Liposomal Cytarabine (DepoCyte) Is Effective and Well Tolerated In Prophylaxis of Central Nervous System (CNS) Relapse of High Risk Lymphoma Patients

CNS relapse is a devastating complication in patients with aggressive NHL and occurs in approximately 5 to 20% of cases. Preventing CNS relapse is an important goal of therapy in high-risk patients with aggressive NHL. The aim of this retrospective study was to evaluate safety and efficacy of Liposomal Cytarabine in a prophylaxis of CNS in high risk lymphoma patients.

Data of patients treated with Liposomal Cytarabine within the last 2 years were retrieved from 2 centres in Poland which routinely administer prophylaxis of CNS in high risk NHL patients. 32 patients were included in this analysis: 26 – DLBCL including Primary Mediastinal B-cell Lymphoma (PMBCL), 2 – PTCL, 2 – LBL and 2 – BL. Demographics: average age: 42 (range 18–75), 12 females and 20 males. High risk was defined as the presence of elevated LDH (average 852 IU/L, range 482–1890 IU/L) and involvement of 2 or more extranodal sites, IPI 3–5 or specific lymphoma localizations (testis, vertebral column, orbits, sinuses, large mediastinal tumors over 10 cm in diameter). None of the patients had neurological symptoms at diagnosis, nor any abnormalities in cerebrospinal fluid analysis (average cellularity 4,7/mm³, range 0–18).

Liposomal Cytarabine was incorporated into 1^st line systemic chemotherapy. On average, 3,4 doses (range 2–6) were applied every 2 (n=22) or 4 (n=10) weeks. Side effects: 18 out of 32 patients had no side effects. 12 patients experienced transitory, mostly mild, grade 1–2 adverse events; headache (n=10), nausea and vomiting (n=7), dizziness (n=4) or fever (n=3). Only 2 patients developed grade 3 headaches or fever. One patient developed transient neurological symptoms, most likely unrelated to Liposomal Cytarabine (vena cava superior syndrome at diagnosis and cerebralal thromboembolism after systemic immunochemotherapy).

After medium observation time of 306 days from the end of therapy (range 36 – 740) 28/32 (87,5%) patients were disease free. Three patients were lost due to systemic disease progression without any signs of CNS relapse on days 36, 101 and 182. One CNS relapse was reported on the day 252 (the patient subsequently died 5 months later).

1) Liposomal Cytarabine is well tolerated, with mild or no adverse events. Its prolonged action allows it to be incorporated into a standard systemic anti-lymphoma therapy, without the necessity of additional hospital admissions.

2) In a described cohort of high risk lymphoma patients, Liposomal Cytarabine reduced the risk of early CNS relapse to 3% at 1 year (1/32 cases) and OS at 1 year 87% (28/32).

No relevant conflicts of interest to declare.