Dr Alishba Saeed, Dr Maida Hassan, Dr Afeen Malik
Objective: Relapses of Central Nervous System of Diffuse Large B-Cell Lymphoma are not common and these are nearly fatal. Two-year risk of central nervous system relapse is 0.8% in low, 3.9% in medium and 12.0% in the patients of high risk. This research work aimed to determine the baseline traits and outcome regarding the median rate of survival of the patients of diffuse large B-cell lymphoma present with relapse of central nervous system. Methodology: This study is a retrospective research work. All patients of diffuse large b-cell lymphoma with relapse of Central Nervous System from 2012 to 2019 were the part of this research work. We collected the information from the database of the hospital to analyze the median rate of survival and relevant characteristics. Results: 21 patients were the part of this research work, in which 66.3% (n: 14) were males and 33.7% (n: 7) were female patients. There was gut of extra-nodal sites in 9.1% (n: 2) whereas 4.5% (n: 1) patient with the involvement of these organs was present; cervix, iliac bone, gluteal muscle, ovaries, liver, pancreas, testes & parotid gland. We gave the chemotherapy CHOP to 76.2% (n: 16) & RCHOP in 23.8% (n: 5) patients. We gave the PIM (Prophylactic Intrathecal Methotrexate) to 47.6% (n: 10) patients. There was a complete response in 47.6% (n: 10) patients, partial response in 14.3% (n: 3) and there was progression of disease in 38.1% (n: 8) patients. There was occurrence of Central Nervous System relapse in 81% (n: 17) patients within 6 months after treatment completion. There was systemic disease along with Central Nervous System relapse in 66.6% (n: 14) patients. We noted the isolated Central Nervous System relapse in 33.3% (n: 7) patients. The regimens of second line chemotherapy were HDMTX 23.8% (n: 5), HDMTX/ TRIO IT 14.2% (n: 3), HDMTX/HDAC 9.5% (n: 2), HCVAD 14.2% (n: 3), ICE 19.4% (n: 4), DHAP 4.7% (n: 1), ICE/HDMTX 4.7% (n: 1), none in 9.5% (n: 2). Overall median rate of survival of the patients with Central Nervous System relapse was fifty-four days. Conclusion: Patients suffering from Diffuse Large B-Cell Lymphoma who were in advanced level, high level of LDH and involvement of extra-nodes at initial appearance are at high danger for relapse of Central Nervous System. About fifty percent patients were present with relapse of Central Nervous System regardless of the primary Central Nervous System prophylaxis. Once there is relapse in the Central Nervous System, there is much adverse diagnosis of these patients. KEYWORDS: Prophylactic Intrathecal Methotrexate, Diffuse Large B-Cell Lymphoma, Retrospective, Ovaries.