title: Influence of Rituximab on Central Nervous System Relapse in Diffuse Large B-Cell Lymphoma and Role of Prophylaxis--A Systematic Review of Prospective Studies.
abstract: Despite the improvement in overall survival in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era, the occurrence of central nervous system (CNS) relapse heralds a very poor prognosis. The evidence is conflicting on the incidence and pattern of CNS relapse in the rituximab era compared with before the rituximab era and on the role of CNS prophylaxis. We conducted a systematic analysis of the data from 7 prospective studies, studying the incidence and type of CNS relapse, the role of prophylaxis, and survival after CNS relapse, with and without rituximab-based chemotherapy. No statistically significant difference was found in the incidence of CNS relapse with the use of rituximab-based chemotherapy compared with CHOP (cyclophosphamide, doxorubicin, vincristine [Oncovin], prednisone) chemotherapy. Leptomeningeal disease was more common and the survival after CNS disease was better in the rituximab era. No difference was found in the incidence of isolated CNS relapse. Chemoprophylaxis significantly decreased the incidence of CNS recurrence. The use of rituximab has not influenced the incidence of CNS relapse compared with the use of CHOP. Chemoprophylaxis plays a significant role in high-risk patients with DLBCL in decreasing CNS recurrence. Large randomized clinical trials are warranted to differentiate between intrathecal and systemic chemoprophylaxis.
authors: Division of Hematology Oncology, University of Cincinnati College of Medicine, Cincinnati, OH. Electronic address: ghoseau@ucmail.uc.edu.
authors: Abhimanyu
authors: A
authors: Ghose
authors: Division of Internal Medicine, St Lukes Roosevelt, New York, NY.
authors: Harold Kunal
authors: HK
authors: Elias
authors: School of Chemical and Biotechnology, Shanmugha Arts, Science, Technology and Research Academy University, Thanjavur, India.
authors: Gunjan
authors: G
authors: Guha
authors: Division of Hematology Oncology, University of Cincinnati College of Medicine, Cincinnati, OH.
authors: Mahender
authors: M
authors: Yellu
authors: Good Samaritan Hospital, Cincinnati, OH.
authors: Ria
authors: R
authors: Kundu
authors: Division of Hematology Oncology, University of Cincinnati College of Medicine, Cincinnati, OH.
authors: Tahir
authors: T
authors: Latif
mesh_terms: D000368:Aged; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D000069283:Rituximab / Q000008:administration & dosage / Q000627:therapeutic use*; D016019:Survival Analysis
chemical_list: D000069283:Rituximab
keywords: CNS prophylaxis; CNS relapse; DLBCL; Lymphoma; Rituximab