Evidence map›Paper›PMID 28961838›Full record

Trial reportAnnals of oncology : official journal of the European Society for Medical Oncology2017

Central nervous system relapse of diffuse large B-cell lymphoma in the rituximab era: results of the UK NCRI R-CHOP-14 versus 21 trial.

M Gleeson, N Counsell, D Cunningham, N Chadwick, A Lawrie, E A Hawkes, A McMillan, K M Ardeshna, A Jack, P Smith and 9 more

Open access · bronzeAbstract readClinical Trial, Phase IIIRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of oncology : official journal of the European Society for Medical Oncology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 1 pooled it
3.9field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 1 synthesis or guideline pooled it, 86 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. High-Dose Methotrexate as CNS Prophylaxis in Ultra High-Risk Large B-Cell Lymphoma: An International Multicenter Analysis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026
    Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Central Nervous System Manifestations of Cutaneous Lymphomas.Current neurology and neuroscience reports · 2025
    Review
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Review
  17. Plasmablastic Lymphoma. A State-of-the-Art Review: Part 2-Focus on Therapy.Mediterranean journal of hematology and infectious diseases · 2024
    Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 11 institutions in 2 countries.

M GleesonDepartment of Medicine, The Royal Marsden Hospital, London and Surrey, UK.
N CounsellCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK.
D CunninghamDepartment of Medicine, The Royal Marsden Hospital, London and Surrey, UK;. Electronic address: david.cunningham@rmh.nhs.uk.
N ChadwickCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK.
A LawrieCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK.
E A HawkesDepartment of Oncology and Clinical Haematology, Austin Health, Heidelberg, Melbourne, Australia;; Department of Medical Oncology, Eastern Health, Melbourne, Australia.
A McMillanDepartment of Haematology, Nottingham City Hospital, Nottingham, UK.
K M ArdeshnaDepartment of Haematology, University College London, London, UK;; Department of Haematology, Mount Vernon Cancer Centre, Northwood, UK.
A JackHMDS, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
P SmithCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK.
P MounceyCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK.
C PocockDepartment of Haematology, East Kent Hospitals, Canterbury, UK.
J A RadfordThe University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
J DaviesDepartment of Haematology, Western General Hospital, Edinburgh, UK.
D TurnerDepartment of Haematology, Torbay Hospital, Torquay, UK.
A KrugerDepartment of Haematology, Royal Cornwall Hospital, Truro, UK.
P JohnsonCancer Research UK Centre, Southampton, UK.
J GambellCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK.
D LinchDepartment of Haematology, University College London, London, UK.
University College London · GBCancer Research UK · GBRoyal Marsden Hospital · GBEastern Health · AUEast Kent Hospitals University NHS Foundation Trust · GBLeeds Teaching Hospitals NHS Trust · GBManchester Academic Health Science Centre · GBNottingham City Hospital · GBRoyal Cornwall Hospital · GBTorbay Hospital · GBWestern General Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCentral nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is associated with a dismal prognosis. Here, we report an analysis of CNS relapse for patients treated within the UK NCRI phase III R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) 14 versus 21 randomised trial. PATIENTS AND

methodsThe R-CHOP 14 versus 21 trial compared R-CHOP administered two- versus three weekly in previously untreated patients aged ≥18 years with bulky stage I-IV DLBCL (n = 1080). Details of CNS prophylaxis were retrospectively collected from participating sites. The incidence and risk factors for CNS relapse including application of the CNS-IPI were evaluated.

results177/984 patients (18.0%) received prophylaxis (intrathecal (IT) methotrexate (MTX) n = 163, intravenous (IV) MTX n = 2, prophylaxis type unknown n = 11 and IT MTX and cytarabine n = 1). At a median follow-up of 6.5 years, 21 cases of CNS relapse (isolated n = 11, with systemic relapse n = 10) were observed, with a cumulative incidence of 1.9%. For patients selected to receive prophylaxis, the incidence was 2.8%. Relapses predominantly involved the brain parenchyma (81.0%) and isolated leptomeningeal involvement was rare (14.3%). Univariable analysis demonstrated the following risk factors for CNS relapse: performance status 2, elevated lactate dehydrogenase, IPI, >1 extranodal site of disease and presence of a 'high-risk' extranodal site. Due to the low number of events no factor remained significant in multivariate analysis. Application of the CNS-IPI revealed a high-risk group (4-6 risk factors) with a 2- and 5-year incidence of CNS relapse of 5.2% and 6.8%, respectively.

conclusionDespite very limited use of IV MTX as prophylaxis, the incidence of CNS relapse following R-CHOP was very low (1.9%) confirming the reduced incidence in the rituximab era. The CNS-IPI identified patients at highest risk for CNS recurrence. CLINICALTRIALS.GOV: ISCRTN number 16017947 (R-CHOP14v21); EudraCT number 2004-002197-34.

Indexed as

Antibodies, Monoclonal, Murine-DerivedAntineoplastic Combined Chemotherapy ProtocolsCentral Nervous System NeoplasmsCyclophosphamideDoxorubicinDrug Administration ScheduleFemaleHumansLymphoma, Large B-Cell, DiffuseMaleMiddle AgedNeoplasm Recurrence, LocalPrednisoneProspective StudiesRituximabVincristineAntibodies, Monoclonal, Murine-DerivedCyclophosphamideDoxorubicinPrednisoneR-CHOP protocolRituximabVincristinecentral nervous systemdiffuse large B-cell lymphomarelapserituximab

Identifiers

PMID28961838
PMCPMC5834096
OpenAlexW2734666624

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.