The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas.
Identifieur interne : 000330 ( Main/Exploration ); précédent : 000329; suivant : 000331The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas.
Auteurs : Niels Murawski [Allemagne] ; Gerhard Held [Allemagne] ; Marita Ziepert [Allemagne] ; Barbara Kempf [Allemagne] ; Andreas Viardot [Allemagne] ; Mathias H Nel [Allemagne] ; Mathias Witzens-Harig [Allemagne] ; Rolf Mahlberg [Allemagne] ; Christian Rübe ; Jochen Fleckenstein ; Carsten Zwick [Allemagne] ; Bertram Glass [Allemagne] ; Norbert Schmitz [Allemagne] ; Samira Zeynalova [Allemagne] ; Michael Pfreundschuh [Allemagne]Source :
- Blood [ 1528-0020 ] ; 2014.
Descripteurs français
- Wicri :
- geographic : Allemagne.
English descriptors
- KwdEn :
- Adolescent, Adult, Antibodies, Monoclonal, Murine-Derived (administration & dosage), Antineoplastic Combined Chemotherapy Protocols (administration & dosage), Central Nervous System Neoplasms (mortality), Central Nervous System Neoplasms (prevention & control), Disease-Free Survival, Facial Neoplasms (mortality), Facial Neoplasms (therapy), Female, Germany, Humans, Injections, Spinal, Lymphoma, B-Cell (mortality), Lymphoma, B-Cell (therapy), Male, Methotrexate (administration & dosage), Middle Aged, Radiotherapy, Rituximab, Skull Neoplasms (mortality), Skull Neoplasms (therapy), Survival Rate.
- MESH :
- chemical , administration & dosage : Antibodies, Monoclonal, Murine-Derived, Methotrexate.
- geographic : Germany, Rituximab.
- administration & dosage : Antineoplastic Combined Chemotherapy Protocols.
- mortality : Central Nervous System Neoplasms, Facial Neoplasms, Lymphoma, B-Cell, Skull Neoplasms.
- prevention & control : Central Nervous System Neoplasms.
- therapy : Facial Neoplasms, Lymphoma, B-Cell, Skull Neoplasms.
- Adolescent, Adult, Disease-Free Survival, Female, Humans, Injections, Spinal, Male, Middle Aged, Radiotherapy, Survival Rate.
Abstract
To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system (CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patients who did not (P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study.
DOI: 10.1182/blood-2013-10-535021
PubMed: 24939657
Affiliations:
- Allemagne
- Bade-Wurtemberg, District de Karlsruhe, District de Leipzig, District de Tübingen, Hambourg, Saxe (Land)
- Hambourg, Heidelberg, Leipzig, Ulm
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Le document en format XML
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type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Held, Gerhard" sort="Held, Gerhard" uniqKey="Held G" first="Gerhard" last="Held">Gerhard Held</name><affiliation wicri:level="3"><nlm:affiliation>Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinik Innere Medizin I, Saarland University Medical School, Hamburg</wicri:regionArea><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Ziepert, Marita" sort="Ziepert, Marita" uniqKey="Ziepert M" first="Marita" last="Ziepert">Marita Ziepert</name><affiliation wicri:level="3"><nlm:affiliation>Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Kempf, Barbara" sort="Kempf, Barbara" uniqKey="Kempf B" first="Barbara" last="Kempf">Barbara Kempf</name><affiliation wicri:level="1"><nlm:affiliation>Klinikum Landshut, Landshut, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinikum Landshut, Landshut</wicri:regionArea><wicri:noRegion>Landshut</wicri:noRegion><wicri:noRegion>Landshut</wicri:noRegion><wicri:noRegion>Landshut</wicri:noRegion></affiliation></author><author><name sortKey="Viardot, Andreas" sort="Viardot, Andreas" uniqKey="Viardot A" first="Andreas" last="Viardot">Andreas Viardot</name><affiliation wicri:level="3"><nlm:affiliation>Universitätsklinikum Ulm, Ulm, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Universitätsklinikum Ulm, Ulm</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Tübingen</region><settlement type="city">Ulm</settlement></placeName></affiliation></author><author><name sortKey="H Nel, Mathias" sort="H Nel, Mathias" uniqKey="H Nel M" first="Mathias" last="H Nel">Mathias H Nel</name><affiliation