Intravenous but not intrathecal central nervous system–directed chemotherapy improves survival in patients with testicular diffuse large B-cell lymphoma

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  • S. Mannisto, University of Helsinki Faculty of Medicine, Helsinki University Central Hospital
  • ,
  • P. Vähämurto, University of Helsinki Faculty of Medicine
  • ,
  • M. Pollari, University of Helsinki Faculty of Medicine, Heart Center, Tampere University Hospital, Tampere, Finland.
  • ,
  • M. R. Clausen
  • S. Jyrkkiö, Turku University Hospital
  • ,
  • P. L. Kellokumpu-Lehtinen, Heart Center, Tampere University Hospital, Tampere, Finland.
  • ,
  • P. Kovanen, Helsinki University Central Hospital
  • ,
  • M. L. Karjalainen-Lindsberg, Helsinki University Central Hospital
  • ,
  • F. d'Amore
  • S. Leppä, University of Helsinki Faculty of Medicine, Helsinki University Central Hospital

Background: Testicular lymphoma is a rare malignancy affecting mainly elderly men, the majority representing diffuse large B-cell lymphoma (DLBCL). Its relapse rate is higher than that of nodal DLBCL, often affecting the central nervous system (CNS)with dismal prognosis. Patients and methods: We searched for patients with testicular DLBCL (T-DLBCL)involvement from the pathology databases of Southern Finland University Hospitals and the Danish Lymphoma Registry. Clinical information was collected, and outcomes between treatment modalities were evaluated. Progression-free survival (PFS), disease-specific survival (DSS)and overall survival (OS)were assessed using Kaplan–Meier and Cox proportional hazards methods. Results: We identified 235 patients; of whom, 192 were treated with curative anthracycline-based chemotherapy. Full survival data were available for 189 patients. In univariate analysis, intravenous CNS-directed chemotherapy, and irradiation or orchiectomy of the contralateral testis translated into favourable PFS, DSS and OS, particularly among the elderly patients (each p ≤ 0.023). Intrathecal chemotherapy had no impact outcome. In multivariate analyses, the advantage of intravenous CNS-directed chemotherapy (hazard ration [HR]for OS, 0.419; 95% confidence interval [CI], 0.256–0.686; p = 0.001)and prophylactic treatment of contralateral testis (HR for OS, 0.514; 95% CI, 0.338–0.782; p = 0.002)was maintained. Rituximab improved survival only among high-risk patients (International Prognostic Index≥3, p = 0.019). The cumulative risk of CNS progression was 8.4% and did not differ between treatment modalities. Conclusion: The results support the use of CNS-directed chemotherapy and prophylactic treatment of the contralateral testis in patients with T-DLBCL involvement. Survival benefit appears resulting from better control of systemic disease rather than prevention of CNS progression.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Cancer
Vol/bind115
Sider (fra-til)27-36
Antal sider10
ISSN0959-8049
DOI
StatusUdgivet - 2019

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