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Orellana-Noia VM , Reed D , McCook AA , Sen JM , Barlow CM , Malecek MK , Watkins MP , Kahl BS , Spinner MA , Advani R , Voorhees TJ , Snow A , Grover NS , Ayers AA , Romancik J , Liu Y , Huntington SF , Chavez JC , Saeed H , Lazaryan A , Raghunathan V , Spurgeon SE , Ollila TA , Del Prete C , Olszewski A , Ayers EC , Landsburg DJ , Echalier B , Lee J , Kamdar M , Caimi PF , Fu T , Liu J , David KA , Alharthy H , Law JY , Karmali R , Shah HR , Stephens DM , Major A , Rojek AE , Smith SM , Yellala A , Kallam A , Nakhoda S , Khan N , Sohail MA , Hill BT , Barrett-Campbell O , Lansigan F , Switchenko JM , Cohen JB , Portell CA
Single-route CNS prophylaxis for aggressive non-Hodgkin lymphomas: real-world outcomes from 21 US academic institutions
Blood. 2021 Sep 27
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Abstract
Prophylaxis is commonly used to prevent central nervous system (CNS) relapse in diffuse large B cell lymphoma, with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013-2019. Prophylaxis was administered intrathecally (IT) in 894 (77%) and using systemic high-dose methotrexate (HD-MTX) in 236 (20%); 32 patients (3%) switched route due to toxicity and were assessed separately. By CNS-International Prognostic Index (IPI), 18% were considered low-risk, 51% moderate, and 30% high. Double-hit lymphoma (DHL) was confirmed in 243 of 866 evaluable patients (21%). Sixty-four patients (5.7 %) had CNS relapse, after median 7.1 months from diagnosis, including 15 of 64 (23%) within the first 6 months. There was no significant difference in CNS relapse between IT and HD-MTX recipients (5.4 vs 6.8%, p=0.4), including after propensity score matching to account for differences between respective recipient groups. Weighting by CNS-IPI, expected versus observed CNS relapse rates were nearly identical (5.8 vs 5.7%). Testicular involvement was associated with high risk of CNS relapse (11.3%) despite most having lower CNS-IPI scores. DHL did not significantly predict for CNS relapse after single-route prophylaxis, including with adjustment for treatment regimen and other factors. This large study of CNS prophylaxis recipients with DLBCL found no significant difference in CNS relapse rates between routes of administration. Relapse rates among high-risk subgroups remain elevated and reconsideration of prophylaxis strategies in DLBCL is of critical need.
Notes
1528-0020 Orellana-Noia, Victor Manuel Orcid: 0000-0002-0742-1436 Reed, Daniel Orcid: 0000-0003-2965-4342 McCook, Ashley Alesia Orcid: 0000-0001-5368-4977 Sen, Jeremy Michael Barlow, Christian M Malecek, Mary-Kate Orcid: 0000-0001-8352-4675 Watkins, Marcus P Orcid: 0000-0002-1224-3478 Kahl, Brad S Orcid: 0000-0003-0459-6609 Spinner, Michael A Advani, Ranjana Voorhees, Timothy J Orcid: 0000-0001-7603-6454 Snow, Anson Grover, Natalie Sophia Orcid: 0000-0002-1346-3157 Ayers, Amy A Romancik, Jason Orcid: 0000-0003-0054-9362 Liu, Yuxin Orcid: 0000-0002-0623-2561 Huntington, Scott F Orcid: 0000-0001-7071-6475 Chavez, Julio C Saeed, Hayder Orcid: 0000-0001-5295-6088 Lazaryan, Aleksandr Orcid: 0000-0001-9605-6436 Raghunathan, Vikram Spurgeon, Stephen E Ollila, Thomas A Orcid: 0000-0003-0102-6491 Del Prete, Christopher Olszewski, Adam Ayers, Emily C Orcid: 0000-0003-3748-4507 Landsburg, Daniel J Echalier, Benjamin Lee, Jun Kamdar, Manali Caimi, Paolo F Fu, Timothy Liu, Jieqi David, Kevin A Alharthy, Hanan Orcid: 0000-0002-9718-084x Law, Jennie Y Karmali, Reem Orcid: 0000-0003-0984-4376 Shah, Harsh R Stephens, Deborah M Orcid: 0000-0001-9188-5008 Major, Ajay Orcid: 0000-0001-7261-1335 Rojek, Alexandra E Smith, Sonali M Orcid: 0000-0002-9893-4949 Yellala, Amulya Kallam, Avyakta Orcid: 0000-0001-6801-1601 Nakhoda, Shazia Khan, Nadia Orcid: 0000-0001-8259-4129 Sohail, Mohammad Ahsan Hill, Brain T Barrett-Campbell, Odeth Lansigan, Frederick Orcid: 0000-0001-6027-3359 Switchenko, Jeffrey M Orcid: 0000-0002-5563-9325 Cohen, Jonathon B Orcid: 0000-0002-2723-6481 Portell, Craig A Orcid: 0000-0002-9487-8345 Journal Article United States Blood. 2021 Sep 27:blood.2021012888. doi: 10.1182/blood.2021012888.