Cargando…
Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience
Central nervous system (CNS) lymphomatosis is a fatal complication of aggressive non-Hodgkin lymphoma (NHL). In lymphoblastic or Burkitt lymphoma, without specific CNS prophylaxis the risk of CNS relapse is 20–30%. DLBCL has a lower risk of relapse (around 5%) but several factors increase its incide...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493300/ https://www.ncbi.nlm.nih.gov/pubmed/28665999 http://dx.doi.org/10.1371/journal.pone.0179595 |
_version_ | 1783247481198346240 |
---|---|
author | García-Recio, Marta Cladera, Antonia Bento, Leyre Dominguez, Julia Ruiz de Gracia, Silvia Sartori, Francesca Del Campo, Raquel García, Lucia Ballester, Carmen Gines, Jordi Bargay, Joan Sampol, Antonia Gutiérrez, Antonio |
author_facet | García-Recio, Marta Cladera, Antonia Bento, Leyre Dominguez, Julia Ruiz de Gracia, Silvia Sartori, Francesca Del Campo, Raquel García, Lucia Ballester, Carmen Gines, Jordi Bargay, Joan Sampol, Antonia Gutiérrez, Antonio |
author_sort | García-Recio, Marta |
collection | PubMed |
description | Central nervous system (CNS) lymphomatosis is a fatal complication of aggressive non-Hodgkin lymphoma (NHL). In lymphoblastic or Burkitt lymphoma, without specific CNS prophylaxis the risk of CNS relapse is 20–30%. DLBCL has a lower risk of relapse (around 5%) but several factors increase its incidence. There is no consensus or trials to conclude which is the best CNS prophylaxis. Best results seem to be associated with the use of intravenous (iv) high-dose methotrexate (HDMTX) but with a significant toxicity. Other options are the administration of intrathecal (IT) MTX, cytarabine or liposomal cytarabine (ITLC). Our aim is to analyze the experience of the centers of the Balearic Lymphoma Group (BLG) about the toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis. We retrospectively reviewed cases from 2005 to 2015 (n = 58) treated with ITLC. Our toxicity results were: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n = 26) with a median follow-up of 55 months (17–81) only 3 CNS relapses (11%) were observed (testicular DLBCL, Burkitt and plasmablastic lymphoma, with a cumulative incidence of 8%, 14% and 20% respectively). In the treatment cohort (n = 32), CSF complete clearance was obtained in 77% cases. Median OS was 6 months (0–16). Death causes were lymphoma progression (19 patients, 79%), treatment toxicity (2 patients) and non-related (3 patients, 12%). Toxicity profile was good especially when concomitant dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse in DLBCL group was similar to previously reported for HDMTX and much better than IT MTX. A high number of ITLC injections was associated with better rates of CSF clearance, clinical responses, PFS and lower relapses. Survival is still poor in CNS lymphomatosis and new therapeutic approaches are still needed. |
format | Online Article Text |
id | pubmed-5493300 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-54933002017-07-18 Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience García-Recio, Marta Cladera, Antonia Bento, Leyre Dominguez, Julia Ruiz de Gracia, Silvia Sartori, Francesca Del Campo, Raquel García, Lucia Ballester, Carmen Gines, Jordi Bargay, Joan Sampol, Antonia Gutiérrez, Antonio PLoS One Research Article Central nervous system (CNS) lymphomatosis is a fatal complication of aggressive non-Hodgkin lymphoma (NHL). In lymphoblastic or Burkitt lymphoma, without specific CNS prophylaxis the risk of CNS relapse is 20–30%. DLBCL has a lower risk of relapse (around 5%) but several factors increase its incidence. There is no consensus or trials to conclude which is the best CNS prophylaxis. Best results seem to be associated with the use of intravenous (iv) high-dose methotrexate (HDMTX) but with a significant toxicity. Other options are the administration of intrathecal (IT) MTX, cytarabine or liposomal cytarabine (ITLC). Our aim is to analyze the experience of the centers of the Balearic Lymphoma Group (BLG) about the toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis. We retrospectively reviewed cases from 2005 to 2015 (n = 58) treated with ITLC. Our toxicity results were: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n = 26) with a median follow-up of 55 months (17–81) only 3 CNS relapses (11%) were observed (testicular DLBCL, Burkitt and plasmablastic lymphoma, with a cumulative incidence of 8%, 14% and 20% respectively). In the treatment cohort (n = 32), CSF complete clearance was obtained in 77% cases. Median OS was 6 months (0–16). Death causes were lymphoma progression (19 patients, 79%), treatment toxicity (2 patients) and non-related (3 patients, 12%). Toxicity profile was good especially when concomitant dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse in DLBCL group was similar to previously reported for HDMTX and much better than IT MTX. A high number of ITLC injections was associated with better rates of CSF clearance, clinical responses, PFS and lower relapses. Survival is still poor in CNS lymphomatosis and new therapeutic approaches are still needed. Public Library of Science 2017-06-30 /pmc/articles/PMC5493300/ /pubmed/28665999 http://dx.doi.org/10.1371/journal.pone.0179595 Text en © 2017 García-Recio et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article García-Recio, Marta Cladera, Antonia Bento, Leyre Dominguez, Julia Ruiz de Gracia, Silvia Sartori, Francesca Del Campo, Raquel García, Lucia Ballester, Carmen Gines, Jordi Bargay, Joan Sampol, Antonia Gutiérrez, Antonio Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience |
title | Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience |
title_full | Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience |
title_fullStr | Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience |
title_full_unstemmed | Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience |
title_short | Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience |
title_sort | analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: the balearic lymphoma group experience |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493300/ https://www.ncbi.nlm.nih.gov/pubmed/28665999 http://dx.doi.org/10.1371/journal.pone.0179595 |
work_keys_str_mv | AT garciareciomarta analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT claderaantonia analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT bentoleyre analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT dominguezjulia analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT ruizdegraciasilvia analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT sartorifrancesca analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT delcamporaquel analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT garcialucia analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT ballestercarmen analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT ginesjordi analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT bargayjoan analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT sampolantonia analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience AT gutierrezantonio analysisoftheroleofintratecalliposomalcytarabineintheprophylaxisandtreatmentofcentralnervoussystemlymphomatosisthebaleariclymphomagroupexperience |