title: Diffuse large B-cell lymphoma with testicular involvement: outcome and risk of CNS relapse in the rituximab era.
abstract: The addition of rituximab has improved outcomes in diffuse large B-cell lymphoma (DLBCL), however, there remains limited information on the impact of rituximab in those with testicular involvement. All patients with diffuse large cell lymphoma and testicular involvement treated with curative intent were identified in the British Columbia Cancer Agency Lymphoid Cancer Database. In total, 134 patients diagnosed between 1982 and 2015 with diffuse large cell lymphoma involving the testis were identified: 61 received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-like chemotherapy and 73 received CHOP plus rituximab (R-CHOP). A greater proportion of R-CHOP treated patients had higher International Prognostic Index (IPI, P = 0·005). In multivariate analysis, the protective effect of rituximab on progression-free survival (hazard ratio (HR) 0·42, P < 0·001), overall survival (HR 0·39, P < 0·001) and cumulative incidence of progression (HR 0·46, P = 0·014) were independent of the IPI. However, in a competing risk multivariate analysis including central nervous system (CNS) prophylaxis and the CNS-IPI, rituximab was not associated with a decreased risk of CNS relapse. The addition of rituximab has reduced the risk of lymphoma recurrence in testicular DLBCL, presumably through improved eradication of systemic disease. However, CNS relapse risk remains high and further studies evaluating effective prophylactic strategies are needed.
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Kridel
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Telio
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Diego
authors.initials: D
authors.lastname: Villa
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Sehn
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alina S
authors.initials: AS
authors.lastname: Gerrie
authors.affiliation: Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Tamara
authors.initials: T
authors.lastname: Shenkier
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Klasa
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Slack
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: King
authors.initials: K
authors.lastname: Tan
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Randy D
authors.initials: RD
authors.lastname: Gascoyne
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.affiliation: Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Savage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001955:British Columbia; D016543:Central Nervous System Neoplasms / Q000517:prevention & control / Q000556:secondary; D003520:Cyclophosphamide / Q000627:therapeutic use; D016208:Databases, Factual; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis / Q000639:trends; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012306:Risk; D000069283:Rituximab / Q000494:pharmacology / Q000627:therapeutic use*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: central nervous system relapse; rituximab; testicular diffuse large B-cell lymphoma