified (2%) lymphomas, with the aim of describing their management and outcomes, as well as the occurrence of central nervous system (CNS) relapses. All but two patients received cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) or CHOP-like regimens, with rituximab in 61% of cases. Forty-six patients received CNS prophylaxis. The 5-year overall survival and progression-free survival were 78% and 65% for DLBCL, and 60% and 48% for indolent lymphomas, respectively. CNS relapses occurred in four (6%) patients, all with DLBCL and all in the cerebellum. Initial decompressive procedures, intradural involvement, cerebrospinal fluid infiltration and lack of CNS prophylaxis did not influence survival. Adverse prognostic factors were male sex, poor performance status, elevated lactate dehydrogenase and high age-adjusted international prognostic index.
authors.affiliation: Hemato-Oncology, AP-HP at Saint-Louis Hospital, Paris VII Diderot- Sorbonne University, IUH , Paris , France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fleury
authors.forename: Sandy
authors.initials: S
authors.lastname: Amorim
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Coiffier
authors.forename: Jehan
authors.initials: J
authors.lastname: Dupuis
authors.forename: Hervè
authors.initials: H
authors.lastname: Tilly
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mazari
authors.forename: Lauriane
authors.initials: L
authors.lastname: Filliatre
authors.forename: Josette
authors.initials: J
authors.lastname: Brière
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
authors.forename: Eric
authors.initials: E
authors.lastname: de Kerviler
authors.forename: Catherine
authors.initials: C
authors.lastname: Thieblemont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D019468:Disease Management; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D013117:Spinal Cord Compression / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Spinal cord compression; central nervous system relapse; lymphoma; management