Titre du document / Document title

Prophylactic intrathecal methotrexate and hydrocortisone reduces central nervous system recurrence and improves survival in aggressive non-Hodgkin lymphoma

Auteur(s) / Author(s)

TOMITA Naoto ⁽¹⁾ ; KODAMA Fumio ⁽²⁾ ; KANAMORI Heiwa ⁽¹⁾ ; MOTOMURA Shigeki ⁽²⁾ ; ISHIGATSUBO Yoshiaki ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ First Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, JAPON
⁽²⁾ Department of Chemotherapy, Kanagawa Cancer Center, Yokohama, JAPON

Résumé / Abstract

BACKGROUND. Central nervous system (CNS) recurrence is almost invariably fatal in patients with aggressive non-Hodgkin lymphoma (NHL). Although some protocols are intended to prevent CNS disease, the value of CNS prophylaxis in patients with aggressive NHL remains to be determined. METHODS. We retrospectively analyzed a cohort of 68 adults with NHL who had been treated uniformly with systemic chemotherapy and had attained complete remission (CR) of disease. Patients ranged in age from 15 to 77 years (median, 56 years). Median follow-up after CR was 40 months. After CR was attained, 29 patients (Group A) received CNS prophylaxis consisting of four doses of intrathecal methotrexate 10 mg/m² and hydrocortisone 15 mg/m² as soon as they could tolerate it. The other 39 patients (Group B) did not receive CNS prophylaxis. RESULTS. Although bulky mass (45% vs.21%, P = 0.03) was more frequent in Group A than in Group B, none of the patients in Group A experienced CNS recurrence (0%), whereas CNS recurrence occurred in six patients in Group B (15%). This difference was significant (P = 0.03). Multivariate logistic regression analysis for CNS recurrence identified no CNS prophylaxis (P = 0.01) and bone marrow involvement (P = 0.02) as independent predictors. Among patients without CNS disease, systemic recurrence occurred in 5 patients in Group A and in 11 patients in Group B (P = 0.12). The 5-year overall survival rate from CR was 80% in Group A and 58% in Group B (P = 0.05). The 5-year recurrence-free survival rate from CR was 85% in Group A and 51% in Group B (P = 0.01). CONCLUSIONS. Prophylactic intrathecal methotrexate and hydrocortisone injection reduces the incidence of CNS recurrence following CR in patients with aggressive NHL and improves the chance of long-term survival.

Revue / Journal Title

Cancer   ISSN 0008-543X   CODEN CANCAR 

Source / Source

2003, vol. 95, n^o3, pp. 576-580 (13 ref.)

Langue / Language

Anglais

Editeur / Publisher

Wiley-Liss, New York, NY, ETATS-UNIS  (1948) (Revue)

Mots-clés anglais / English Keywords

Nervous system diseases ; Central nervous system disease ; Lymphoproliferative syndrome ; Malignant hemopathy ; Human ; Prognosis ; Prevention ; Chemoprophylaxis ; Corticosteroid ; Glucocorticoid ; Hydrocortisone ; Drug combination ; Intrathecal administration ; Antineoplastic agent ; Antifolate ; Antimetabolic ; Methotrexate ; Relapse ; Central nervous system ; Tumorous infiltration ; High malignancy ; Non Hodgkin lymphoma ;

Mots-clés français / French Keywords

Système nerveux pathologie ; Système nerveux central pathologie ; Lymphoprolifératif syndrome ; Hémopathie maligne ; Homme ; Pronostic ; Prévention ; Chimioprophylaxie ; Corticostéroïde ; Glucocorticoïde ; Hydrocortisone ; Association médicamenteuse ; Voie intrarachidienne ; Anticancéreux ; Antifolate ; Antimétabolite ; Méthotrexate ; Récidive ; Système nerveux central ; Infiltration tumorale ; Haute malignité ; Lymphome non hodgkinien ;

Mots-clés espagnols / Spanish Keywords

Sistema nervioso patología ; Sistema nervosio central patología ; Linfoproliferativo síndrome ; Hemopatía maligna ; Hombre ; Pronóstico ; Prevención ; Quimioprofilaxis ; Corticoesteroide ; Glucocorticoide ; Hidrocortisona ; Asociación medicamentosa ; Vía intraraquídea ; Anticanceroso ; Antifolato ; Antimetabólito ; Metotrexato ; Recaida ; Sistema nervioso central ; Infiltración tumoral ; Alta malignidad ; Linfoma no Hodgkin ;

Localisation / Location

INIST-CNRS, Cote INIST : 2701, 35400010893338.0140