201
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Zou Y, Tong J, Leng H, Jiang J, Pan M, Chen Z. Diagnostic value of using 18F-FDG PET and PET/CT in immunocompetent patients with primary central nervous system lymphoma: A systematic review and meta-analysis. Oncotarget 2018; 8:41518-41528. [PMID: 28514747 PMCID: PMC5522282 DOI: 10.18632/oncotarget.17456] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/12/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/CT have become two of the most powerful tools for malignant lymphoma exploration, but their diagnostic role in primary central nervous system lymphoma (PCNSL) is still disputed. The purpose of our study is to identify the usefulness of 18F-FDG PET and PET/CT for detecting PCNSL. RESULTS A total of 129 patients, obtained from eight eligible studies, were included for this systematic review and meta-analysis. The performance of 18F-FDG PET and PET/CT for diagnosing PCNSL were as follows: the pooled sensitivity was 0.88 (95% CI: 0.80-0.94), specificity was 0.86 (95% CI: 0.73-0.94), positive likelihood ratio (PLR) was 3.99 (95% CI: 2.31-6.90), negative likelihood ratio (NLR) was 0.11 (95% CI: 0.04-0.32), and diagnostic odds ratio (DOR) was 33.40 (95% CI: 10.40-107.3). In addition, the area under the curve (AUC) and Q index were 0.9192 and 0.8525, respectively. MATERIALS AND METHODS PubMed/MEDLINE, Embase and Cochrane Library were systematically searched for potential publications (last updated on July 16th, 2016). Reference lists of included articles were also checked. Original articles that reported data on patients who were suspected of having PCNSL were considered suitable for inclusion. The sensitivities and specificities of 18F-FDG PET and PET/CT in each study were evaluated. The Stata software and Meta-Disc software were employed in the process of data analysis. CONCLUSIONS 18F-FDG PET and PET/CT showed considerable accuracy in identifying PCNSL in immunocompetent patients and could be a valuable radiological diagnostic tool for PCNSL.
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Affiliation(s)
- Yaru Zou
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jianjing Tong
- Exclusive Medical Care Center, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Haiyan Leng
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jingwei Jiang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zi Chen
- Quintiles Asia Medical Oncology, Shanghai 200032, China.,Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China
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202
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Citterio G, Calimeri T, Ferreri AJM. Challenges and prospects in the diagnosis and treatment of primary central nervous system lymphoma. Expert Rev Neurother 2018; 18:379-393. [PMID: 29633883 DOI: 10.1080/14737175.2018.1462700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Primary central nervous system lymphoma (PCNSL) retains peculiar biological and clinical characteristics and a worse prognosis with respect to other comparable lymphomas. The need for high doses of chemotherapy to achieve valid drug concentrations in cerebral tissues and/or radiotherapy results in severe treatment-related toxicities, mainly neurologic, which are frequently as disabling as the disease itself.Areas covered: Several emerging combined therapies are addressed that focus on treating PCNSL. The prognosis has improved in the last years but several questions remain unanswered and the research of more effective therapies goes on. Information and data were obtained from direct authors' experience and a PubMed search of recent peer-reviewed original articles, review articles, and clinical guidelines.Expert commentary: The substantial progress observed in PCNSL has to be ascribed to a carefully combination of standard chemotherapeutic drugs. High-dose methotrexate-based polychemotherapy followed by mainteinance therapy offers one of the best chances to control the disease. Major issues that deserve many efforts by researchers are the definition of optimal consolidation treatment and a shared management of specific conditions such as elderly population and intra-ocular localization.
