FOR WHICH PATIENTS WITH AGGRESSIVE NON-HODGKINS-LYMPHOMA IS PROPHYLAXIS FOR CENTRAL-NERVOUS-SYSTEM DISEASE MANDATORY

Purpose. Data of a multicenter study in non-Hodgkin's lymphoma (NHL) b y the Dutch Hovon Group were reanalyzed to assess the risk of relapse in the central nervous system (CNS) related to the international risk index for NHL. In addition we assessed the risk for CNS disease in rel ation to the presence of bone marrow localisation at presentation. Des ign. We focused our analysis on those patients reaching a complete rem ission (CR). Two hundred eighty-six patients (histological subtypes D- H Working Formulation) and with stages II-IV were analyzed. One hundre d ninety-three (67%) patients reached a CR. Results. Relapse occurred in 78 patients of whom 10 patients with concomitant or isolated CNS di sease. According to the international risk index the following observa tions were made: low risk (n = 38) nine out of 34 CR relapsed, none ha d CNS involvement; low-intermediate risk (n = 115) 27 out of 83 CR rel apsed, three had CNS involvement; high-intermediate risk (n = 110) 37 out of 68 CR relapsed, six had CNS involvement; high risk (n = 22) fou r out of seven CR relapsed, one had CNS involvement. Two out of 10 dev eloped isolated CNS disease and eight out of 10 patients developed CNS disease with systemic relapse. Conclusion: Our data show that the num ber of CNS relapses after CR is relatively low (10 out of 193 = 5%), w ith an increasing incidence in the high-risk groups according to the i nternational risk index. The occurrence of CNS relapse seems to be rel ated to the risk of systemic relapse after CR. No subgroup could be di scriminated in which prophylactic treatment would be of substantial be nefit.