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document
Outcome of CNS disease at diagnosis in disseminated small noncleaved-cell lymphoma and B-cell leukemia : a Children 's Cancer Group study . PURPOSE To examine the impact of initial CNS involvement on outcome and patterns of failure in patients with disseminated small noncleaved-cell lymphoma and B-cell leukemia who were treated in four successive Children 's Cancer Group trials . PATIENTS AND METHODS Of 462 patients with disseminated disease , 49 ( 10.6 % ) had CNS disease at diagnosis ( CNS+ ) . CNS disease included meningeal disease or CNS parenchymal masses with or without cranial neuropathies ( CSF+/Mass ; CNPs ) in 36 patients and isolated CNPs in 13 . Of the CNS+ patients , 28 had M2 ( 5 % to 25 % blasts ) or M3 ( > 25 % blasts ) bone marrow involvement . All patients received protocol-based systemic and intrathecal chemotherapy . Thirty-six patients also received CNS irradiation . RESULTS Relapses occurred in 21 ( 43 % ) of 49 patients , predominantly in the CNS ( 71 % ) and bone marrow ( 52 % ) . The 3-year event-free survival +/- SE for all patients with CNS+ disease was 45 % +/- 7 % . Patients with CSF+/Mass had a nominally higher treatment failure rate compared with patients with CNS- after adjusting for marrow status and lactate dehydrogenase ( LDH ) diagnosis , with a relative failure rate ( RFR ) of 1.52 ( 95 % confidence interval [ CI ] , 0.88 to 2.6 ; P =.15 ) . In comparison , the RFRs for patients with M2 or M3 marrow and for those with LDH levels greater than 500 IU/L after adjusting for CNS disease were 1.4 ( 95 % CI , 0.96 to 2.0 ; P =.029 ) and 2.2 ( 95 % CI , 1.5 to 3.0 ; P < .001 ) , respectively . The RFR for patients with isolated CNPs was 0.87 ( 95 % CI , 0.36 to 2.1 ; P =.76 ) . CONCLUSION We conclude that , with the treatments used during the period covered by these studies , the presence of CSF+/Mass CNS disease at diagnosis was associated with a nominally worse outcome independent of initial bone marrow status and LDH level , but the effect was not statistically significant .
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Intervention_Other
Children 's Cancer Group trials
3559
Intervention_Pharmacological
protocol-based systemic and intrathecal chemotherapy
3560
Intervention_Physical
CNS irradiation
3561
Outcome_Physical
Relapses
3562
Outcome_Mortality
3-year event-free survival
3563
Outcome_Other
higher treatment failure rate
3564
Outcome_Physical
relative failure rate ( RFR )
3565
Outcome_Physical
RFRs
3566
Outcome_Physical
CNS disease
3567
Outcome_Other
nominally worse outcome
3568
Participant_Condition
disseminated small noncleaved-cell lymphoma
3569
Participant_Condition
B-cell leukemia
3570
Participant_Age
Children 's
3571
Participant_Condition
Cancer
3572
Participant_Condition
disseminated small noncleaved-cell lymphoma
3573
Participant_Condition
B-cell leukemia
3574
Participant_Age
Children 's
3575
Participant_Condition
Cancer
3576
Participant_Sample-size
462
3577
Participant_Condition
disseminated disease
3578
Participant_Sample-size
49
3579
Participant_Condition
CNS
3580
Participant_Condition
CNS+
3581
Participant_Condition
CNS+
3582
Participant_Sample-size
28
3583
Participant_Sample-size
All