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Affiliation(s)
- Giovanni Citterio
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Teresa Calimeri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
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203
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Yang F, Yang P, Zhang C, Wang Y, Zhang W, Hu H, Wang Z, Qiu X, Jiang T. Stratification according to recursive partitioning analysis predicts outcome in newly diagnosed glioblastomas. Oncotarget 2018; 8:42974-42982. [PMID: 28496000 PMCID: PMC5522120 DOI: 10.18632/oncotarget.17322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/16/2016] [Indexed: 12/04/2022] Open
Abstract
Glioblastoma accounts for more than half of diffuse gliomas. The prognosis of patients with glioblastoma remains poor despite comprehensive and intensive treatments. Furthermore, the clinical significance of molecular parameters and routinely available clinical variables for the prognosis prediction of glioblastomas remains limited. The authors describe a novel model may help in prognosis prediction and clinical management of glioblastoma patients. We performed a recursive partitioning analysis to generate three independent prognostic classes of 103 glioblastomas patients from TCGA dataset. Class I (MGMT promoter methylated, age <58), class II (MGMT promoter methylation, age ≥58; MGMT promoter unmethylation, age <54, KPS ≥70; MGMT promoter unmethylation, age >59, KPS ≥70), class III (MGMT promoter unmethylation, age 54-58, KPS ≥70; MGMT promoter unmethylation, KPS <70). Age, KPS and MGMT promoter methylation were the most significant prognostic factors for overall survival. The results were validated in CGGA dataset. This was the first study to combine various molecular parameters and clinical factors into recursive partitioning analysis to predict the prognosis of patients with glioblastomas. We included MGMT promoter methylation in our study, which could give better suggestion to patients for their chemotherapy. This clinical study will serve as the backbone for the future incorporation of molecular prognostic markers currently in development. Thus, our recursive partitioning analysis model for glioblastomas may aid in clinical prognosis evaluation.
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Affiliation(s)
- Fan Yang
- Department of Molecular Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Pei Yang
- Department of Molecular Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chuanbao Zhang
- Department of Molecular Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yongzhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huimin Hu
- Department of Molecular Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhiliang Wang
- Department of Molecular Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoguang Qiu
- Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Molecular Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
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204
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Prognostic Significance of High Ki-67 Index and Histogenetic Subclassification in Primary Central Nervous System Lymphoma. Appl Immunohistochem Mol Morphol 2018; 26:254-262. [DOI: 10.1097/pai.0000000000000424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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205
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Birsen R, Blanc E, Willems L, Burroni B, Legoff M, Le Ray E, Pilorge S, Salah S, Quentin A, Deau B, Franchi P, Vignon M, Mabille L, Nguyen C, Kirova Y, Varlet P, Edjlali M, Dezamis E, Hoang-Xuan K, Soussain C, Houillier C, Damotte D, Pallud J, Bouscary D, Tamburini J. Prognostic value of early 18F-FDG PET scanning evaluation in immunocompetent primary CNS lymphoma patients. Oncotarget 2018; 9:16822-16831. [PMID: 29682187 PMCID: PMC5908288 DOI: 10.18632/oncotarget.24706] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/25/2018] [Indexed: 12/18/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare topographic variant of diffuse large B-cell lymphoma (DLBCL). While prognostic scales are useful in clinical trials, no dynamic prognostic marker is available in this disease. We report here the prognostic value of early metabolic response by 18F-FDG PET scanner (PET) in 25 newly diagnosed immunocompetent PCNSL patients. Induction treatment consisted of four cycles of Rituximab, Methotrexate and Temozolamide (RMT). Based on patient's general condition, consolidation by high-dose Etoposide and Aracytine was given to responding patients. Brain MRI and PET were performed at diagnosis, after two and four cycles of RMT, and after treatment completion. Two-year progression-free (PFS) and overall survival (OS) were 62% and 74%, respectively for the whole cohort. Best responses after RMT induction were 18 (72%) complete response (CR)/CR undetermined (CRu), 4 (16%) partial response, 1 (4%) progressive disease and 2 (8%) stable disease. Response evaluation was concordant between MRI and PET at the end of induction therapy. Nineteen patients (76%) had a negative PET2. Predictive positive and negative values of PET2 on end-of-treatment (ETR) CR were 66.67% and 94.74%, respectively. We observed a significant association between PET2 negativity and ETR (p = 0.001) and longer PFS (p = 0.02), while having no impact on OS (p = 0.32). Two years PFS was 72% and 33% for PET2- and PET2+ patients, respectively (p < 0.02). PET2 evaluation may help to early define a subgroup of CR PCNSL patients with a favorable outcome.
