Incidence and risk factors of central nervous system relapse in histologically aggressive non-Hodgkin's lymphoma uniformly treated and receiving intrathecal central nervous system prophylaxis: A GELA study on 974 patients
C. Haioun et al., Incidence and risk factors of central nervous system relapse in histologically aggressive non-Hodgkin's lymphoma uniformly treated and receiving intrathecal central nervous system prophylaxis: A GELA study on 974 patients, ANN ONCOL, 11(6), 2000, pp. 685-690
Background: Incidence of central nervous system (CNS) recurrence in patient
s with aggressive non-Hodgkin's lymphoma who did not receive meningeal prop
hylaxis is about 5%. Controversy remains regarding risk factors associated
with such an event preventing a rational approach of prophylactic strategie
s.
Patients and methods: We analyzed a cohort of 974 patients with aggressive
lymphoma in complete remission (CR). All the patients received a CNS prophy
laxis consisting of intrathecal injections and intravenous high-dose methot
rexate. The risk repartition on the basis of the international prognostic i
ndex (IPI) of these 974 CR-patients was low (L): 41%, low-intermediate (LI)
: 27%, high-intermediate (HI): 19%, high (H): 13%.
Results: The incidence of isolated CNS relapse was 1.6%. In a first multiva
riate logistic regression analysis an increased LDH (P= 0.05, RR = 5) and t
he presence of more than one extranodal site (P= 0.05, RR = 3) were identif
ied as independent risk factors for isolated CNS relapse. Another multivari
ate analysis incorporating IPI as a unique parameter showed that only IPI r
emained significantly associated with a higher risk of CNS relapse (L-LI: 0
.6% vs. HI-H: 4.1%, P = 0.002; RR = 7).
Conclusion: Prophylaxis notably reduces the risk of CNS recurrence in the h
igher risk patients. By contrast, we propose the deletion of prophylactic i
ntrathecal injections in the lower risk patients.