Risk of central nervous system relapse in non-Hodgkin lymphoma patients treated with EPOCH-R

The authors looked at relapses that occur in the central nervous system of patients with non-Hodgkin lymphoma who were treated with EPOCH chemotherapy and rituximab. The authors concluded that there is no increased risk of CNS relapse when treated with EPOCH-R compared with previous treatments. 

Many forms of non-Hodgkin lymphoma (NHL) are treatable. However, some patients will relapse. One rare but serious relapse type is central nervous system (CNS; brain and spinal cord) relapse. Patients who experience CNS relapse have poor outcomes. More research is needed on medication that may be able to prevent CNS relapse (prophylaxis).

The use of EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) chemotherapy regimen is increasing. It is most often used for patients with diffuse large B cell lymphoma (DLBCL), a type of NHL. More research is needed on the effects of EPOCH-R on CNS relapse. 

The medical records of 223 patients were reviewed. All patients had a type of NHL. All patients received EPOCH-R. 72% of patients had DLBCL. The average length of follow-up was

38.6% of patients were given some form of CNS relapse prophylaxis. The most common treatment was intrathecal (IT; medication delivered directly to spinal cord) methotrexate.

5.8% of patients (13 patients) experienced a CNS relapse.

The 4-year overall survival (time from treatment to death from any cause) was 72.6% for all patients. The 4-year overall survival for patients who received prophylaxis was 69.7% for patients who received prophylaxis. The 4-year overall survival for patients who did not receive prophylaxis was 74.1%. The difference was not significant.

The same proportion of patients experienced CNS relapse in both the prophylaxis and no prophylaxis groups (5.8%). 

The study concluded that EPOCH-R treatment does not increase risk of CNS relapse above previous therapies, and prophylaxis may be useful in patients at higher risk for CNS relapse. 

The difference between the overall survival of patients who received prophylaxis and those who did not was most likely due to the fact that patients who received prophylaxis were already at high risk of having a CNS relapse. Prophylaxis does not shorten overall survival.