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Blood, 23 April 2009, Vol. 113, No. 17, pp. 3896-3902. Prepublished online as a Blood First Edition Paper on January 14, 2009; DOI 10.1182/blood-2008-10-182253. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2008-10-182253v1 113/17/3896    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Boehme, V. Articles by Pfreundschuh, M. Search for Related Content PubMed PubMed Citation Articles by Boehme, V. Articles by Pfreundschuh, M. Related Collections Free Research Articles Lymphoid Neoplasia Clinical Trials and Observations Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS 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) Volkmar Boehme*,1, Norbert Schmitz*,1, Samira Zeynalova2, Markus Loeffler2, and Michael Pfreundschuh3 1 Department of Hematology and Stem Cell Transplantation, Asklepios Hospital St Georg, Hamburg, Germany; 2 Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; and 3 Department of Internal Medicine I, Saarland University, Homburg/Saar, Germany 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. The original clinical trials are registered on www.clinicaltrials.gov as NCT000052936. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Intrathecal MTX for DLBCL: from an inappropriate prophylactic tradition to a medical error? Pierre-Yves Dietrich Blood 2009 114: 1999. [Full Text] [PDF] This article has been cited by other articles: D. Villa, J. M. Connors, T. N. Shenkier, R. D. Gascoyne, L. H. Sehn, and K. J. Savage Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: the impact of the addition of rituximab to CHOP chemotherapy Ann. Onc., October 27, 2009; (2009) mdp432v1. [Abstract] [Full Text] [PDF] E. Brusamolino First-line therapy of CD20+ diffuse large B-cell lymphoma: facts and open questions Haematologica, September 1, 2009; 94(9): 1194 - 1198. [Full Text] [PDF] P.-Y. Dietrich Intrathecal MTX for DLBCL: from an inappropriate prophylactic tradition to a medical error? Blood, August 27, 2009; 114(9): 1999 - 1999. [Full Text] [PDF] S. H. Bernstein, J. M. Unger, M. LeBlanc, J. Friedberg, T. P. Miller, and R. I. Fisher Reply to M.C. Chamberlain J. Clin. Oncol., July 20, 2009; 27(21): e27 - e28. [Full Text] [PDF]

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