Frequency, risk factors, and outcomes of central nervous system relapse in lymphoma patients treated with dose-adjusted EPOCH plus rituximab

Mary Kate Malecek, Adam M. Petrich, Shaina Rozell, Benjamin Chu, Steven Trifilio, Natalie Galanina, Matthew Maurer, Umar Farooq, Brian K. Link, Grzegorz S Nowakowski, Chadi Nabhan, Ayed O. Ayed

Research output: Contribution to journalArticle

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Abstract

Background: Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) is a rare but serious complication that carries a poor prognosis. The use of infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) for frontline treatment of diffuse large B cell lymphoma (DLBCL) is increasing, though little is known about incidence of and risk factors for CNS relapse with this regimen Patients and methods: We completed a chart review of patients with NHL who received EPOCH-R as front line therapy. Data obtained included baseline and treatment characteristics including if patients received CNS directed therapy. We measured overall survival (OS), progression free survival (PFS), and progression to CNS involvement. Results: We identified 223 patients who met the inclusion criteria, 72% had DLBCL. Of all the patients, 5.8% experienced CNS relapse, and 38.6% were treated with CNS prophylaxis. There was no difference in rate of CNS relapse, OS, or PFS between patients who had and had not received CNS prophylaxis. Patients whose serum lactate dehydrogenase was greater than twice the upper limit of normal at diagnosis and those with extranodal disease were significantly more likely to have CNS relapse (P=.0247 and 0.022, respectively) than their counterparts. Conclusions: The rate of CNS relapse in this patient population approaches 6%, not significantly different from reports on those receiving R-CHOP. The results of this study suggest that CNS prophylaxis might be more selectively used among patients treated with EPOCH-R with certain high-risk features.

Original languageEnglish (US)
JournalAmerican Journal of Hematology
DOIs
StateAccepted/In press - 2017

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Lymphoma
Central Nervous System
Recurrence
Vincristine
Etoposide
Prednisone
Doxorubicin
Cyclophosphamide
Lymphoma, Large B-Cell, Diffuse
Non-Hodgkin's Lymphoma
Disease-Free Survival
Rituximab
Survival
Therapeutics
L-Lactate Dehydrogenase
Incidence
Serum

ASJC Scopus subject areas

  • Hematology

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Frequency, risk factors, and outcomes of central nervous system relapse in lymphoma patients treated with dose-adjusted EPOCH plus rituximab. / Malecek, Mary Kate; Petrich, Adam M.; Rozell, Shaina; Chu, Benjamin; Trifilio, Steven; Galanina, Natalie; Maurer, Matthew; Farooq, Umar; Link, Brian K.; Nowakowski, Grzegorz S; Nabhan, Chadi; Ayed, Ayed O.

In: American Journal of Hematology, 2017.

Research output: Contribution to journalArticle

Malecek, Mary Kate ; Petrich, Adam M. ; Rozell, Shaina ; Chu, Benjamin ; Trifilio, Steven ; Galanina, Natalie ; Maurer, Matthew ; Farooq, Umar ; Link, Brian K. ; Nowakowski, Grzegorz S ; Nabhan, Chadi ; Ayed, Ayed O. / Frequency, risk factors, and outcomes of central nervous system relapse in lymphoma patients treated with dose-adjusted EPOCH plus rituximab. In: American Journal of Hematology. 2017.
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abstract = "Background: Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) is a rare but serious complication that carries a poor prognosis. The use of infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) for frontline treatment of diffuse large B cell lymphoma (DLBCL) is increasing, though little is known about incidence of and risk factors for CNS relapse with this regimen Patients and methods: We completed a chart review of patients with NHL who received EPOCH-R as front line therapy. Data obtained included baseline and treatment characteristics including if patients received CNS directed therapy. We measured overall survival (OS), progression free survival (PFS), and progression to CNS involvement. Results: We identified 223 patients who met the inclusion criteria, 72{\%} had DLBCL. Of all the patients, 5.8{\%} experienced CNS relapse, and 38.6{\%} were treated with CNS prophylaxis. There was no difference in rate of CNS relapse, OS, or PFS between patients who had and had not received CNS prophylaxis. Patients whose serum lactate dehydrogenase was greater than twice the upper limit of normal at diagnosis and those with extranodal disease were significantly more likely to have CNS relapse (P=.0247 and 0.022, respectively) than their counterparts. Conclusions: The rate of CNS relapse in this patient population approaches 6{\%}, not significantly different from reports on those receiving R-CHOP. The results of this study suggest that CNS prophylaxis might be more selectively used among patients treated with EPOCH-R with certain high-risk features.",
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T1 - Frequency, risk factors, and outcomes of central nervous system relapse in lymphoma patients treated with dose-adjusted EPOCH plus rituximab

AU - Malecek, Mary Kate

AU - Petrich, Adam M.

AU - Rozell, Shaina

AU - Chu, Benjamin

AU - Trifilio, Steven

AU - Galanina, Natalie

AU - Maurer, Matthew

AU - Farooq, Umar

AU - Link, Brian K.

AU - Nowakowski, Grzegorz S

AU - Nabhan, Chadi

AU - Ayed, Ayed O.

PY - 2017

Y1 - 2017

N2 - Background: Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) is a rare but serious complication that carries a poor prognosis. The use of infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) for frontline treatment of diffuse large B cell lymphoma (DLBCL) is increasing, though little is known about incidence of and risk factors for CNS relapse with this regimen Patients and methods: We completed a chart review of patients with NHL who received EPOCH-R as front line therapy. Data obtained included baseline and treatment characteristics including if patients received CNS directed therapy. We measured overall survival (OS), progression free survival (PFS), and progression to CNS involvement. Results: We identified 223 patients who met the inclusion criteria, 72% had DLBCL. Of all the patients, 5.8% experienced CNS relapse, and 38.6% were treated with CNS prophylaxis. There was no difference in rate of CNS relapse, OS, or PFS between patients who had and had not received CNS prophylaxis. Patients whose serum lactate dehydrogenase was greater than twice the upper limit of normal at diagnosis and those with extranodal disease were significantly more likely to have CNS relapse (P=.0247 and 0.022, respectively) than their counterparts. Conclusions: The rate of CNS relapse in this patient population approaches 6%, not significantly different from reports on those receiving R-CHOP. The results of this study suggest that CNS prophylaxis might be more selectively used among patients treated with EPOCH-R with certain high-risk features.

AB - Background: Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) is a rare but serious complication that carries a poor prognosis. The use of infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) for frontline treatment of diffuse large B cell lymphoma (DLBCL) is increasing, though little is known about incidence of and risk factors for CNS relapse with this regimen Patients and methods: We completed a chart review of patients with NHL who received EPOCH-R as front line therapy. Data obtained included baseline and treatment characteristics including if patients received CNS directed therapy. We measured overall survival (OS), progression free survival (PFS), and progression to CNS involvement. Results: We identified 223 patients who met the inclusion criteria, 72% had DLBCL. Of all the patients, 5.8% experienced CNS relapse, and 38.6% were treated with CNS prophylaxis. There was no difference in rate of CNS relapse, OS, or PFS between patients who had and had not received CNS prophylaxis. Patients whose serum lactate dehydrogenase was greater than twice the upper limit of normal at diagnosis and those with extranodal disease were significantly more likely to have CNS relapse (P=.0247 and 0.022, respectively) than their counterparts. Conclusions: The rate of CNS relapse in this patient population approaches 6%, not significantly different from reports on those receiving R-CHOP. The results of this study suggest that CNS prophylaxis might be more selectively used among patients treated with EPOCH-R with certain high-risk features.

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