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Affiliation(s)
- Rudy Birsen
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Estelle Blanc
- Department of Nuclear Medicine, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Lise Willems
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Barbara Burroni
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Pathology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marielle Legoff
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Le Ray
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvain Pilorge
- Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sawsen Salah
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Ophtalmology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Benedicte Deau
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patricia Franchi
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marguerite Vignon
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurence Mabille
- Department of Nuclear Medicine, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Charles Nguyen
- Department of Nuclear Medicine, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Yioula Kirova
- Radiotherapy Department, Curie Institute, Paris, France
| | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | - Myriam Edjlali
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of NeuroImaging, Sainte-Anne Hospital, Paris, France
| | - Edouard Dezamis
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités UPMC Universités Paris VI, IHU, ICM, Paris, France
| | - Carole Soussain
- Hematology Department, René Huguenin-Institut Curie Hospital, Saint Cloud, France
| | - Caroline Houillier
- Department of Neurology 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités UPMC Universités Paris VI, IHU, ICM, Paris, France
| | - Diane Damotte
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Pathology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Johan Pallud
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Didier Bouscary
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jerome Tamburini
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Hematology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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206
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Bairey O, Siegal T. The possible role of maintenance treatment for primary central nervous system lymphoma. Blood Rev 2018; 32:378-386. [PMID: 29551465 DOI: 10.1016/j.blre.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/27/2018] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive brain tumor. The prognosis is poor, with high rates of relapse and disease progression after treatment. In addition, PCNSL affects a largely older population, so that a significant proportion of patients are ineligible for intensive therapies and high-dose chemotherapy. The elderly patients are also susceptible to the accelerated and detrimental cognitive side effects of whole-brain irradiation which is an alternative consolidation to high-dose chemotherapy. Maintenance therapy has been shown to be a promising strategy to prolong remission time in other hematopoietic malignancies. Herein, we discuss the place of maintenance treatment in PCNSL in view of perspective obtained from hematological malignancies and non-Hodgkin's lymphoma.
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Affiliation(s)
- Osnat Bairey
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tali Siegal
- Neuro-Oncology Center, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
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207
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Treatment with methotrexate, rituximab, and cytosine arabinoside followed by autologous stem cell transplantation in primary central nervous system lymphoma: A single-center experience. Hematol Oncol Stem Cell Ther 2018. [DOI: 10.1016/j.hemonc.2017.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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208
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Jahr G, Broi MD, Holte H, Beiske K, Meling TR. Evaluation of Memorial Sloan-Kettering Cancer Center and International Extranodal Lymphoma Study Group prognostic scoring systems to predict Overall Survival in intracranial Primary CNS lymphoma. Brain Behav 2018; 8:e00928. [PMID: 29541540 PMCID: PMC5840438 DOI: 10.1002/brb3.928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the validity of Memorial Sloan-Kettering Cancer Center (MSKCC) and International Extranodal Lymphoma Study Group (IELSG) prognostic scoring systems for Overall Survival (OS) in intracranial Primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center. MATERIAL AND METHODS Pretreatment clinical factors including tumor characteristics and histology, treatment, and survival of PCNSL patients with diagnostic biopsies over a 12-year period (2003-2014) were retrieved from a prospective database at Oslo University Hospital. RESULTS Seventy-nine patients with intracranial PCNSL were identified. The female:male ratio was 1:1.63 and the median age was 65.3 years [range 18.9-80.7]. Involvement of deep brain structures was shown in 63 patients. Six patients were MSKCC risk group 1, 35 patients were in risk group 2, and 38 patients were in risk group 3. International Extranodal Lymphoma Study Group scores were <2 in 17 patients (22%). After a median follow-up of 70.5 months, 55 patients were dead. Median OS was 16.4 months [range 0.2-157.7]. Age, sLDH by recursive partitioning analysis (RPA), Eastern Cooperative Oncology Group score (ECOG), lesion size, involvement of deep brain structures, IELSG score, and MSKCC score were significant factors for OS in univariate analysis. Multivariate analysis confirmed the significance of age (p < .05), sLDH by RPA (p < .005), ECOG (p < .05), and deep brain structure involvement (p < .05) for OS. The six-tiered IELSG scores had to be dichotomized according to RPA analysis into <2 and ≥2 in order to have prognostic value. In contrast, when using the three-tiered MSKCC, three distinct risk groups were identified. CONCLUSIONS Our study failed to verify the IELSG, but validated the use of MSKCC for prognostication of OS in intracranial PCNSL.
