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Title: | 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. | Authors: | Talaulikar D.;Wight J.C.;Yue M.;Keane C.;Johnston A.;Linton K.;Chin C.;Wai S.H.;Gasiorowski R.;Hawkes E.A.;Lam S.;Ku M.;Coombes C.;Minson A.;Dickinson M.;Gregory G.P.;Cheah C.Y. | Institution: | (Wight, Hawkes) Austin Health, Heidelberg, VIC, Australia (Wight, Hawkes) Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia (Wight, Hawkes) The University of Melbourne, Melbourne, VIC, Australia (Yue, Keane) Princess Alexandra Hospital, Brisbane, QLD, Australia (Yue, Keane) University of Queensland, Brisbane, QLD, Australia (Johnston, Linton) The Christie NHS Foundation Trust, Manchester, United Kingdom (Johnston) Royal Hobart Hospital, Hobart, Australia (Linton) The Manchester Cancer Research Centre, Manchester, United Kingdom (Chin, Cheah) Sir Charles Gardiner Hospital, Perth, WA, Australia (Wai, Gregory) Monash Health, Clayton, VIC, Australia (Talaulikar, Coombes) Canberra Hospital, Canberra, ACT, Australia (Gasiorowski) Concord Hospital, Sydney, NSW, Australia (Gasiorowski) University of Sydney, Sydney, NSW, Australia (Cheah) University of Western Australia Medical School, Melbourne, VIC, Australia (Gregory) School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia (Dickinson, Minson) Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia (Dickinson) The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (Ku) St Vincent's Hospital Melbourne, Melbourne, VIC, Australia (Lam) Royal Perth Hospital, Perth, WA, Australia (Hawkes) La Trobe University, Melbourne, VIC, Australia (Talaulikar) Australian National University Medical School, Canberra, ACT, Australia | Issue Date: | 28-Oct-2019 | Copyright year: | 2019 | Publisher: | Blackwell Publishing Ltd | Place of publication: | United Kingdom | Publication information: | British Journal of Haematology. 187 (2) (pp 174-184), 2019. Date of Publication: 01 Oct 2019. | Journal: | British Journal of Haematology | 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.Copyright © 2019 British Society for Haematology and John Wiley & Sons Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/bjh.16064 | PubMed URL: | 31236941 [http://www.ncbi.nlm.nih.gov/pubmed/?term=31236941] | ISSN: | 0007-1048 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35962 | Type: | Article | Subjects: | priority journal overall survival *neurologic disease male female human incidence disease association disease control drug megadose major clinical study adult aged article Australia autologous stem cell transplantation cancer radiotherapy cancer survival clinical feature *clinical outcome cohort analysis comparative study controlled study *diffuse large B cell lymphoma/dt [Drug Therapy] progression free survival relapse retrospective study treatment duration treatment outcome United Kingdom cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine/dt [Drug Therapy] cytarabine/cb [Drug Combination] cytarabine/dt [Drug Therapy] cytarabine/iv [Intravenous Drug Administration] methotrexate/cb [Drug Combination] methotrexate/dt [Drug Therapy] comparative study controlled study Article disease association disease control drug megadose female human incidence major clinical study male *neurologic disease overall survival priority journal progression free survival relapse retrospective study treatment duration treatment outcome United Kingdom aged adult *diffuse large B cell lymphoma / *drug therapy Australia autologous stem cell transplantation cancer radiotherapy cancer survival clinical feature *clinical outcome cohort analysis |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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