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CNS relapse of diffuse large B cell Lymphoma A single centre experience
Adil Nazir1, Fawad2, Neelam Siddique3
1Dr. Adil Nazir, MBBS, FCPS (Medicine). Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
Pakistan Journal of Medical Sciences
|March 2, 2018
Summary
Central nervous system (CNS) relapse in diffuse large B cell lymphoma (DLBCL) is a rare but fatal event. Patients with advanced stage, high LDH, and extra-nodal involvement face a high risk of CNS relapse, with a very poor prognosis once it occurs.
Area of Science:
- Hematology
- Oncology
- Clinical Medicine
Background:
- Central nervous system (CNS) relapse in diffuse large B cell lymphoma (DLBCL) is uncommon but associated with a near-fatal outcome.
- The risk of CNS relapse varies significantly based on patient risk stratification, ranging from 0.8% in low-risk to 12% in high-risk groups.
- Understanding baseline characteristics and survival outcomes in DLBCL patients experiencing CNS relapse is crucial for improving patient management.
Purpose of the Study:
- To investigate the baseline characteristics of diffuse large B cell lymphoma (DLBCL) patients who experience central nervous system (CNS) relapse.
- To determine the median survival outcomes for DLBCL patients following CNS relapse.
- To identify factors associated with an increased risk of CNS relapse in DLBCL.
Main Methods:
- A retrospective analysis was conducted on DLBCL patients with CNS relapse between 2006 and 2014.
- Data on patient demographics, disease characteristics, treatment regimens, and outcomes were collected from a computerized Hospital Information System.
- Statistical analysis focused on identifying baseline characteristics and calculating median survival for the cohort.
Main Results:
- The study included 21 DLBCL patients with CNS relapse, predominantly males (66.3%), with a median age of 37.4 years at initial diagnosis.
- High-risk features at initial diagnosis were common, including advanced Ann Arbor stage (57.1% stage IV), high LDH (85.7%), and extra-nodal involvement (76.2%).
- CNS relapse occurred in 81% of patients within six months of therapy completion, with a median survival of only 54 days post-relapse.
Conclusions:
- Advanced stage, high LDH, and extra-nodal involvement at initial DLBCL diagnosis are significant risk factors for CNS relapse.
- Approximately half of the patients experienced CNS relapse despite receiving primary CNS prophylaxis.
- DLBCL patients with CNS relapse exhibit a very poor prognosis, underscoring the need for improved prevention and treatment strategies.
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