%0 Journal Article %1 Boehme.2009 %A Boehme, Volkmar %A Schmitz, Norbert %A Zeynalova, Samira %A Loeffler, Markus %A Pfreundschuh, Michael %D 2009 %J Blood %K Aged Aged,_80_and_over Antibodies,_Monoclonal/adverse_effects/immunology/therapeutic_use Antibodies,_Monoclonal,_Murine-Derived Antineoplastic_Combined_Chemotherapy_Protocols/adverse_effects/therapeutic_use Central_Nervous_System_Diseases/chemically_induced/prevention_&_control Combined_Modality_Therapy Cyclophosphamide/adverse_effects/therapeutic_use Doxorubicin/adverse_effects/therapeutic_use Female Germany Humans Immunotherapy Lymphoma,_Non-Hodgkin/drug_therapy/immunology/pathology/radiotherapy Male Middle_Aged Prednisone/adverse_effects/therapeutic_use Risk_Factors Vincristine/adverse_effects/therapeutic_use %N 17 %P 3896–3902 %T CNS events in elderly patients with aggressive lymphoma treated with modern chemotherapy (CHOP-14) with or without rituximab: an analysis of patients treated in the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL) %V 113 %X One thousand two hundred twenty-two patients treated in the Rituximab with CHOP over age 60 years (RICOVER-60) trial were examined for central nervous system (CNS) disease developing during first-line therapy or after a complete or partial remission had been achieved. Patients received 6 or 8 courses of CHOP (cyclophosphamide, adriamycin, vincristine, prednisone) administered every 2 weeks (CHOP-14) with or without rituximab. CNS prophylaxis for patients with involvement of bone marrow, testes, upper neck, or head consisted of intrathecal (i.th.) methotrexate (days 1 and 5 of first 2 courses). Fifty-eight cases of lymphoma in the CNS were observed (36/609 patients in the CHOP-14 and 22/608 patients in the arituximab-CHOP-14 R-CHOP-14 arm). The estimated 2-year incidence of CNS disease was 6.9\% (confidence interval CI 4.5; 9.3) after CHOP-14 and 4.1\% (CI 2.3; 5.9) after R-CHOP-14. R-CHOP reduced the relative risk for CNS disease to 0.58 (95\% CI 0.3; 1.0, P = .046). Cox regression analysis identified \ïnvolvement of more than 1 extranodal site\\" and \\"B-symptoms\\" as significant risk factors for CNS disease. Patients treated with R-CHOP-14 did not show any benefit from i.th. methotrexate. We conclude that elderly patients with aggressive CD20-positive lymphoma show a significantly lower incidence of CNS disease if treated with R-CHOP-14 instead of CHOP-14. Intrathecal methotrexate has no role in preventing CNS disease for patients treated with combined immunochemotherapy (R-CHOP-14)--with the possible exception of patients with testicular involvement.

@article{Boehme.2009, abstract = {One thousand two hundred twenty-two patients treated in the Rituximab with CHOP over age 60 years (RICOVER-60) trial were examined for central nervous system (CNS) disease developing during first-line therapy or after a complete or partial remission had been achieved. Patients received 6 or 8 courses of CHOP (cyclophosphamide, adriamycin, vincristine, prednisone) administered every 2 weeks (CHOP-14) with or without rituximab. CNS prophylaxis for patients with involvement of bone marrow, testes, upper neck, or head consisted of intrathecal (i.th.) methotrexate (days 1 and 5 of first 2 courses). Fifty-eight cases of lymphoma in the CNS were observed (36/609 patients in the CHOP-14 and 22/608 patients in the arituximab-CHOP-14 [R-CHOP-14] arm). The estimated 2-year incidence of CNS disease was 6.9\% (confidence interval [CI] 4.5; 9.3) after CHOP-14 and 4.1\% (CI 2.3; 5.9) after R-CHOP-14. R-CHOP reduced the relative risk for CNS disease to 0.58 (95\% CI 0.3; 1.0, P = .046). Cox regression analysis identified \\"involvement of more than 1 extranodal site\\" and \\"B-symptoms\\" as significant risk factors for CNS disease. Patients treated with R-CHOP-14 did not show any benefit from i.th. methotrexate. We conclude that elderly patients with aggressive CD20-positive lymphoma show a significantly lower incidence of CNS disease if treated with R-CHOP-14 instead of CHOP-14. Intrathecal methotrexate has no role in preventing CNS disease for patients treated with combined immunochemotherapy (R-CHOP-14)--with the possible exception of patients with testicular involvement.}, added-at = {2014-10-15T15:03:40.000+0200}, author = {Boehme, Volkmar and Schmitz, Norbert and Zeynalova, Samira and Loeffler, Markus and Pfreundschuh, Michael}, biburl = {https://www.bibsonomy.org/bibtex/2e1d616af8725ea7606540460408ad742/drtester}, interhash = {93a08b24e4718a45c1e7627bc175eca9}, intrahash = {e1d616af8725ea7606540460408ad742}, journal = {Blood}, keywords = {Aged Aged,_80_and_over Antibodies,_Monoclonal/adverse_effects/immunology/therapeutic_use Antibodies,_Monoclonal,_Murine-Derived Antineoplastic_Combined_Chemotherapy_Protocols/adverse_effects/therapeutic_use Central_Nervous_System_Diseases/chemically_induced/prevention_&_control Combined_Modality_Therapy Cyclophosphamide/adverse_effects/therapeutic_use Doxorubicin/adverse_effects/therapeutic_use Female Germany Humans Immunotherapy Lymphoma,_Non-Hodgkin/drug_therapy/immunology/pathology/radiotherapy Male Middle_Aged Prednisone/adverse_effects/therapeutic_use Risk_Factors Vincristine/adverse_effects/therapeutic_use}, number = 17, pages = {3896–3902}, timestamp = {2014-10-15T15:03:40.000+0200}, title = {CNS events in elderly patients with aggressive lymphoma treated with modern chemotherapy (CHOP-14) with or without rituximab: an analysis of patients treated in the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL)}, volume = 113, year = 2009 }