What are the risk factors for CNS relapse in DLBCL?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

CNS relapse is a rare but significant complication in the management of patients with diffuse large B-cell lymphoma (DLBCL). It has been estimated that the probability of CNS relapse after 1 year of diagnosis is 2.3-4.5%. [139, 140] The risk of CNS relapse appears to be higher in subsets of DLBCL (4- to 15-fold increase in risk), and identification of such patients is imperative in an attempt to implement prophylactic therapy (ie, intrathecal chemotherapy).

Boehme et al retrospectively evaluated the incidence and risk factors of CNS recurrence in 1693 patients with aggressive lymphomas. [141] In a multivariate analysis, only an elevated lactate dehydrogenase (LDH) level at diagnosis and lymphoma involvement of 2 or more extranodal sites were identified as predictor factors for CNS relapse. Similar findings had been observed in patients receiving chemoimmunotherapy.

Boehme et al studied the factors associated with CNS relapse in patients treated with rituximab and the 14-day cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) (R-CHOP-14) regimen. In this retrospective study, the estimated 2-year incidence of CNS relapse was 6.9%. Using a Cox regression analysis, the investigators found that involvement of more than one extranodal site or the presence of B-symptoms was a predictor factor for CNS relapse. [141]


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