Impact of rituximab on incidence of and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: a systematic review and meta-analysis

Abstract

The impact of rituximab (R) on the incidence of central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is unclear. We performed a meta-analysis to explore the risk factors and assess the association between R-chemotherapy (R-chemo) and CNS relapse. We searched MEDLINE, PubMed, EMBASE and OVID for eligible studies. Published group statistics were extracted from each study for analysis; individual patient data from each study were not accessed. Fixed- or random-effects models were used to estimate the odds ratio (OR) with a 95% confidence interval (CI). Eight studies were identified. The OR for R-chemo compared with identical chemotherapy was 0.70 (95% CI 0.54–0.91). Stage III/IV (OR 2.25, 95% CI 1.64–3.08), International Prognostic Index (IPI) > 1 (OR 2.62, 95% CI 1.59–4.33), performance status (PS) > 1 (OR 1.67, 95% CI 1.23–2.27), elevated lactate dehydrogenase (LDH) (OR 2.23, 95% CI 1.54–3.22), bone marrow involvement (OR 2.85, 95% CI 1.99–4.07), more than one extranodal involvement (OR 2.61, 95% CI 1.93–3.54), presence of B symptoms (OR 1.87, 95% CI 1.37–2.56) and testicular involvement (OR 3.83, 95% CI 1.84–7.97) were associated with increased risks of CNS relapse. This meta-analysis demonstrated a lower incidence of CNS relapse of DLBCL in the rituximab era. The risk of CNS relapse can be assessed by stage, IPI, PS, LDH, presence of B symptoms, number of extranodal sites, bone marrow and testicular involvement.

Keywords::

• Rituximab
• central nervous system relapse
• diffuse large B-cell lymphoma
• risk factors
• meta-analysis

Potential conflict of interest:

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This study was funded by Grant No. 2008064 from the Scientific Fund of Shanghai Health Bureau and Grant No. 10ZR1405200 from the Shanghai Natural Science Fund.