Original Article

Lack of benefit of central nervous system prophylaxis for diffuse large B-cell lymphoma in the rituximab era

Findings from a large national database

  1. Anita Kumar MD1,
  2. Ann Vanderplas MS2,
  3. Ann S. LaCasce MD1,4,
  4. Maria A. Rodriguez MD6,
  5. Allison L. Crosby MS5,
  6. Eva Lepisto MSc, MA7,
  7. Myron S. Czuczman MD8,
  8. Auayporn Nademanee MD3,
  9. Joyce Niland PhD2,
  10. Leo I. Gordon MD9,
  11. Michael Millenson MD10,
  12. Andrew D. Zelenetz MD, PhD11,
  13. Jonathan W. Friedberg MD12,
  14. Gregory A. Abel MD, MPH1,5,†,*

Article first published online: 17 OCT 2011

DOI: 10.1002/cncr.26588

Issue

Cancer

Cancer

Volume 118, Issue 11, pages 2944–2951, 1 June 2012

Additional Information

How to Cite

Kumar, A., Vanderplas, A., LaCasce, A. S., Rodriguez, M. A., Crosby, A. L., Lepisto, E., Czuczman, M. S., Nademanee, A., Niland, J., Gordon, L. I., Millenson, M., Zelenetz, A. D., Friedberg, J. W. and Abel, G. A. (2012), Lack of benefit of central nervous system prophylaxis for diffuse large B-cell lymphoma in the rituximab era. Cancer, 118: 2944–2951. doi: 10.1002/cncr.26588

Author Information

  1. 1

    Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

  2. 2

    Division of Information Sciences, City of Hope National Medical Center, Duarte, California

  3. 3

    Division of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, California

  4. 4

    Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

  5. 5

    Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

  6. 6

    Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas

  7. 7

    NCCN VP of Technology Research and Development, National Comprehensive Cancer Network, Fort Washington, Pennsylvania

  8. 8

    Division of Medicine, Roswell Park Cancer Institute, Buffalo, New York

  9. 9

    Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois

  10. 10

    Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania

  11. 11

    Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, New York

  12. 12

    Division of Hematology/Oncology, James P. Wilmot Cancer Center, Rochester, New York

  1. †

    Fax: (617) 632-2933

*Dana Farber Cancer Institute, Boston, MA 02215

  1. †

    Fax: (617) 632-2933

Publication History

  1. Issue published online: 18 MAY 2012
  2. Article first published online: 17 OCT 2011
  3. Manuscript Accepted: 23 AUG 2011
  4. Manuscript Revised: 16 AUG 2011
  5. Manuscript Received: 25 JUL 2011

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Keywords:

  • diffuse large B-cell lymphoma;
  • central nervous system prophylaxis;
  • propensity score analysis;
  • health services research

Abstract

BACKGROUND:

Little is known about the utility of central nervous system (CNS) prophylaxis for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. The objective of this study was to characterize patterns of CNS prophylaxis for patients who received combined rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy using the National Comprehensive Cancer Network Non-Hodgkin Lymphoma Outcomes Database, a prospective cohort study that collects clinical and outcomes data for patients at 7 participating centers.

METHODS:

Patients who were eligible for this analysis presented with newly diagnosed DLBCL between January 2001 and July 2008, had no evidence of baseline CNS disease, and had received R-CHOP within 180 days of diagnosis. The authors assessed incidence and covariates of prophylaxis, prophylaxis modality, and, using propensity score analysis, outcomes such as overall survival.

RESULTS:

Of 989 eligible patients, 117 received CNS prophylaxis (11.8%), most intrathecally (71.8%). Involvement of bone marrow, other high-risk site, >1 extranodal site, higher International Prognostic Index score, and higher stage were associated individually with the receipt of prophylaxis (all P < .0001). At a median follow-up of 2.5 years, there were 20 CNS recurrences (2% [95% confidence interval, 1.1%-2.9%]) among all patients, and overall survival was not affected by prophylaxis.

CONCLUSIONS:

Given the overall low rate of CNS recurrence and lack of prophylaxis-associated survival benefit, the current data called into question the practice of CNS prophylaxis in the rituximab era. Cancer 2011. © 2011 American Cancer Society.

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