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Favorable Outcome of Intensive Treatment for Relapsed Diffuse Large B Cell Lymphoma With Secondary Central Nervous
Hung Chang1,2,3, Ming-Chung Kuo4,2, Che-Wei Ou5
1Division of Hematology, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C.; horng@adm.cgmh.org.tw.
Background/Aim:
Relapsed diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) involvement carries a poor prognosis and is underrepresented in clinical trials.
Patients And Methods:
In this study, we analyzed outcomes of 174 patients with relapsed DLBCL over a 14-year period, involving 20 individuals (10 male and 10 female) with secondary CNS involvement.
Results:
The median age was 64 years. Twelve patients had isolated CNS relapse whereas eight had concurrent systemic relapse. Median time to relapse was 14 months. CNS International Prognostic Index (CNS-IPI) scores at initial diagnosis ranged from low to high risk. Although 8 patients had low risk, all of them had extranodal disease. Median progression-free survival (PFS) was 16.6 months; overall survival (OS) was 19.5 months. Patients receiving aggressive therapy (mainly ESHAP), including stem cell transplantation, had significantly improved outcomes (PFS, 79.4 vs. 7.1 months; OS, 135.0 vs. 7.5 months). All palliative patients (two R-COP and eight only supportive) died.
Conclusion:
Intensive treatment may substantially improve survival in relapsed DLBCL patients with CNS involvement. A potential bias is likely with the present sample size and further studies are warranted.