Favorable Outcome of Intensive Treatment for Relapsed Diffuse Large B Cell Lymphoma With Secondary Central Nervous System Involvement.
Relapsed diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) involvement carries a poor prognosis and is underrepresented in clinical trials.
In this study, we analyzed outcomes of 174 patients with relapsed DLBCL over a 14-year period, involving 20 individuals (10 male and 10 female) with secondary CNS involvement.
The median age was 64 years. Twelve patients had isolated CNS relapse whereas eight had concurrent systemic relapse. Median time to relapse was 14 months. CNS International Prognostic Index (CNS-IPI) scores at initial diagnosis ranged from low to high risk. Although 8 patients had low risk, all of them had extranodal disease. Median progression-free survival (PFS) was 16.6 months; overall survival (OS) was 19.5 months. Patients receiving aggressive therapy (mainly ESHAP), including stem cell transplantation, had significantly improved outcomes (PFS, 79.4 vs. 7.1 months; OS, 135.0 vs. 7.5 months). All palliative patients (two R-COP and eight only supportive) died.
Intensive treatment may substantially improve survival in relapsed DLBCL patients with CNS involvement. A potential bias is likely with the present sample size and further studies are warranted.
In this study, we analyzed outcomes of 174 patients with relapsed DLBCL over a 14-year period, involving 20 individuals (10 male and 10 female) with secondary CNS involvement.
The median age was 64 years. Twelve patients had isolated CNS relapse whereas eight had concurrent systemic relapse. Median time to relapse was 14 months. CNS International Prognostic Index (CNS-IPI) scores at initial diagnosis ranged from low to high risk. Although 8 patients had low risk, all of them had extranodal disease. Median progression-free survival (PFS) was 16.6 months; overall survival (OS) was 19.5 months. Patients receiving aggressive therapy (mainly ESHAP), including stem cell transplantation, had significantly improved outcomes (PFS, 79.4 vs. 7.1 months; OS, 135.0 vs. 7.5 months). All palliative patients (two R-COP and eight only supportive) died.
Intensive treatment may substantially improve survival in relapsed DLBCL patients with CNS involvement. A potential bias is likely with the present sample size and further studies are warranted.