Diffuse large XXXX with involvement of the kidney: outcome and risk of central nervous system relapse.

@entity1 @entity5 @entity3726 @entity262 @entity1892 @entity880
BACKGROUND: Renal involvement is uncommon in diffuse large @entity1892 . Recent data suggest that it is an independent risk factor for central nervous system relapse. We reviewed the clinical features, risk of central nervous system involvement, and survival of @entity1 with diffuse large @entity1892 with involvement of the kidney at diagnosis. DESIGN AND METHODS: All @entity1 with diffuse large @entity1892 and renal involvement diagnosed from January 1, 1982 to December 31, 2008 at the British @entity5 Agency were retrospectively identified in the @entity5 Database. @entity1 were included if they were 16 years old or over, had advanced stage disease [stage III/IV, or stage I/II with B symptoms or bulky mass (>10 cm)] and were treated with curative intent. Central nervous system involvement was diagnosed by cerebrospinal fluid cytology, radiology or clinically. RESULTS: We identified 55/2656 (2%) @entity1 with diffuse large @entity1892 and renal involvement at diagnosis. The male to female ratio was 2:1. The @entity1 ' median age was 58 years. Bilateral renal involvement was present in 24 (44%) and stage IV disease in 50 (91%). The International Prognostic Index score was 3, 4 or 5 in 52 (95%), the glomerular filtration rate was less than 30 mL/min/m   in 9 (16%) and elevated @entity880 dehydrogenase was recorded in 46 (84%). Twenty-five (46%) @entity1 received @entity3726 plus rituximab and 30 (54%) received @entity3726 -like regimens without rituximab. In total, 20 (36%) @entity1 had central nervous system involvement: four at the time of diagnosis and 16 at relapse. The median time to central nervous system relapse was 5.6 months (range, 1.2 months-4.6 years), and was not affected by the addition of rituximab (P=0.547). The 5-year overall and progression-free survival rates for the whole cohort were 29% and 25%, respectively. In @entity1 who received rituximab, there were trends towards improved 5-year overall survival (43% versus 18%, P=0.071) and progression-free survival (40% versus 13%, P=0.057). CONCLUSIONS: There is an exceptionally high incidence of central nervous system relapse in @entity1 with diffuse large @entity1892 at diagnosis. The addition of rituximab may improve overall survival in this poor-risk population, likely through improved control of @entity262 .
