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dc.contributor.authorWight, J
dc.contributor.authorYue, M
dc.contributor.authorKeane, C
dc.contributor.authorJohnston, Anna
dc.contributor.authorLinton, Kim M
dc.contributor.authorChin, C
dc.contributor.authorWai, S
dc.contributor.authorTalaulikar, D
dc.contributor.authorGasiorowski, R
dc.contributor.authorCheah, C
dc.contributor.authorGregory, G
dc.contributor.authorDickinson, M
dc.contributor.authorMinson, A
dc.contributor.authorCoombes, C
dc.contributor.authorKu, M
dc.contributor.authorLam, S
dc.contributor.authorHawkes, E
dc.date.accessioned2019-09-11T09:09:18Z
dc.date.available2019-09-11T09:09:18Z
dc.date.issued2019en
dc.identifier.citationWight 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.en
dc.identifier.pmid31236941en
dc.identifier.doi10.1111/bjh.16064en
dc.identifier.urihttp://hdl.handle.net/10541/622031
dc.description.abstractDe 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.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.1111/bjh.16064en
dc.titleOutcomes 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 Allianceen
dc.typeArticleen
dc.contributor.departmentAustin Health, Heidelberg, Victoria, Australiaen
dc.identifier.journalBritish Journal of Haematologyen
dc.description.noteen]


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