Low rate of CNS recurrence in a cohort of 309 primary extranodal head and neck diffuse large B-cell lymphoma (HN-DLBCL) (IELSG 23)

Introduction: Head and neck is the second most common site of localized extranodal presentation of non-Hodgkin’s lymphomas and it is at high risk of CNS recurrence. Aim of the study: To evaluate the clinical outcome, prognostic factors and the rate of CNS recurrence in patients with HN-DLBCL. Patients and Methods: From December 1982 to June 2004, 309 patients with HN-DLBCL (median age 60 yrs, range 18–91) were referred to 9 international centers. The most common sites were Waldeyer’ring (68%), nose and paranasal sinuses (10%) and tyroid (8%). Adverse prognostic features included: stage II (67%), elevated LDH (16%), bulky disease (11%), No of extranodal sites >1(9%), B symptoms (8%), ECOG-PS >1 (8%) and stage-modified IPI (MIPI) >1 (50%). Two hundred sixty patients (84%) were given CHOP or CHOP-like regimen ± IFRT. Only few patients 26/260 (10%) received CNS prophylaxis (Methotrexate 12 mg i.t.; median of cycles 3, range 1–6). Results: Two hundred sixty two patients (85%) achieved a complete remission and 60 (23%) of them eventually relapsed, in the same site (40%), in other sites (53%) and 7% in both. Only 1/234 (0.4%) patients, who did not receive prophylaxis, relapsed in CNS. After a median followup of 42 months (range 6–220 months), 5-year estimate of OS, EFS and DFS was 72%, 55% and 73%, respectively. By Cox multivariate analysis, a risk factor >1 according to MIPI predicted a poor EFS. Conclusions: The present study showed a very low rate of CNS recurrence in high risk patients, who did not receive adequate prophylaxis, suggesting that CNS prophylaxis could not be mandatory in HN-DLBCL patients. This should be confirmed by prospective studies of clinical outcome.