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Original Articles: Clinical

The standard international prognostic index for predicting the risk of CNS involvement in DLBCL without specific prophylaxis

Naoto TomitaBay-area Lymphoma Information Network, Tokyo, Japan; ;Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan; ;Department of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Correspondence[email protected]

Masahiro YokoyamaBay-area Lymphoma Information Network, Tokyo, Japan; ;Department of Hematology and Medical Oncology, Cancer Institute Hospital, Tokyo, Japan; ;Ganken Ariake Lymphoma Study Group, Tokyo, Japan;

Wataru YamamotoDepartment of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan;

Reina WatanabeDepartment of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan;

Yutaka ShimazuDepartment of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;

Yasufumi MasakiDepartment of Hematology and Immunology, Kanazawa Medical University, Kanazawa, Japan;

Saburo TsunodaDivision of Hematology, Tochigi Cancer Center, Utsunomiya, Japan;

Chizuko HashimotoDepartment of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan;

Kayoko MurayamaDepartment of Hematology, Gunma Cancer Center, Ota, Japan;

Takahiro YanoDivision of Hematology, Department of Internal Medicine, National Tokyo Medical Center, National Hospital Organization, Tokyo, Japan;

Rumiko OkamotoDepartment of Chemotherapy, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan;

Ako KikuchiDepartment of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan;

Kazuo TamuraDepartment of Medicine, Division of Medical Oncology, Hematology, and Infectious Diseases, School of Medicine, Fukuoka University, Fukuoka, Japan;

Kazuya SatoDivision of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan;

Kazutaka SunamiDepartment of Hematology, National Hospital Organization, Okayama Medical Center, Okayama, Japan;

Hirohiko ShibayamaDepartment of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan;

Rishu TakimotoFourth Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan;

Rika OhshimaDepartment of Hematology, Yokohama City University Medical Center, Yokohama, Japan;

Hiromichi TakahashiDepartment of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan;

Yukiyoshi MoriuchiDepartment of Internal Medicine, Sasebo City General Hospital, Sasebo, Japan;

Tomohiro KinoshitaDepartment of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan;

Masahide YamamotoDepartment of Hematology, Tokyo Medical and Dental University, Tokyo, Japan;

Ayumi NumataDepartment of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan;

Hideaki NakajimaDepartment of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan;

Ikuo MiuraDivision of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan;

Kengo TakeuchiBay-area Lymphoma Information Network, Tokyo, Japan; ;Ganken Ariake Lymphoma Study Group, Tokyo, Japan; ;Pathology Project for Molecular Targets, Cancer Institute Japanese Foundation for Cancer Research, Tokyo, Japan

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Abstract

Central nervous system (CNS) involvement is a serious complication in patients with diffuse large B-cell lymphoma (DLBCL) and evaluating CNS risk is an important issue. Using the standard international prognostic index (IPI) and CNS-IPI, a recently proposed model including IPI risk factors and adrenal/kidney involvement, we assessed CNS risk in 1220 untreated DLBCL patients who received R-CHOP without prophylaxis. According to the standard IPI, the cumulative incidences of CNS involvement at 2 years were 1.3, 4.6, 8.8, and 12.7% in the low-, low-intermediate-, high-intermediate-, and high-risk groups, respectively (p <.001). This result is comparable with that of the CNS-IPI. Patients with breast involvement tended to have lower risk according to the standard IPI but showed frequent CNS involvement, similar to patients with testis involvement. The standard IPI is also a useful predictor of CNS involvement. Patients with breast/testis involvement would be candidates for prophylaxis regardless of the standard IPI risk.

Keywords:

Acknowledgments

We are grateful to Yoshio Saburi (Oita Prefectural Hospital), Haruhisa Nagoshi (St. Marianna University School of Medicine Yokohama City Seibu Hospital), Jun Ishikawa (Osaka Medical Center for Cancer and Cardiovascular Diseases), Takaaki Miyake (Shimane University Hospital), Masaaki Noda (Hiroshima City Hospital), Takashi Okamura (Kurume University Hospital), Jun Takizawa (Niigata University Medical and Dental Hospital), Shingo Yano (Jikei University Hospital), Morio Matsumoto (Nishigunma National Hospital), Masanobu Nakata (Sapporo Hokuyu Hospital), Norio Yokose (Nippon Medical School Chiba Hokusoh Hospital), Masayuki Hino (Osaka City University Hospital), Takahiko Utsumi (Shiga Medical Center for Adults), Tomufumi Yano (Okayama Rosai Hospital), Nobuhiko Uoshima (Matsushita Memorial Hospital), Haruko Tashiro (Teikyo University Hospital), Yuji Kanisawa (Oji General Hospital), Yoshinori Tanaka (Yamaguchi University Hospital), Yoshimasa Kura (Kasukabe Municipal Hospital), Michiaki Koike (Juntendo University Shizuoka Hospital), Shiro Matsuura (Shizuoka Red Cross Hospital), Gou Aoki (Keiju Medical Center), Juichi Tanabe (Fujieda Municipal General Hospital), Sadaya Matano (Tonami General Hospital), Masanori Kume (Hiraka General Hospital), Tatsuyuki Hayashi (Tokyo Metropolitan Police Hospital), Kunio Hayashi (Hirakata Kohsai Hospital), and Takamasa Hayashi (Tenri Hospital).

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2017.1330541.

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The standard international prognostic index for predicting the risk of CNS involvement in DLBCL without specific prophylaxis

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The standard international prognostic index for predicting the risk of CNS involvement in DLBCL without specific prophylaxis

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