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Affiliation(s)
- Guro Jahr
- Department of Neurosurgery Oslo University Hospital Oslo Norway
| | - Michele Da Broi
- Department of Neurosurgery Oslo University Hospital Oslo Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Harald Holte
- Department of Oncology Oslo University Hospital Oslo Norway
| | - Klaus Beiske
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Department of Pathology Oslo University Hospital Oslo Norway
| | - Torstein R Meling
- Department of Neurosurgery Oslo University Hospital Oslo Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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209
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Abstract
PURPOSE OF REVIEW Primary central nervous system lymphoma (PCNSL) is an aggressive malignancy confined to the brain, spinal cord, leptomeninges, and eyes. Due to its rarity, there is a paucity of randomized trials and a varied approach to its management in the oncologic community. This review summarizes recent literature guiding current clinical practice. RECENT FINDINGS The presentation, work up, and management of PCNSL are discussed. Induction therapy incorporates a methotrexate-based chemotherapy regimen and is generally followed by a consolidation regimen including high dose chemotherapy (with or without autologous stem cell rescue). Whole brain radiation therapy (WBRT) is a potential additional consolidation strategy. Management of relapsed and refractory disease poses a special challenge due to poor outcomes. Immunotherapy and targeted treatments are promising novel strategies for recurrent/refractory patients. Currently, there is little consensus in the management of PCNSL. Treatment recommendations should be tailored to the individual patient, with consideration for risk of neurotoxicity. New, exciting strategies are in development and when feasible, enrollment in a clinical trial should be considered.
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Affiliation(s)
- Lauren R Schaff
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- , New York, USA.
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210
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Shinojima N, Fujimoto K, Makino K, Todaka K, Yamada K, Mikami Y, Oda K, Nakamura K, Jono H, Kuratsu JI, Nakamura H, Yano S, Mukasa A. Clinical significance of polyglutamylation in primary central nervous system lymphoma. Acta Neuropathol Commun 2018; 6:15. [PMID: 29475458 PMCID: PMC6389236 DOI: 10.1186/s40478-018-0522-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 02/08/2023] Open
Abstract
The therapeutic response to high-dose methotrexate (HD-MTX) therapy for primary central nervous system lymphoma (PCNSL) varies. Polyglutamylation is a reversible protein modification with a high occurrence rate in tumor cells. MTX incorporated into cells is polyglutamylated and strongly binds to dihydrofolate reductase without competitive inhibition by leucovorin (LV). Tumor cells with high polyglutamylation levels are selectively killed, whereas normal cells with lower polyglutamylation are rescued by LV. We hypothesized that the extent of polyglutamylation in tumor cells determines treatment resistance. Here, we investigated the therapeutic response of PCNSL to HD-MTX therapy with LV rescue based on polyglutamylation status. Among 113 consecutive PCNSL patients who underwent HD-MTX therapy in our department between 2001 and 2014, polyglutamylation was evaluated by immunostaining in 82 cases, with relationships between polyglutamylation and therapeutic response retrospectively examined. Human malignant lymphoma lines were used for in vitro experiments, and folpolyglutamate synthetase (FPGS), which induces polyglutamylation, was knocked down with short-hairpin RNA, and a stable cell line with a low rate of polyglutamylation was established. Cell viability after MTX treatment with LV rescue was evaluated using sodium butyrate (NaBu), a histone-deacetylase inhibitor that induces polyglutamylation by elevating FPGS expression. The complete response rate was significantly higher in the group with polyglutamylation than in the non-polyglutamylation group [58.1% (25/43) and 33.3% (13/39), respectively] (p < 0.05), and progression-free survival was also significantly increased in the group with polyglutamylation (p < 0.01). In vitro, the relief effect of LV after MTX administration was significantly enhanced after FPGS knockdown in al cell lines, whereas enhancement of FPGS expression by NaBu treatment significantly reduced this relief effect. These findings suggested that polyglutamylation could be a predictor of therapeutic response to HD-MTX therapy with LV rescue in PCNSL. Combination therapy with HD-MTX and polyglutamylation-inducing agents might represent a promising strategy for PCNSL treatment.
