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    Outcomes of synchronous systemic and central nervous system (CNS) involvement of diffuse large B-cell lymphoma are dictated by the CNS disease: a collaborative study of the Australasian Lymphoma Alliance

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    Authors
    Wight, J
    Yue, M
    Keane, C
    Johnston, Anna
    Linton, Kim M
    Chin, C
    Wai, S
    Talaulikar, D
    Gasiorowski, R
    Cheah, C
    Gregory, G
    Dickinson, M
    Minson, A
    Coombes, C
    Ku, M
    Lam, S
    Hawkes, E
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    Affiliation
    Austin Health, Heidelberg, Victoria, Australia
    Issue Date
    2019
    
    Metadata
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    Abstract
    De novo diffuse large B-cell lymphoma (DLBCL) presenting with synchronous central nervous system (CNS) and systemic disease (synDLBCL) is not well described and is excluded from clinical trials. We performed a retrospective analysis of 80 synDLBCL patients treated across 10 Australian and UK centres. Of these patients, 96% had extranodal systemic disease. CNS-directed treatment with combination intravenous cytarabine and high-dose methotrexate ("CNS-intensive") (n = 38) was associated with favourable survival outcomes compared with "CNS-conservative" strategies such as intravenous high-dose methotrexate monotherapy, intrathecal therapy and/or radiotherapy (2-year progression-free survival [PFS] 50% vS 31%, P = 0.006; 2-year overall survival [OS] 54% vS 44%, P = 0.037). Outcomes were primarily dictated by the ability to control the CNS disease, with 2-year cumulative CNS relapse incidence of 42% and non-CNS relapse 21%. Two-year OS for CNS-relapse patients was 13% vS 36% for non-CNS relapses (P = 0.02). Autologous stem cell transplantation as consolidation (n = 14) was not observed to improve survival in those patients who received CNS-intensive induction when matched for induction outcomes (2-year PFS 69% vS 56%, P = 0.99; 2-year OS 66% vS 56%, P = 0.98). Hyperfractionated or infusional systemic treatment did not improve survival compared to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) (2-year OS 49% for both groups). Our study suggests that adequate control of the CNS disease is paramount and is best achieved by intensive CNS-directed induction.
    Citation
    Wight JC, Yue M, Keane C, Johnston A, Linton K, Chin C, et al. Outcomes of synchronous systemic and central nervous system (CNS) involvement of diffuse large B-cell lymphoma are dictated by the CNS disease: a collaborative study of the Australasian Lymphoma Alliance. Br J HaematoL 2019.
    Journal
    British Journal of Haematology
    URI
    http://hdl.handle.net/10541/622031
    DOI
    10.1111/bjh.16064
    PubMed ID
    31236941
    Additional Links
    https://dx.doi.org/10.1111/bjh.16064
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1111/bjh.16064
    Scopus Count
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