Journal: Blood advances
Study type and population
- Retrospective cohort from two centers over 21 years
- 63 consecutive, previously untreated patients with synchronous systemic and de novo secondary CNS large B‑cell lymphoma
- Majority had diffuse large B‑cell lymphoma histology (73%)
Treatment and responses
- Most patients received ~6 cycles of R‑CHOP intercalated with high‑dose IV methotrexate (R‑CHOP‑M)
- Overall response rate: 84%
- Complete response rate: 75%
Outcomes (median follow-up 8.1 years)
- Median progression-free survival (PFS): 1.2 years
- 6‑year PFS: 37%
- Median overall survival (OS): 7.9 years
- 6‑year OS: 52%
Prognostic factors
- Better PFS associated with:
- Normal LDH
- Low International Prognostic Index (IPI)
- Brain parenchymal–only CNS disease
- Better OS associated with:
- Normal LDH
- Parenchymal CNS involvement (vs more extensive patterns)
Impact of consolidation with HDC/ASCT
- 25% of patients received high‑dose chemotherapy with autologous stem cell transplant consolidation
- This group had superior PFS and OS vs non‑transplant patients
- Benefit particularly notable in patients with IPI ≥3
Key implications for practice
- A meaningful proportion of patients with synchronous systemic and secondary CNS involvement can achieve long-term survival and likely cure with upfront R‑CHOP‑M, with or without HDC/ASCT.
- Normal LDH, low IPI, and isolated parenchymal CNS disease identify a more favorable subgroup and can aid in counseling and risk stratification.
- HDC/ASCT consolidation appears most valuable in higher‑risk patients (IPI ≥3).