Publication:
Secondary central nervous system relapse in diffuse large B cell lymphoma in a resource limited country: result from the Thailand nationwide multi-institutional registry

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Issued Date

2017

Resource Type

Article

File Type

application/pdf

ISSN

9395555

DOI

10.1007/s00277-016-2848-y

Other identifier(s)

2-s2.0-84991660172

Rights Holder(s)

Scopus

Bibliographic Citation

Annals of Hematology. Vol 96, No.1 (2017), p.57-64

Suggested Citation

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 Secondary central nervous system relapse in diffuse large B cell lymphoma in a resource limited country: result from the Thailand nationwide multi-institutional registry. Annals of Hematology. Vol 96, No.1 (2017), p.57-64. doi:10.1007/s00277-016-2848-y Retrieved from: https://hdl.handle.net/20.500.14740/4819

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

Author(s)

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

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.

Subject(s)

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

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URI

https://hdl.handle.net/20.500.14740/4819

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