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211
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Ture M, Kurt Omurlu I. Determining of complexity parameter for recursive partitioning trees by simulation of survival data and an application on breast cancer data. JOURNAL OF STATISTICS & MANAGEMENT SYSTEMS 2018. [DOI: 10.1080/09720510.2017.1386878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mevlut Ture
- Medical Faculty, Department of Biostatistics, Adnan Menderes University, Aydın, Turkey
| | - Imran Kurt Omurlu
- Medical Faculty, Department of Biostatistics, Adnan Menderes University, Aydın, Turkey
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212
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Blasel S, Vorwerk R, Kiyose M, Mittelbronn M, Brunnberg U, Ackermann H, Voss M, Harter PN, Hattingen E. New MR perfusion features in primary central nervous system lymphomas: pattern and prognostic impact. J Neurol 2018; 265:647-658. [DOI: 10.1007/s00415-018-8737-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/30/2017] [Accepted: 01/04/2018] [Indexed: 02/08/2023]
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213
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Can metabolic tumour parameters on primary staging 18 F-FDG-PET/CT contribute to risk stratification of primary central nervous system lymphomas for patient management as a prognostic model? Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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214
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Ahn Y, Ahn HJ, Yoon DH, Hong JY, Yoo C, Kim S, Huh J, Suh C. Primary central nervous system lymphoma: a new prognostic model for patients with diffuse large B-cell histology. Blood Res 2017; 52:285-292. [PMID: 29333405 PMCID: PMC5762739 DOI: 10.5045/br.2017.52.4.285] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/28/2017] [Accepted: 07/20/2017] [Indexed: 12/05/2022] Open
Abstract
Background Age and performance status are important prognostic factors in primary central nervous system (CNS) lymphoma. Although several prognostic models have been proposed, there is no consensus on the optimal model for patients with diffuse large B-cell histology. Methods Seventy-seven patients with primary CNS diffuse large B-cell lymphoma were retrospectively analyzed to determine factors affecting survival. Three Western models were applied to our eligible patients; we devised a novel model based on our findings. Results The median patient age was 59 years (range, 29–77); the median event-free and overall survival (OS) durations were 35.9 and 12.6 months, respectively. Nottingham/Barcelona and Memorial Sloan Kettering Cancer Center models were applicable to our cohorts. Multivariate analysis showed that advanced age, multifocal lesions, and high cerebrospinal fluid (CSF) protein concentrations were correlated significantly. A novel model for predicting prognosis was then developed based on these variables. Each variable was assigned 1 point; patients with a total score of 0, 1, 2, and 3 were categorized into the low- (N=17), moderate- (N=26), high- (N=14), and very high-risk groups (N=4), respectively. Sixty-one patients were eligible considering our model; the median OS was 58.2, 34.8, 9.0, and 1.8 months in the low-, moderate-, high-, and very high-risk groups, respectively (P<0.01). Conclusion Advanced age, multifocal lesions, and high CSF protein concentration were adversely related with prognosis. Our model can be helpful in pre-treatment risk stratification for patients with primary CNS lymphoma with diffuse large B-cell histology.
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Affiliation(s)
- Yongchel Ahn
- Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Heui June Ahn
- Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Yong Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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215
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Lee J, Shishido-Hara Y, Suzuki K, Shimizu S, Kobayashi K, Kamma H, Shiokawa Y, Nagane M. Prognostic factors for primary central nervous system lymphomas treated with high-dose methotrexate-based chemo-radiotherapy. Jpn J Clin Oncol 2017; 47:925-934. [PMID: 28981733 DOI: 10.1093/jjco/hyx098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) remains an aggressive and refractory tumor despite high-dose methotrexate-based chemo-radiotherapy. Age and performance status have been shown to be important clinical prognostic factors, however others, especially molecular factors, affecting the prognosis are still uncertain. Methods We investigate clinical, neuroimaging and immunohistochemical data in tissue from 41 PCNSL patients treated primarily with methotrexate-based chemo-radiotherapy and evaluate the influence of potential prognostic factors on clinical outcome as well as correlation among these factors. Results Median progression-free survival (PFS) and overall survival (OS) were 29 and 73 months, respectively. Expression of the mismatch repair (MMR) proteins, MLH1, MSH2, MSH6 and PMS2, correlated tightly with each other and high expression of MSH2 was significantly associated with better OS and PFS (P = 0.005 and P = 0.007), while methotrexate metabolism-related proteins did not affect survival. In addition, low expression of PMS2 was an independent predictor of methotrexate resistance (P = 0.039). Among neuroimaging findings, involvement of the fornix and tegmentum/velum were significantly associated with poorer OS (P < 0.001 and P = 0.013) and PFS (P = 0.014 and P = 0.043, respectively). Germinal center B cell (GCB)-PCNSL subtype as opposed to non-GCB subtype, tended toward better survival. Regarding oncogenes, cMYC-positive cases showed unfavorable OS (P = 0.046). By multivariate analysis, MSH2 and involvement of the fornix were independent predictors for both OS and PFS, whereas tegmentum/velum location and cMYC expression were significantly associated with OS. Conclusions Although further studies are needed, these results suggest that MMR protein expression, as well as specific deep locations and cMYC expression, may be a novel prognostic and predictive markers for PCNSL.
