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Detection and outcome of occult leptomeningeal disease in diffuse large B-cell lymphoma and Burkitt lymphoma Wilson, Wyndham H. Bromberg, Jacoline E.C. Stetler-Stevenson, Maryalice Steinberg, Seth M. Martin Martin, Lourdes Muñiz, Carmen Sancho, Juan Manuel Caballero García, María Dolores Davidis, Marjan A. Brooimans, Rik A. Sánchez González, Blanca Salar, Antonio González Barca, Eva Ribera, Josep Maria Shovlin, Margaret Filie, Armando Dunleavy, Kieron Mehrling, Thomas Spina, Michele Orfao, Alberto Limfomes Citometria de fluxe Lymphomas Flow cytometry The benefit of intrathecal therapy and systemic rituximab on the outcome of diffuse large B-cell lymphoma at risk of central nervous system disease is controversial. Furthermore, the effect of intrathecal treatment and rituximab in diffuse large B-cell and Burkitt lymphoma with occult leptomeningeal disease detected by flow cytometry at diagnosis is unknown. Untreated diffuse large B-cell (n=246) and Burkitt (n=80) lymphoma at clinical risk of central nervous system disease and having had pre-treatment cerebrospinal fluid were analyzed by flow cytometry and cytology. Spinal fluid involvement was detected by flow cytometry alone (occult) in 33 (13%) diffuse large B-cell and 9 (11%) Burkitt lymphoma patients, and detected by cytology in 11 (4.5%) and 5 (6%) patients, respectively. Diffuse large B-cell lymphoma with occult spinal fluid involvement had poorer survival (P=0.0001) and freedom from central nervous system relapse (P<0.0001) compared to negative cases. Burkitt lymphoma with occult spinal fluid involvement had an inferior freedom from central nervous system relapse (P=0.026) but not survival. The amount of intrathecal chemotherapy was quantitatively associated with survival in diffuse large B-cell lymphoma with (P=0.02) and without (P=0.001) occult spinal fluid involvement. However, progression of systemic disease and not control of central nervous system disease was the principal cause of treatment failure. In diffuse large B-cell lymphoma, systemic rituximab was associated with improved freedom from central nervous system relapse (P=0.003) but not with survival. Our results suggest that patients at risk of central nervous system disease should be evaluated by flow cytometry and that intrathecal prophylaxis/therapy is beneficial. 2018-11-08T14:26:48Z 2018-11-08T14:26:48Z 2014-07 2018-11-08T14:26:48Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Reproducció del document publicat a: https://doi.org/10.3324/haematol.2013.101741 Haematologica, 2014, vol. 99, num. 7, p. 1228-1235 https://doi.org/10.3324/haematol.2013.101741 (c) Ferrata Storti Foundation, 2014 info:eu-repo/semantics/openAccess Ferrata Storti Foundation Articles publicats en revistes (Ciències Clíniques)