wicri:level="1"><nlm:affiliation>Klinikum Chemnitz, Chemnitz, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinikum Chemnitz, Chemnitz</wicri:regionArea><wicri:noRegion>Chemnitz</wicri:noRegion><wicri:noRegion>Chemnitz</wicri:noRegion><wicri:noRegion>Chemnitz</wicri:noRegion></affiliation></author><author><name sortKey="Witzens Harig, Mathias" sort="Witzens Harig, Mathias" uniqKey="Witzens Harig M" first="Mathias" last="Witzens-Harig">Mathias Witzens-Harig</name><affiliation wicri:level="3"><nlm:affiliation>Medizinische Klinik V, Heidelberg University, Heidelberg, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Klinik V, Heidelberg University, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Mahlberg, Rolf" sort="Mahlberg, Rolf" uniqKey="Mahlberg R" first="Rolf" last="Mahlberg">Rolf Mahlberg</name><affiliation wicri:level="1"><nlm:affiliation>Klinikum Mutterhaus der Borromäerinnen, Trier, Trier, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinikum Mutterhaus der Borromäerinnen, Trier, Trier</wicri:regionArea><wicri:noRegion>Trier</wicri:noRegion><wicri:noRegion>Trier</wicri:noRegion><wicri:noRegion>Trier</wicri:noRegion></affiliation></author><author><name sortKey="Rube, Christian" sort="Rube, Christian" uniqKey="Rube C" first="Christian" last="Rübe">Christian Rübe</name><affiliation><nlm:affiliation>Klinik für Strahlentherapie, Saarland University Medical School, Hamburg, Germany; and.</nlm:affiliation><wicri:noCountry code="subField">Germany; and</wicri:noCountry></affiliation></author><author><name sortKey="Fleckenstein, Jochen" sort="Fleckenstein, Jochen" uniqKey="Fleckenstein J" first="Jochen" last="Fleckenstein">Jochen Fleckenstein</name><affiliation><nlm:affiliation>Klinik für Strahlentherapie, Saarland University Medical School, Hamburg, Germany; and.</nlm:affiliation><wicri:noCountry code="subField">Germany; and</wicri:noCountry></affiliation></author><author><name sortKey="Zwick, Carsten" sort="Zwick, Carsten" uniqKey="Zwick C" first="Carsten" last="Zwick">Carsten Zwick</name><affiliation wicri:level="3"><nlm:affiliation>Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinik Innere Medizin I, Saarland University Medical School, Hamburg</wicri:regionArea><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Glass, Bertram" sort="Glass, Bertram" uniqKey="Glass B" first="Bertram" last="Glass">Bertram Glass</name><affiliation wicri:level="3"><nlm:affiliation>Asklepios-Klinik St. Georg, Hamburg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Asklepios-Klinik St. Georg, Hamburg</wicri:regionArea><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Schmitz, Norbert" sort="Schmitz, Norbert" uniqKey="Schmitz N" first="Norbert" last="Schmitz">Norbert Schmitz</name><affiliation wicri:level="3"><nlm:affiliation>Asklepios-Klinik St. Georg, Hamburg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Asklepios-Klinik St. Georg, Hamburg</wicri:regionArea><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Zeynalova, Samira" sort="Zeynalova, Samira" uniqKey="Zeynalova S" first="Samira" last="Zeynalova">Samira Zeynalova</name><affiliation wicri:level="3"><nlm:affiliation>Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Pfreundschuh, Michael" sort="Pfreundschuh, Michael" uniqKey="Pfreundschuh M" first="Michael" last="Pfreundschuh">Michael Pfreundschuh</name><affiliation wicri:level="3"><nlm:affiliation>Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinik Innere Medizin I, Saarland University Medical School, Hamburg</wicri:regionArea><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author></analytic><series><title level="j">Blood</title><idno type="eISSN">1528-0020</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Antibodies, Monoclonal, Murine-Derived (administration & dosage)</term><term>Antineoplastic Combined Chemotherapy Protocols (administration & dosage)</term><term>Central Nervous System Neoplasms (mortality)</term><term>Central Nervous System Neoplasms (prevention & control)</term><term>Disease-Free Survival</term><term>Facial Neoplasms (mortality)</term><term>Facial Neoplasms (therapy)</term><term>Female</term><term>Germany</term><term>Humans</term><term>Injections, Spinal</term><term>Lymphoma, B-Cell (mortality)</term><term>Lymphoma, B-Cell (therapy)</term><term>Male</term><term>Methotrexate (administration & dosage)</term><term>Middle Aged</term><term>Radiotherapy</term><term>Rituximab</term><term>Skull Neoplasms (mortality)</term><term>Skull Neoplasms (therapy)</term><term>Survival Rate</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antibodies, Monoclonal, Murine-Derived</term><term>Methotrexate</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Germany</term><term>Rituximab</term></keywords><keywords scheme="MESH" qualifier="administration & dosage" xml:lang="en"><term>Antineoplastic Combined Chemotherapy Protocols</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Central Nervous System Neoplasms</term><term>Facial Neoplasms</term><term>Lymphoma, B-Cell</term><term>Skull Neoplasms</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Central Nervous System Neoplasms</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Facial Neoplasms</term><term>Lymphoma, B-Cell</term><term>Skull Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Disease-Free Survival</term><term>Female</term><term>Humans</term><term>Injections, Spinal</term><term>Male</term><term>Middle Aged</term><term>Radiotherapy</term><term>Survival Rate</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Allemagne</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system (CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patients who did not (P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study.</div></front></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Bade-Wurtemberg</li><li>District de Karlsruhe</li><li>District de Leipzig</li><li>District de Tübingen</li><li>Hambourg</li><li>Saxe (Land)</li></region><settlement><li>Hambourg</li><li>Heidelberg</li><li>Leipzig</li><li>Ulm</li></settlement></list><tree><noCountry><name sortKey="Fleckenstein, Jochen" sort="Fleckenstein, Jochen" uniqKey="Fleckenstein J" first="Jochen" last="Fleckenstein">Jochen Fleckenstein</name><name sortKey="Rube, Christian" sort="Rube, Christian" uniqKey="Rube C" first="Christian" last="Rübe">Christian Rübe</name></noCountry><country name="Allemagne"><region name="Hambourg"><name sortKey="Murawski, Niels" sort="Murawski, Niels" uniqKey="Murawski N" first="Niels" last="Murawski">Niels Murawski</name></region><name sortKey="Glass, Bertram" sort="Glass, Bertram" uniqKey="Glass B" first="Bertram" last="Glass">Bertram Glass</name><name sortKey="H Nel, Mathias" sort="H Nel, Mathias" uniqKey="H Nel M" first="Mathias" last="H Nel">Mathias H Nel</name><name sortKey="Held, Gerhard" sort="Held, Gerhard" uniqKey="Held G" first="Gerhard" last="Held">Gerhard Held</name><name sortKey="Kempf, Barbara" sort="Kempf, Barbara" uniqKey="Kempf B" first="Barbara" last="Kempf">Barbara Kempf</name><name sortKey="Mahlberg, Rolf" sort="Mahlberg, Rolf" uniqKey="Mahlberg R" first="Rolf" last="Mahlberg">Rolf Mahlberg</name><name sortKey="Pfreundschuh, Michael" sort="Pfreundschuh, Michael" uniqKey="Pfreundschuh M" first="Michael" last="Pfreundschuh">Michael Pfreundschuh</name><name sortKey="Schmitz, Norbert" sort="Schmitz, Norbert" uniqKey="Schmitz N" first="Norbert" last="Schmitz">Norbert Schmitz</name><name sortKey="Viardot, Andreas" sort="Viardot, Andreas" uniqKey="Viardot A" first="Andreas" last="Viardot">Andreas Viardot</name><name sortKey="Witzens Harig, Mathias" sort="Witzens Harig, Mathias" uniqKey="Witzens Harig M" first="Mathias" last="Witzens-Harig">Mathias Witzens-Harig</name><name sortKey="Zeynalova, Samira" sort="Zeynalova, Samira" uniqKey="Zeynalova S" first="Samira" last="Zeynalova">Samira Zeynalova</name><name sortKey="Ziepert, Marita" sort="Ziepert, Marita" uniqKey="Ziepert M" first="Marita" last="Ziepert">Marita Ziepert</name><name sortKey="Zwick, Carsten" sort="Zwick, Carsten" uniqKey="Zwick C" first="Carsten" last="Zwick">Carsten Zwick</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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