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Affiliation(s)
- Jeunghun Lee
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Kaori Suzuki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Hiroshi Kamma
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
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216
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Han CH, Batchelor TT. Diagnosis and management of primary central nervous system lymphoma. Cancer 2017; 123:4314-4324. [DOI: 10.1002/cncr.30965] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Catherine H. Han
- Department of Neurology, Division of Hematology/Oncology; Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston Massachusetts
- Auckland Cancer Society Research Centre, School of Medical Sciences, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Tracy T. Batchelor
- Department of Neurology, Division of Hematology/Oncology; Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston Massachusetts
- Department of Radiation Oncology, Division of Hematology/Oncology; Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston Massachusetts
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217
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Tabouret E, Houillier C, Martin-Duverneuil N, Blonski M, Soussain C, Ghesquières H, Houot R, Larrieu D, Soubeyran P, Gressin R, Gyan E, Chinot O, Taillandier L, Choquet S, Alentorn A, Leclercq D, Omuro A, Tanguy ML, Hoang-Xuan K. Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial. Neuro Oncol 2017; 19:422-429. [PMID: 27994065 DOI: 10.1093/neuonc/now238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Our aim was to review MRI characteristics of patients with primary CNS lymphoma (PCNSL) enrolled in a randomized phase II trial and to evaluate their potential prognostic value and patterns of relapse, including T2 fluid attenuated inversion recovery (FLAIR) MRI abnormalities. Methods Neuroimaging findings in 85 patients with PCNSL enrolled in a prospective trial were reviewed blinded to outcomes. MRI characteristics and responses according to International PCNSL Collaborative Group (IPCG) criteria were correlated with progression-free survival (PFS) and overall survival (OS). Results Multivariate analysis showed that objective response at 2 months (P < .001) and at end of treatment (P = .015) were predictors of prolonged OS. Infratentorial location (P = .008) and large (>11.4 cm3) enhancing tumor volume (P = .006) were associated with poor OS and PFS, respectively. Ratio of change in product of largest diameters at early MRI evaluation but not timing of complete response achievement (early vs delayed) was prognostic for OS. Sixty-nine patients relapsed. Relapse in the brain (n = 52) involved an initial enhancing site, a different site, or both in 46%, 40%, and 14% of patients, respectively. At baseline, non-enhancing T2-FLAIR hypersignal lesions distant from the enhancing tumor site were detected in 18 patients. These lesions markedly decreased (>50%) in 16 patients after chemotherapy, supporting their neoplastic nature. Of these patients, 10/18 relapsed, half (n = 5) in the initially non-enhancing T2-FLAIR lesions. Conclusions Baseline tumor size and infratentorial localization are of prognostic value in PCNSL. Our findings provide evidence that non-enhancing FLAIR abnormalities may add to overall tumor burden, suggesting that response criteria should be refined to incorporate evaluation of T2-weighted/FLAIR sequences.
