Central nervous system prophylaxis with intrathecal liposomal cytarabine in diffuse large B‑cell lymphomas

Abstract

Central nervous system (CNS) involvement is a serious and potentially fatal complication in patients with lymphoma because it is associated with a particularly poor prognosis (median progression‑free survival [PFS] of 4-6 months). Although CNS prophylaxis is considered necessary, there are no clear guidelines on identifying high‑risk patients or selecting treatment regimen. The aim of the study was to assess the safety and efficacy of CNS prophylaxis with intrathecal liposomal cytarabine. We analyzed the data of 79 patients (46 men and 33 women; median age, 48.5 years [20-79]) with diffuse large B‑cell lymphoma (83.5% of the patients) and primary mediastinal large B‑cell lymphoma (16.5%). Patients were treated in the departments of hematology in Kraków and Wrocław, Poland, between the years 2009-2012. They were considered to be at a high risk of developing CNS involvement associated with a lymphoma. Adverse reactions after intrathecal liposomal cytarabine were reported in 59 patients (74.7%); in 7 cases, the reactions were severe. The most common side effect was headache (67.1%). During antilymphoma therapy and prophylaxis, the functional status assessed by the Karnofsky score improved in 56 patients (70.9%) and remained unchanged in the remaining cases. A median follow‑up time did not exceed 28 months (range, 1.4-52.1); during follow‑up, neither median overall survival (OS) nor PFS were reached (projected OS and PFS at 48 months are 86.1% and 90.1%, respectively). Our results encourage the use of intrathecal liposomal cytarabine in CNS prophylaxis in patients with lymphoma.