Annals of Oncology 11:685-690, 2000
© 2000 European Society for Medical Oncology
research-article |
Incidence and risk factors of central nervous system relapse in histologically aggressive non-Hodgkin's lymphoma uniformly treated and receiving intrathecal central nervous system prophylaxis: A GELA study on 974 patients
1Hôpital Henri Mondor-AP-HP Créteil
2Hospices civih de Lyon Lyon
3Hôpital Saint Louis-AP-HP Paris
4Hôpital Saint Vincent Lille
5Centre Henri Becquerel Rouen
6Hôpital Mont Godinne Yvoir
7Hôpital Brabois Nancy
8Hôpital Purpan Toulouse, France
Correspondence to: Corinne Haioun, MD, Service d'Hematologie Clinique, Hôpital Henri Mondor, 94010 Creteil, France, E-mail: corinne.haioun{at}hmn-ap-hop-paris
Background: Incidence of central nervous system (CNS) recurrence in patients with aggressive non-Hodgkin's lymphoma who did not receive meningeal prophylaxis is about 5%. Controversy remains regarding risk factors associated with such an event preventing a rational approach of prophylactic strategies.
Patients and methods: We analyzed a cohort of 974 patients with aggressive lymphoma in complete remission (CR). All the patients received a CNS prophylaxis consisting of intrathecal injections and intravenous high-dose methotrexate. The risk repartition on the basis of the international prognostic index (IPI) of these 974 CR-patients was low (L): 41%, low-intermediate (LI): 27%, high-intermediate (HI): 19%, high (H): 13%.
Results: The incidence of isolated CNS relapse was 1.6%. In a first multivariate logistic regression analysis an increased LDH (P = 0.05, RR = 5) and the presence of more than one extranodal site (P = 0.05, RR = 3) were identified as independent risk factors for isolated CNS relapse. Another multivariate analysis incorporating IPI as a unique parameter showed that only IPI remained significantly associated with a higher risk of CNS relapse (L-LI: 0.6% vs. HI-H: 4.1%, P = 0.002; RR = 7).
Conclusion: Prophylaxis notably reduces the risk of CNS recurrence in the higher risk patients. By contrast, we propose the deletion of prophylactic intrathecal injections in the lower risk patients.
aggressive non-Hodgkin's, CNS relapse, meningeal prophylaxis, methotrexate, risk factors
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