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Affiliation(s)
- Emeline Tabouret
- APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France.,Aix-Marseille Universite, UMR911, Marseille, France.,APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Caroline Houillier
- APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Marie Blonski
- Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie-René Huguenin, Saint-Cloud, France
| | - Herve Ghesquières
- Department of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Roch Houot
- Service d'Hématologie Clinique, CHU-Hôpital Pontchaillou de Rennes, Rennes, France
| | | | | | - Remy Gressin
- Hématologie Clinique, Hôpital A Michallon, Grenoble, France
| | - Emmanuel Gyan
- Service d'Hématologie Clinique de Tours, Tours, France
| | - Olivier Chinot
- APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France.,Aix-Marseille Universite, UMR911, Marseille, France
| | - Luc Taillandier
- Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France
| | - Sylvain Choquet
- Service d'Hématologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Agusti Alentorn
- APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Delphine Leclercq
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Antonio Omuro
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Marie-Laure Tanguy
- Service de biostatistiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Khe Hoang-Xuan
- APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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218
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Cho H, Kim SH, Kim SJ, Chang JH, Yang WI, Suh CO, Kim YR, Jang JE, Cheong JW, Min YH, Kim JS. Programmed cell death 1 expression is associated with inferior survival in patients with primary central nervous system lymphoma. Oncotarget 2017; 8:87317-87328. [PMID: 29152083 PMCID: PMC5675635 DOI: 10.18632/oncotarget.20264] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
Programmed cell death 1 (PD-1) and its ligands PD-L1/PD-L2 have been shown to mediate immune evasion in various cancers, but their prognostic implications in patients with primary central nervous system lymphoma (PCNSL) are poorly understood. Therefore, we analyzed 76 PCNSL patients at initial diagnosis who were treated homogenously with high-dose methotrexate-based chemotherapy, and evaluated the prognostic roles of high immunohistochemical PD-1, PD-L1, and PD-L2 expression. The cut-off values for high PD-1 (≥ 70 cells/high power field [HPF]), PD-L1 (≥ 100 cells/HPF), and PD-L2 (≥ 100 cells/HPF) were determined by the area under the receiver operating characteristic curve. Expression of PD-1, PD-L1, and PD-L2 was high in 7.9%, 13.2%, and 42.1% patients, respectively. High PD-1, (P = 0.007) and Memorial Sloan Kettering Cancer Center (MSKCC) prognostic scoring (P = 0.019) were independently associated with inferior overall survival on multivariate analysis. High PD-1 also remained an independent prognostic factor for inferior progression-free survival (P = 0.028), as did MSKCC prognostic scoring (P = 0.041) on multivariate analysis. However, there were no differences in survival according to the expression levels of PD-L1/PD-L2 in PCNSL tumor microenvironment. Our results suggest that PD-1 may be considered a biomarker and potential therapeutic target in PCNSL.
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Affiliation(s)
- Hyunsoo Cho
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Woo-Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Yu Ri Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Ji Eun Jang
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Yoo Hong Min
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
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219
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Hattori K, Sakata-Yanagimoto M, Okoshi Y, Kato T, Kurita N, Yokoyama Y, Obara N, Takano S, Ishikawa E, Yamamoto T, Matsumura A, Hasegawa Y, Chiba S. A single institutional retrospective evaluation for younger patients with primary central nervous lymphomas on a modified R-MPV regimen followed by radiotherapy and high dose cytarabine. J Clin Exp Hematop 2017; 57:41-46. [PMID: 28781291 DOI: 10.3960/jslrt.17012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We conducted a retrospective analysis of patients younger than 60 years (N = 10, median age 54.5) with newly diagnosed primary central nervous system lymphoma (PCNSL) at the University of Tsukuba Hospital from January 2008 to November 2016. All the patients were scheduled to receive a single regimen without registration to any clinical trials. This was based on a phase 2 study by Memorial Sloan-Kettering Cancer Center (MSKCC); induction chemotherapy with rituximab, methotrexate, procarbazine, and vincristine (R-MPV) (five to seven cycles), followed by whole-brain radiotherapy (rd-WBRT) (23.4 Gy) and two high-dose cytarabine (HD-AC) cycles as a consolidation. The median age was 54.5 years, and median follow up duration was 33.1 months. The 3-year overall survival (OS) and progression-free survival (PFS) were 69% (95% CI 31-89%) and 56% (95% CI 20-81%). The median OS and PFS were not reached, respectively. Acute and delayed toxicities were manageable. In particular, OS and PFS of seven patients who achieved CR by the R-MPV induction chemotherapy were significantly superb (3-year OS, 100%; 3-year PFS, 80%), implying that a large proportion of patients in CR after the completion of this treatment may achieve durable disease control. On the other hand, all of the three patients who had progressive disease during this treatment died of disease progression within 1 year after diagnosis without achieving CR. Identifying the patients having a risk of failure in the R-MPV induction chemotherapy is important, and may allow us to consider a potentially more effective regimen.
