DLBCL with CNS involvement: RCHOP-HD MTX extends remission

  • Chava P & al.
  • Am J Hematol
  • 18 juin 2019

  • Par David Reilly
  • Résumés d'articles
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Takeaway

  • In a review of patients with newly diagnosed systemic diffuse large B-cell lymphoma (DLBCL) and central nervous system (CNS) involvement, RCHOP-HD MTX (rituximab, cyclophosphamide, doxorubicin, oncovin, prednisone+high-dose methotrexate) was associated with improved survival outcomes, whereas consolidation autologous stem cell transplantation (auto-SCT) offered no significant benefit.

Why this matters

  • Many patients in this setting are excluded from clinical trials, making related data scarce.

Study design

  • Study to evaluate real-world outcomes in 44 patients with newly diagnosed systemic DLBCL and CNS involvement presenting between 2004 and 2017.  
  • Funding: None disclosed.

Key results

  • With chemotherapy (n=41):
    • 80.5% response after induction, with 66% complete response (CR).
  • With auto-SCT (n=19):
    • 86% maintained response; 3 patients improved from partial response (PR) to CR.
  • 56%±8.3% overall projected 3-year median OS.
  • 42%±8.9% overall projected 3-year median PFS.
  • Factors predictive of improved PFS in multivariate analysis included:
    • RCHOP-HD MTX-based induction: HR, 0.24; 95% CI, 0.068-0.846; P=.026.
    • MTX 3.5 g/m2 vs lower doses: HR, 0.810; 95% CI, 0.689-0.941; P=.006.
  • Factors predictive of improved OS in multivariate analysis included:
    • RCHOP-HD MTX-based induction: HR, 0.228; 95% CI, 0.054-0.96; P=.04.
    • Use of HD-MTX dose 3.5 g/m2: HR, 0.735; 95%CI, 0.62-0.87; P<.001.>
  • No significant effect of consolidation auto-SCT on PFS (P=.850).

 Limitations

  • Retrospective data.