Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy.
Blood Cancer J. 2018 Jun 26;8(7):63. doi: 10.1038/s41408-018-0097-0.
Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is a devastating event occurring in ~ 5% of patients treated with R-CHOP. We hypothesized that adding lenalidomide to R-CHOP (R2CHOP) may decrease the risk of CNS relapse. We analyzed records for patients with DLBCL from two R2CHOP trials. We assessed variables pertinent to the CNS-International Prognostic Index (CNS-IPI) scoring system and classified patients into groups of low, intermediate, and high risk of CNS relapse. The 2-year CNS relapse rate for each risk group was estimated using the Kaplan-Meier method and compared with reported rates in cohorts treated with contemporary chemoimmunotherapy. A total of 136 patients were included. Mean age was 65 and median follow-up was 48.2 months. 10.3, 71.3, and 18.4% of patients were classified into low, intermediate, and high-risk CNS-IPI groups, respectively. Only one of 136 patients developed CNS relapse, corresponding to an incidence of 0.7% and an estimated 2-year CNS relapse rate of 0.9% for the entire R2CHOP cohort. The estimated 2-year CNS relapse rates for the low, intermediate, and high-risk groups were 0, 0, and 5.0%, respectively. Frontline therapy with R2CHOP in patients with DLBCL is associated with a lower-than-expected rate of CNS relapse.
中枢神经系统 (CNS) 复发弥漫性大 B 细胞淋巴瘤 (DLBCL) 是一种毁灭性事件，约发生在接受 R-CHOP 治疗的患者的 5%。我们假设在 R-CHOP 中加入来那度胺 (R2CHOP) 可能会降低 CNS 复发的风险。我们分析了两项 R2CHOP 试验中 DLBCL 患者的记录。我们评估了与 CNS-国际预后指数 (CNS-IPI) 评分系统相关的变量，并将患者分为 CNS 复发低、中、高危组。使用 Kaplan-Meier 法估计每个风险组的 2 年 CNS 复发率，并与接受当代化疗免疫治疗的队列报告的比率进行比较。共纳入 136 例患者。平均年龄为 65 岁，中位随访时间为 48.2 个月。分别有 10.3%、71.3%和 18.4%的患者被归类为低、中、高危 CNS-IPI 组。136 例患者中仅 1 例发生 CNS 复发，发生率为 0.7%，整个 R2CHOP 队列的估计 2 年 CNS 复发率为 0.9%。低、中、高危组的估计 2 年 CNS 复发率分别为 0、0 和 5.0%。在 DLBCL 患者中，一线治疗采用 R2CHOP 与 CNS 复发率低于预期相关。
