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First-Line Treatment for Primary Breast Diffuse Large B-Cell Lymphoma Using Immunochemotherapy and Central Nervous System Prophylaxis: A Multicenter Phase 2 Trial

Authors
Yhim, Ho-YoungYoon, Dok HyunKim, Seok JinYang, Deok-HwanEom, Hyeon-SeokHa Kim, KyoungPark, YongKim, Jin SeokKim, Hyo JungSuh, CheolwonKim, Won SeogKwak, Jae-Yong
Issue Date
8월-2020
Publisher
MDPI
Keywords
central nervous system; diffuse large B-cell lymphoma; primary breast lymphoma; prophylaxis; rituximab
Citation
CANCERS, v.12, no.8
Indexed
SCIE
SCOPUS
Journal Title
CANCERS
Volume
12
Number
8
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/54248
DOI
10.3390/cancers12082192
ISSN
2072-6694
Abstract
There are limited data from prospective controlled trials regarding optimal treatment strategies in patients with primary breast diffuse large B-cell lymphoma (DLBCL). In this phase 2 study (NCT01448096), we examined the efficacy and safety of standard immunochemotherapy and central nervous system (CNS) prophylaxis using intrathecal methotrexate (IT-MTX). Thirty-three patients with newly diagnosed primary breast DLBCL received six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and four fixed doses of IT-MTX (12 mg). The median age was 50 years (range, 29-75), and all patients were females. According to the CNS-International Prognostic Index, most patients (n= 28) were categorized as the low-risk group. Among the 33 patients, 32 completed R-CHOP, and 31 completed IT-MTX as planned. With a median follow-up of 46.1 months (interquartile range (IQR), 31.1-66.8), the 2-year progression-free and overall survival rates were 81.3% and 93.5%, respectively. Six patients experienced treatment failures, which included the CNS in four patients (two parenchyma and two leptomeninges) and breast in two patients (one ipsilateral and one contralateral). The 2-year cumulative incidence of CNS relapse was 12.5%. Although standard R-CHOP and IT-MTX without routine radiotherapy show clinically meaningful survival outcomes, this strategy may not be optimal for reducing CNS relapse and warrants further investigation.
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