Clinical and emerging biomarker factors associated with an increased risk of CNS relapse in DLBCL patients treated with R-CHOP(-like) chemotherapy
| . | Frequency . | 2 y risk CNS relapse . | Comment . |
|---|---|---|---|
| Clinical risk factors | |||
| High-risk CNS-IPI ≥4 | 12%-23% | 10%-12% | Robust CNS risk model; low specificity |
| Extranodal sites >2 | 9.5% | 15.3% | Greater specificity but lower sensitivity |
| High LDH >3× ULN | 6.7% | ∼30% | Estimated from Kaplan-Meier curve |
| Kidney/adrenal | 2% | ∼40% | Very high CNS risk with concurrent testicular involvement |
| Testicular | 5% | 10% (limited);24% (advanced) | Rituximab is not protective of CNS relapse |
| Uterine | 2% | 44% (4 y) | Independent risk factor; ovarian involvement is not a risk factor |
| Biomarkers | |||
| MYC+ BCL2+ DHIT | ∼5% | 13%-50% | Estimates highly variable depending on selection criteria |
| MYC+ BCL2+ DEs | ∼30% | All, 9.3%; CNS-IPI high, 22.7%; CNS-IPI intermediate, 11% | Independent risk factor of CNS-IPI |
| ABC DLBCL | All ∼30%-40% MYC+BCL2+(DE) MYC−BCL2−(non-DE) | 9.1% 15.3% 2.2% | Similar results with non-GCB DLBCL; impact mostly in DEs (MYC+BCL2+) |
| CD5+ DLBCL | 5%-10% | 12.7%* | Multivariate analysis not performed; only observed in a Japanese series |
| IgM paraprotein | 12.5% | 41%* | Multivariate analysis not performed |
| . | Frequency . | 2 y risk CNS relapse . | Comment . |
|---|---|---|---|
| Clinical risk factors | |||
| High-risk CNS-IPI ≥4 | 12%-23% | 10%-12% | Robust CNS risk model; low specificity |
| Extranodal sites >2 | 9.5% | 15.3% | Greater specificity but lower sensitivity |
| High LDH >3× ULN | 6.7% | ∼30% | Estimated from Kaplan-Meier curve |
| Kidney/adrenal | 2% | ∼40% | Very high CNS risk with concurrent testicular involvement |
| Testicular | 5% | 10% (limited);24% (advanced) | Rituximab is not protective of CNS relapse |
| Uterine | 2% | 44% (4 y) | Independent risk factor; ovarian involvement is not a risk factor |
| Biomarkers | |||
| MYC+ BCL2+ DHIT | ∼5% | 13%-50% | Estimates highly variable depending on selection criteria |
| MYC+ BCL2+ DEs | ∼30% | All, 9.3%; CNS-IPI high, 22.7%; CNS-IPI intermediate, 11% | Independent risk factor of CNS-IPI |
| ABC DLBCL | All ∼30%-40% MYC+BCL2+(DE) MYC−BCL2−(non-DE) | 9.1% 15.3% 2.2% | Similar results with non-GCB DLBCL; impact mostly in DEs (MYC+BCL2+) |
| CD5+ DLBCL | 5%-10% | 12.7%* | Multivariate analysis not performed; only observed in a Japanese series |
| IgM paraprotein | 12.5% | 41%* | Multivariate analysis not performed |
DEs, dual expressors.
Reported as frequency of CNS relapse.