Central nervous system international prognostic index impacts overall survival in diffuse large b-cell lymphoma treated with r-chop in a third level cancer center from Mexico: a survey of 642 patients

Background: Central nervous system international prognosis index (CNS-IPI) is validated in European and the USA cancer databases. However, no validation has been done in Mexican population. Objective: The objective of the study was to assess the impact of the CNS-IPI on central nervous system (CNS) relapse and survival in Mexican patients with diffuse large B-cell lymphoma (DLBCL). Methods: In this retrospective analysis, clinical, biochemical, and histological variables and the CNS-IPI were analyzed. Results: Six hundred and forty-two patients with DBLCL were included in the study. The mean ± SD age was 56.8 ± 14.9 years. Most had an ECOG of 0-1: 75% (n = 484) had absence of B-symptoms and advanced disease (clinical stage: III-IV, n = 433, 67.4%). According to the CNS-IPI, almost one-half were in the low-risk category. According to the CNS-IPI, CNS relapse rate was 1.36% (95% CI: 83.2-92.8), 3.1% (95% CI: 132.4-162.8), and 7.4% (95% CI 61-91) for patients in the low-, intermediate-, and high-risk categories, respectively. The median overall survival in the high-risk group (CNS-IPI) was 22 months, and it has not been achieved after 80 months of follow-up for the other groups. Conclusions: CNS-IPI was associated with survival; therefore, we propose its use as a prognostic tool for prospective validation.

Patterns of Relapse and Survival for Neuroblastoma / 대한소아혈액종양학회지

PURPOSE: Nowadays, survival of neuroblastoma patients has improved by high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT). But, many of these patients experienced treatment failure, and relapse was the most important factor of treatment failure. The aim of this study was to investigate the relation between pattern of relapse and survival of neuroblastoma for 10 years. METHODS: Fifty nine neuroblastoma patients were enrolled in the study. Retrospective investigation of medical records was performed. RESULTS: Twenty two patients experienced relapse among total 59 patients. Two patients had relapse two times, and another two patients had two or more relpase sites. Median time from diagnosis to relapse is 16.8 months (2~40 months). According to International Neuroblastoma Staging System (INSS), stage of patients with relapse at diagnosis is as follows; Stage II-2 patients, Stage III-4 patients, and Stage IV-16 patients. 11 patients received high dose chemotherapy followed by autologous PBSCT, and 7 patients (63.6%) of them experienced relapse. 48 patients received only chemotherapy, and 17 patients (35.4%) of them experienced relapse. Sites of relapse are as follows; central nervous system (CNS) 6 patients (22.2%), primary site 4 patients (14.8%), bone 4 patients (14.8%), bone marrow 4 patients (14.8%), distant lymph node 2 patients (7.4%), liver 2 patients (7.4%), and others 5 patients (18.5%). CONCLUSION: In this study, relapses were observed in about 37% of cases. And, the more relapse, the lesser survivals are observed. Although this single institution result had limitation to generalize, CNS was the most common site of relapse. However, multi-center study for relapse sites of neuroblastoma should be evaluated further.

The CNS Relapse of the Acute Lymphoblastic Leukemia: Radiotherapy Results / 대한치료방사선과학회지

PURPOSE: To assess the efficacy of craniospinal radiotherapy in patients with acute lymphoblastic leukemia (ALL) experiencing the CNS relapse. MATERIALS AND METHODS: Thirty ALL patients with relapse in the central nervous system(CNS) were treated with radiotherapy and intrathecal chemotherapy. Age ranged 2 to 46. The number of males and females were all 15. Twenty-two cases were previously treated with presymptomatic radiotherapy to the whole brain. The extent of radiotherapy was the whole brain (18-24 Gy) and the whole spine (12 Gy) in 21 cases but the whole brain only in the 9 cases with poor performance. RESULTS: The complete remission rate in the CNS was 10%. Among the 12 cases(40%) who had secondary relapse, 9 cases had the bone marrow relapse alone, 2 cases had the CNS and bone marrow relapse, 1 case had the CNS relapse alone. Higher CNS remission rate was observed when the initial remission duration was longer than 24 months or radiation was delivered to the whole brain and the whole spine. Survival rate at 2 year was 31.6%. Remission duration in the 10 living patients ranged from 9 to 87 months(median ; 58 months). CONCLUSION: The whole craniospinal area should be included in the radiotherapy port for the effective control of CNS relapse in ALL cases

The CNS Relapse of the Acute Lymphoblastic Leukemia: Radiotherapy Results / 대한치료방사선과학회지

PURPOSE: To assess the efficacy of craniospinal radiotherapy in patients with acute lymphoblastic leukemia (ALL) experiencing the CNS relapse. MATERIALS AND METHODS: Thirty ALL patients with relapse in the central nervous system(CNS) were treated with radiotherapy and intrathecal chemotherapy. Age ranged 2 to 46. The number of males and females were all 15. Twenty-two cases were previously treated with presymptomatic radiotherapy to the whole brain. The extent of radiotherapy was the whole brain (18-24 Gy) and the whole spine (12 Gy) in 21 cases but the whole brain only in the 9 cases with poor performance. RESULTS: The complete remission rate in the CNS was 10%. Among the 12 cases(40%) who had secondary relapse, 9 cases had the bone marrow relapse alone, 2 cases had the CNS and bone marrow relapse, 1 case had the CNS relapse alone. Higher CNS remission rate was observed when the initial remission duration was longer than 24 months or radiation was delivered to the whole brain and the whole spine. Survival rate at 2 year was 31.6%. Remission duration in the 10 living patients ranged from 9 to 87 months(median ; 58 months). CONCLUSION: The whole craniospinal area should be included in the radiotherapy port for the effective control of CNS relapse in ALL cases