dc.contributor.author | Gleeson, M | |
dc.contributor.author | Counsell, N | |
dc.contributor.author | Cunningham, D | |
dc.contributor.author | Chadwick, N | |
dc.contributor.author | Lawrie, A | |
dc.contributor.author | Hawkes, EA | |
dc.contributor.author | McMillan, A | |
dc.contributor.author | Ardeshna, KM | |
dc.contributor.author | Jack, A | |
dc.contributor.author | Smith, P | |
dc.contributor.author | Mouncey, P | |
dc.contributor.author | Pocock, C | |
dc.contributor.author | Radford, JA | |
dc.contributor.author | Davies, J | |
dc.contributor.author | Turner, D | |
dc.contributor.author | Kruger, A | |
dc.contributor.author | Johnson, P | |
dc.contributor.author | Gambell, J | |
dc.contributor.author | Linch, D | |
dc.date.accessioned | 2017-07-26T14:33:55Z | |
dc.date.issued | 2017-10 | |
dc.identifier.citation | Annals of oncology : official journal of the European Society for Medical Oncology, 2017, 28 (10), pp. 2511 - 2516 | |
dc.identifier.issn | 0923-7534 | |
dc.identifier.uri | https://repository.icr.ac.uk/handle/internal/745 | |
dc.identifier.eissn | 1569-8041 | |
dc.identifier.doi | 10.1093/annonc/mdx353 | |
dc.description.abstract | Background Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is associated with a dismal prognosis. Here, we report an analysis of CNS relapse for patients treated within the UK NCRI phase III R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) 14 versus 21 randomised trial.Patients and methods The R-CHOP 14 versus 21 trial compared R-CHOP administered two- versus three weekly in previously untreated patients aged ≥18 years with bulky stage I-IV DLBCL (n = 1080). Details of CNS prophylaxis were retrospectively collected from participating sites. The incidence and risk factors for CNS relapse including application of the CNS-IPI were evaluated.Results 177/984 patients (18.0%) received prophylaxis (intrathecal (IT) methotrexate (MTX) n = 163, intravenous (IV) MTX n = 2, prophylaxis type unknown n = 11 and IT MTX and cytarabine n = 1). At a median follow-up of 6.5 years, 21 cases of CNS relapse (isolated n = 11, with systemic relapse n = 10) were observed, with a cumulative incidence of 1.9%. For patients selected to receive prophylaxis, the incidence was 2.8%. Relapses predominantly involved the brain parenchyma (81.0%) and isolated leptomeningeal involvement was rare (14.3%). Univariable analysis demonstrated the following risk factors for CNS relapse: performance status 2, elevated lactate dehydrogenase, IPI, >1 extranodal site of disease and presence of a 'high-risk' extranodal site. Due to the low number of events no factor remained significant in multivariate analysis. Application of the CNS-IPI revealed a high-risk group (4-6 risk factors) with a 2- and 5-year incidence of CNS relapse of 5.2% and 6.8%, respectively.Conclusion Despite very limited use of IV MTX as prophylaxis, the incidence of CNS relapse following R-CHOP was very low (1.9%) confirming the reduced incidence in the rituximab era. The CNS-IPI identified patients at highest risk for CNS recurrence.Clinicaltrials.gov ISCRTN number 16017947 (R-CHOP14v21); EudraCT number 2004-002197-34. | |
dc.format | Print | |
dc.format.extent | 2511 - 2516 | |
dc.language | eng | |
dc.language.iso | eng | |
dc.rights.uri | https://creativecommons.org/licenses/by-nc/4.0 | |
dc.subject | Humans | |
dc.subject | Central Nervous System Neoplasms | |
dc.subject | Neoplasm Recurrence, Local | |
dc.subject | Cyclophosphamide | |
dc.subject | Vincristine | |
dc.subject | Doxorubicin | |
dc.subject | Prednisone | |
dc.subject | Antineoplastic Combined Chemotherapy Protocols | |
dc.subject | Drug Administration Schedule | |
dc.subject | Prospective Studies | |
dc.subject | Middle Aged | |
dc.subject | Female | |
dc.subject | Male | |
dc.subject | Lymphoma, Large B-Cell, Diffuse | |
dc.subject | Antibodies, Monoclonal, Murine-Derived | |
dc.subject | Rituximab | |
dc.title | Central nervous system relapse of diffuse large B-cell lymphoma in the rituximab era: results of the UK NCRI R-CHOP-14 versus 21 trial. | |
dc.type | Journal Article | |
dcterms.dateAccepted | 2017-07-16 | |
rioxxterms.funder | The Institute of Cancer Research | |
rioxxterms.identifier.project | Unspecified | |
rioxxterms.versionofrecord | 10.1093/annonc/mdx353 | |
rioxxterms.licenseref.uri | https://creativecommons.org/licenses/by-nc/4.0 | |
rioxxterms.licenseref.startdate | 2017-10 | |
rioxxterms.type | Journal Article/Review | |
dc.relation.isPartOf | Annals of oncology : official journal of the European Society for Medical Oncology | |
pubs.issue | 10 | |
pubs.notes | No embargo | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.) | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.) | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.publication-status | Published | |
pubs.volume | 28 | |
pubs.embargo.terms | No embargo | |
icr.researchteam | Medicine (RMH Smith Cunningham) | en_US |
dc.contributor.icrauthor | Cunningham, David | en |
dc.contributor.icrauthor | Marsden, | en |