The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas
To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinus...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
June 17, 2014
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| In: |
Blood
Year: 2014, Volume: 124, Issue: 5, Pages: 720-728 |
| ISSN: | 1528-0020 |
| DOI: | 10.1182/blood-2013-10-535021 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1182/blood-2013-10-535021 Verlag, lizenzpflichtig, Volltext: https://ashpublications.org/blood/article/124/5/720/116615/The-role-of-radiotherapy-and-intrathecal-CNS 
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| Author Notes: | Niels Murawski, Gerhard Held, Marita Ziepert, Barbara Kempf, Andreas Viardot, Mathias Hänel, Mathias Witzens-Harig, Rolf Mahlberg, Christian Rübe, Jochen Fleckenstein, Carsten Zwick, Bertram Glass, Norbert Schmitz, Samira Zeynalova, and Michael Pfreundschuh |
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| 245 | 1 | 4 | |a The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas |c Niels Murawski, Gerhard Held, Marita Ziepert, Barbara Kempf, Andreas Viardot, Mathias Hänel, Mathias Witzens-Harig, Rolf Mahlberg, Christian Rübe, Jochen Fleckenstein, Carsten Zwick, Bertram Glass, Norbert Schmitz, Samira Zeynalova, and Michael Pfreundschuh |
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| 520 | |a To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system (CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patients who did not (P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study. | ||
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