Aggressive craniofacial lymphoma in the pre-rituximab and rituximab era.

Abstract

8038 Background: Among 4,165 patients treated in trials of the German High Grade Non-Hodgkin Lymphoma Study Group (DSHNHL), 316 pts had craniofacial involvement by their lymphoma. Methods: To analyze clinical characteristics and response to therapy of 316 pts with craniofacial lymphomas treated with CHOP-like chemotherapy with and without rituximab (R). A retrospective analysis was performed to compare characteristics and treatment outcome of pts with craniofacial lymphoma to all the other pts of these trials. Results: Of the 316 pts, 32 had orbital, 101 paranasal sinus, 44 main nasal cavity, 109 mouth, 28 tongue and 57 salivary gland involvement. Pts with craniofacial lymphoma presented with a significantly lower LDH, better performance status, lower Ann Arbor Stage and less bulky disease compared to the entire population (elevated LDH: 16.8% vs. 35.9%, p=<0.001; ECOG >1: 2.8% vs. 10.1%, p=<0.001; stage III/IV: 28.2% vs. 40.7%, p=<0.001; bulky disease: 14.9% vs. 39.3%, p=<0.001). 3-year event free survival (70.4% vs. 60.5%, p=<0.001) and 3-year overall survival (81.2% vs. 75.6%; p=0.044) were better in pts with craniofacial involvement compared to the entire population of these trials. Multivariate analysis confirmed all IPI-relevant risk factors as significant and independent. With respect to different treatment strategies, the addition of rituximab to CHOP-14 in the RICOVER-60 trial reduced the relative risk to 0.6 for EFS and 0.5 for OS. This is clinically very relevant, but not significant due to the limited number of patients. In contrast, additive Rx to the craniofacial involvement for pts in CR/CRu or PR at the end chemo- or immunochemotherapy, which was given to 178 pts had no influence on the outcome of these pts compared to pts not receiving additive Rx (n=68). The relative risk for EFS was 1.0 (p=0.863) and 1.5 (p=0.315) for OS in patients receiving additional Rx compared to pts receiving systemic therapy only. Conclusions: Pts with craniofacial lymphoma present with favorable prognostic parameters and treatment results are better in this population compared to the whole population. Our results do not support the addition of radiotherapy to systemic therapy in these patients.