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Annals of Oncology Advance Access published online on October 27, 2009
Annals of Oncology, doi:10.1093/annonc/mdp432
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: the impact of the addition of rituximab to CHOP chemotherapy

D. Villa1, J. M. Connors1, T. N. Shenkier1, R. D. Gascoyne2, L. H. Sehn1 and K. J. Savage1,*

1 Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
2 Division of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada

* Correspondence to: Dr K. J. Savage, Division of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, Canada BC V5Z 4E6. Tel: +1-604-877-6000; Fax: +1-604-877-0585; E-mail: ksavage{at}bccancer.bc.ca

Background: The addition of rituximab to CHOP (R-CHOP; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy improves outcome in patients with diffuse large B-cell lymphoma (DLBCL). We evaluated the risk of central nervous system (CNS) relapse in the R-CHOP in a population-based cohort of patients with DLBCL.

Methods: Patients with DLBCL diagnosed from 1 September 1999 to 14 January 2005 at the British Columbia Cancer Agency (BCCA) were identified. Patients were included if they were ≥16 years old with advanced stage or any stage with testicular involvement and were treated with CHOP (1999–2001) or R-CHOP (2001–2005) with curative intent.

Results: Four hundred and thirty-five patients were identified; 126 (29%) were treated with CHOP and 309 (71%) with R-CHOP. With a median follow-up of 5.7 years, there were 31 CNS relapses in total with a trend to a reduced likelihood of CNS relapse in R-CHOP-treated patients (3-year risk 9.7% versus 6.4, P = 0.085). In multivariate analysis, the use of rituximab significantly reduced the risk of CNS relapse [hazard ratio (HR) 0.45, P = 0.034]; this benefit was more striking in patients who achieved a complete response (HR 0.18, P = 0.005).

Conclusion: The use of R-CHOP appears to reduce the overall risk of CNS relapse in patients with DLBCL particularly in patients who achieve a complete response.

central nervous system, CNS relapse, diffuse large B-cell lymphoma, DLBCL, R-CHOP, rituximab

Received for publication July 24, 2009. Accepted for publication August 3, 2009.


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