Please use this identifier to cite or link to this item: http://ir.swu.ac.th/jspui/handle/123456789/13303
Title: Secondary central nervous system relapse in diffuse large B cell lymphoma in a resource limited country: result from the Thailand nationwide multi-institutional registry
Authors: Wudhikarn K.
Bunworasate U.
Julamanee J.
Lekhakula A.
Chuncharunee S.
Niparuck P.
Ekwattanakit S.
Khuhapinant A.
Norasetthada L.
Nawarawong W.
Makruasi N.
Kanitsap N.
Sirijerachai C.
Chansung K.
Wong P.
Numbenjapon T.
Prayongratana K.
Suwanban T.
Wongkhantee S.
Praditsuktavorn P.
Intragumtornchai T.
on behalf of Thai Lymphoma Study Group
Keywords: cyclophosphamide
cytarabine
doxorubicin
lactate dehydrogenase
methotrexate
prednisolone
rituximab
vincristine
adolescent
adult
aged
Article
autologous hematopoietic stem cell transplantation
cancer combination chemotherapy
cancer patient
cancer prevention
cancer radiotherapy
cancer recurrence
cancer survival
cause of death
central nervous system metastasis
chemoprophylaxis
clinical outcome
controlled study
diffuse large B cell lymphoma
drug exposure
drug megadose
encephale isole
female
follow up
high risk patient
human
induction chemotherapy
intermediate risk patient
International Prognostic Index
lactate dehydrogenase blood level
leptomeninx
low risk patient
major clinical study
male
medical record review
multiple cycle treatment
overall survival
paranasal sinus
priority journal
progression free survival
skull irradiation
systemic disease
Thailand
treatment response
Central Nervous System Neoplasms
clinical trial
health care planning
Lymphoma, Large B-Cell, Diffuse
middle aged
multicenter study
prospective study
register
trends
tumor recurrence
very elderly
young adult
Adolescent
Adult
Aged
Aged, 80 and over
Central Nervous System Neoplasms
Female
Follow-Up Studies
Health Resources
Humans
Lymphoma, Large B-Cell, Diffuse
Male
Middle Aged
Neoplasm Recurrence, Local
Prospective Studies
Registries
Thailand
Young Adult
Issue Date: 2017
Abstract: Secondary central nervous system (CNS) relapse is a serious and fatal complication of diffuse large B cell lymphoma (DLBCL). Data on secondary CNS (SCNS) relapse were mostly obtained from western countries with limited data from developing countries. We analyzed the data of 2034 newly diagnosed DLBCL patients enrolled into the multi-center registry under Thai Lymphoma Study Group from setting. The incidence, September 2006 to December 2013 to represent outcome from a resource limited pattern, management, and outcome of SCNS relapse were described. The 2-year cumulative incidence (CI) of SCNS relapse was 2.7 %. A total of 729, 1024, and 281 patients were classified as low-, intermediate-, and high-risk CNS international prognostic index (CNS-IPI) with corresponding 2-year CI of SCNS relapse of 1.5, 3.1, and 4.6 %, respectively (p < 0.001). Univariate analysis demonstrated advance stage disease, poor performance status, elevated lactate dehydrogenase, presence of B symptoms, more than one extranodal organ involvement, high IPI, and high CNS-IPI group as predictive factors for SCNS relapse. Rituximab exposure and intrathecal chemoprophylaxis offered no protective effect against SCNS relapse. At the time of analysis, six patients were alive. Median OS in SCNS relapsed patients was significantly shorter than relapsed patients without CNS involvement (13.2 vs 22.6 months) (p < 0.001). Primary causes of death were progressive disease (n = 35, 63.6 %) and infection (n = 9, 16.7 %). In conclusion, although the incidence of SCNS relapse in our cohort was low, the prognosis was dismal. Prophylaxis for SCNS involvement was underused even in high-risk patients. Novel approaches for SCNS relapse prophylaxis and managements are warranted. © 2016, Springer-Verlag Berlin Heidelberg.
URI: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84991660172&doi=10.1007%2fs00277-016-2848-y&partnerID=40&md5=aa4573d8b29e64a1043427d224ae0658
http://ir.swu.ac.th/jspui/handle/123456789/13303
ISSN: 9395555
Appears in Collections:Scopus 1983-2021

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