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Central nervous system relapse in patients over 80 years with diffuse large B-cell lymphoma : an analysis of two LYSA studies

(2018) CANCER MEDICINE. 7(3). p.539-548
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Abstract
CNS relapse is reported in 2-5% of diffuse large B-cell lymphoma (DLBCL) patients, dramatically decreasing overall survival (OS). Very few studies address incidence and risk factors of CNS relapse in very elderly patients, a challenging population to treat given their commonly associated comorbidities. A retrospective analysis was performed of 270 DLBCL patients >80 years treated between 2004 and 2013 in two multicentre phase II LYSA trials (LNH03-7B, LNH09-7B) evaluating the addition of rituximab or ofatumumab to mini-CHOP as front-line therapy. No patients received CNS prophylaxis. CNS relapse was evaluated according to cumulative incidence, patient characteristics, risk factors, and survival. Median age was 83 years (range: 79-95). After a median follow-up of 28.7 months, eight patients had CNS relapse (3.0%). Median time between inclusion and CNS relapse was 19.2 months (range: 3.2-32.6). Patients survived a median of 1.5 months after CNS relapse (range: 0.4-4.1). Median OS from relapse was significantly lower in CNS relapse patients (1.5 months, 95% CI: 0.4-3.5) compared to patients with non-CNS relapse (6.6 months; 95% CI: 4.6- 11.9). No baseline characteristics were associated with CNS relapse. The proportion of patients with CNS disease did not differ significantly between patients with low-intermediate risk according to CNS-IPI and patients with high risk (3% vs. 2.8%, P = 1.00). CNS relapse cumulative incidence in very elderly treatment-naive patients is 1.8% at 2 years and is associated with poor survival. This population had a long median time to CNS relapse. Absence of prophylaxis did not strongly impact CNS relapse incidence.
Keywords
NON-HODGKINS-LYMPHOMA, STUDY-GROUP DSHNHL, ELDERLY-PATIENTS, RISK-FACTORS, CNS PROPHYLAXIS, AGGRESSIVE LYMPHOMA, CHOP CHEMOTHERAPY, PHASE-2 TRIAL, RITUXIMAB ERA, SINGLE-ARM, Aged 80 and over, CNS relapse, DLBCL, elderly

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Chicago
Cabannes-Hamy, Aurélie, Frederic Peyrade, Fabrice Jardin, Jean-François Emile, Vincent Delwail, Nicolas Mounier, Corinne Haioun, et al. 2018. “Central Nervous System Relapse in Patients over 80 Years with Diffuse Large B-cell Lymphoma : an Analysis of Two LYSA Studies.” Cancer Medicine 7 (3): 539–548.
APA
Cabannes-Hamy, Aurélie, Peyrade, F., Jardin, F., Emile, J.-F., Delwail, V., Mounier, N., Haioun, C., et al. (2018). Central nervous system relapse in patients over 80 years with diffuse large B-cell lymphoma : an analysis of two LYSA studies. CANCER MEDICINE, 7(3), 539–548.
Vancouver
1.
Cabannes-Hamy A, Peyrade F, Jardin F, Emile J-F, Delwail V, Mounier N, et al. Central nervous system relapse in patients over 80 years with diffuse large B-cell lymphoma : an analysis of two LYSA studies. CANCER MEDICINE. 2018;7(3):539–48.
MLA
Cabannes-Hamy, Aurélie, Frederic Peyrade, Fabrice Jardin, et al. “Central Nervous System Relapse in Patients over 80 Years with Diffuse Large B-cell Lymphoma : an Analysis of Two LYSA Studies.” CANCER MEDICINE 7.3 (2018): 539–548. Print.
@article{8563266,
  abstract     = {CNS relapse is reported in 2-5\% of diffuse large B-cell lymphoma (DLBCL) patients, dramatically decreasing overall survival (OS). Very few studies address incidence and risk factors of CNS relapse in very elderly patients, a challenging population to treat given their commonly associated comorbidities. A retrospective analysis was performed of 270 DLBCL patients {\textrangle}80 years treated between 2004 and 2013 in two multicentre phase II LYSA trials (LNH03-7B, LNH09-7B) evaluating the addition of rituximab or ofatumumab to mini-CHOP as front-line therapy. No patients received CNS prophylaxis. CNS relapse was evaluated according to cumulative incidence, patient characteristics, risk factors, and survival. Median age was 83 years (range: 79-95). After a median follow-up of 28.7 months, eight patients had CNS relapse (3.0\%). Median time between inclusion and CNS relapse was 19.2 months (range: 3.2-32.6). Patients survived a median of 1.5 months after CNS relapse (range: 0.4-4.1). Median OS from relapse was significantly lower in CNS relapse patients (1.5 months, 95\% CI: 0.4-3.5) compared to patients with non-CNS relapse (6.6 months; 95\% CI: 4.6- 11.9). No baseline characteristics were associated with CNS relapse. The proportion of patients with CNS disease did not differ significantly between patients with low-intermediate risk according to CNS-IPI and patients with high risk (3\% vs. 2.8\%, P = 1.00). CNS relapse cumulative incidence in very elderly treatment-naive patients is 1.8\% at 2 years and is associated with poor survival. This population had a long median time to CNS relapse. Absence of prophylaxis did not strongly impact CNS relapse incidence.},
  author       = {Cabannes-Hamy, Aur{\'e}lie and Peyrade, Frederic and Jardin, Fabrice and Emile, Jean-Fran\c{c}ois and Delwail, Vincent and Mounier, Nicolas and Haioun, Corinne and Perrot, Aurore and Fitoussi, Olivier and Lara, Diane and Delarue, Richard and Andr{\'e}, Marc and Offner, Fritz and Ghesqui{\`e}res, Herve and Pascal, Laurent and Soussain, Carole and Lazarovici, Julien and Schiano, Jean-Marc and Gaulard, Philippe and Tilly, Herv{\'e} and Thieblemont, Catherine},
  issn         = {2045-7634},
  journal      = {CANCER MEDICINE},
  keyword      = {NON-HODGKINS-LYMPHOMA,STUDY-GROUP DSHNHL,ELDERLY-PATIENTS,RISK-FACTORS,CNS PROPHYLAXIS,AGGRESSIVE LYMPHOMA,CHOP CHEMOTHERAPY,PHASE-2 TRIAL,RITUXIMAB ERA,SINGLE-ARM,Aged 80 and over,CNS relapse,DLBCL,elderly},
  language     = {eng},
  number       = {3},
  pages        = {539--548},
  title        = {Central nervous system relapse in patients over 80 years with diffuse large B-cell lymphoma : an analysis of two LYSA studies},
  url          = {http://dx.doi.org/10.1002/cam4.1139},
  volume       = {7},
  year         = {2018},
}

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