DESCRIPTION AND ANALYSIS OF 36 CENTRAL NERVOUS SYSTEM RELAPSE IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA WITHIN LYSA STUDIES
Author(s): ,
Sophie Bernard
Affiliations:
Hemato-oncology,Hôpital Saint Louis - APHP,PARIS,France
,
Lucie OBERIC
Affiliations:
Hematology,IUCT Oncopole,Toulouse,France
,
Julien LAZAROVICI
Affiliations:
Hematology,Institut Gustave Roussy IGR,Villejuif,France
,
Aurore PERROT
Affiliations:
Hematology,CHU Brabois,Vandoeuvre les Nancy ,France
,
KOEN VAN EYGEN
Affiliations:
Hematology,Kortrijk,Kortrijk,Belgium
,
Clementine SARKOZY
Affiliations:
Hematology,CHU Lyon Sud Pierre Benite,Lyon,France
,
Catherine SEBBAN
Affiliations:
Hematology,Centre Leon Berard,Lyon,France
,
Eric Van Den Neste
Affiliations:
hematology,UCL ,Louvains Saint Luc ,Belgium
,
Olivier FITOUSSI
Affiliations:
Hematology,Polyclinique Bordeaux Nord ,Bordeaux,France
,
Borhane SLAMA
Affiliations:
CH Avignon,Avignon,France
,
Yazid ARKAM
Affiliations:
hematology,CH Emile Muller,Mulhouse,France
Catherine THIEBLEMONT
Affiliations:
Hemato-oncology,Hôpital Saint Louis - APHP,PARIS,France
EHA Learning Center. BERNARD S. Jun 14, 2018; 216648
Sophie BERNARD
Sophie BERNARD

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Abstract
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Abstract: PB1759

Type: Publication Only

Background
Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is an uncommon event (2-5%) associated with a very poor prognosis. We present a descriptive analysis of characteristics and outcome of 36 patients who presented CNS relapse following their 1st line of treatment for a DLBCL treated prospectively in 7 LYSA Phase III trials (LNH03 / LNH07)/LNH09).

Aims
CNS relapse in the rituximab era is a rare event but with still a poor prognois. We proposed in this study to collect datas of patients with a CNS relapse and treated with RCHOP regimen to analyse pertinent clinical findings to improve diagnosis and therapeutic options in this population.   

Methods
We reviewed the records of 1885 patients with de novo DLBCL and included in 7 phase III LYSA studies between 2003 and 2009. 1615 patients younger than 80 were treated with CHOP +/- Rituximab and ACVBP +/- Rituximab, and 270 older than 80 were treated with miniCHOP-Rituximab. All patients with a documented CNS relapses (CSF analysis, MRI, CT-Scan) were collected and analysed.

Results
Median age of patients with CNS relapse was 71 (20-89).28 patients were under 80 years of age and were treated for 4 patients with R-ACVBP, and for 24 patients with RCHOP21/14. 8 patients were older than 80 years and were treated with RminiCHOP. At the initial diagnosis, 2 patients had a low risk CNS-IPI score (0-1), 15 an intermediate risk (2-3) and 17 patients presented a high risk (4-6) (2 unassessed patients). The median time to relapse was 247.5 days (93-781). At CNS relapse, 18 patients (50%) had parenchymal involvement, 16 had meningeal involvement (44%), 6 had epidural disease (17%), 1 had ocular involvement (2.8%), and 7 had two associated CNS lesions (19%). Treatment of this CNS relapse included methotrexate and / or aracytin high dose-based chemotherapy in 20 cases (56%) with 3 intensifications (8.3%), local treatment in 20 cases [intrathecal chemotherapy in 12 cases (33%) ; radiotherapy in 8 cases (22%)], and palliative treatment in 10 cases (28%). The median survival after CNS relapse was 86 days (2-3172), or 2.9 months. 2 patients (5.4%) had a survival greater than 2 years; in both cases patients had benefited of an autologous stem cell tranplantation (ASCT).

Conclusion
We confirm the poor prognosis of CNS relapses in DLBCL patients, as well as their early onset. An optimization of CNS relapses prophylaxis is essential in agressive lymphoma. The therapeutic management of CNS relapses is disparate and non-consensual, requiring the establishment of multicenter relapse therapy protocols adapted to these rare events.

Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): CNS, DLBCL, Relapse, Risk factor

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