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Affiliation(s)
- Keiichiro Hattori
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Mamiko Sakata-Yanagimoto
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Yasushi Okoshi
- Ibaraki Clinical Education and Training Center, University of Tsukuba Hospital; Department of Hematology, Ibaraki Prefectural Central Hospital
| | - Takayasu Kato
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Naoki Kurita
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Yasuhisa Yokoyama
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Naoshi Obara
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Shingo Takano
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba
| | - Akira Matsumura
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba
| | - Yuichi Hasegawa
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
| | - Shigeru Chiba
- Department of Clinical and Experimental Hematology, Institute of Clinical Medicine, University of Tsukuba
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220
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Jo JC, Yoon DH, Kim S, Lee K, Kang EH, Park JS, Ryu JS, Huh J, Park CS, Kim JH, Lee SW, Suh C. Interim 18F-FGD PET/CT may not predict the outcome in primary central nervous system lymphoma patients treated with sequential treatment with methotrexate and cytarabine. Ann Hematol 2017; 96:1509-1515. [DOI: 10.1007/s00277-017-3068-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022]
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221
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Okuyucu K, Alagoz E, Ince S, Ozaydin S, Arslan N. Can metabolic tumor parameters on primary staging 18F-FDG PET/CT aid in risk stratification of primary central nervous system lymphomas for patient management as a prognostic model? Rev Esp Med Nucl Imagen Mol 2017; 37:9-14. [PMID: 28733137 DOI: 10.1016/j.remn.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/22/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Primary central nervous system (CNS) lymphoma is an aggressive and fatal extranodal non-Hodgkin lymphoma jailed in CNS at initial diagnosis. Its prognosis is poor and the disease has a fatal outcome when compared with systemic non-Hodgkin lymphoma. A few baseline risk stratification scoring systems have been suggested to estimate the prognosis mainly based on serum lactate dehydrogenase level,age, Karnofsky performance score, involvement of deep brain structures and cerebrospinal fluid protein concentration. 18F-FDG PET/CT has a high prognostic value with respect to overall survival and disease-free survival in many cancers and lymphomas. We aimed to investigate metabolic tumor indexes on primary staging 18F-FDG PET/CT as prognostic markers in primary CNS lymphoma. MATERIAL AND METHODS Fourteen patients with primary CNS diffuse large B-cell lymphoma (stage i) were enrolled in this retrospective cohort study. Primary staging 18F-FDG PET/CT was performed and quantitative parameters like maximum standardized uptake value, average standardized uptake value, metabolic tumor volume and total lesion glycolysis (TLG) were calculated for all patients before the treatment. Cox regression models were performed to determine their relation with survival time. RESULTS In the evaluation of all potential risk factors impacting recurrence/metastases (age, sex, serum lactate dehydrogenase, involvement of deep brain structures, maximum standardized uptake value, average standardized uptake value, metabolic tumor volume, and TLG) with univariate analysis, TLG remained statistically significant (P=.02). CONCLUSION Metabolic tumor parameters are useful in prognosis estimation of primary CNS lymphomas, especially TLG, which is the most important one and may play a role in patient management.
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Affiliation(s)
- K Okuyucu
- Nuclear Medicine Department, Gulhane Training and Research Hospital, Ankara, Turquía
| | - E Alagoz
- Nuclear Medicine Department, Gulhane Training and Research Hospital, Ankara, Turquía
| | - S Ince
- Nuclear Medicine Department, Gulhane Training and Research Hospital, Ankara, Turquía.
| | - S Ozaydin
- Medical Oncology Department, Gulhane Training and Research Hospital, Ankara, Turquía
| | - N Arslan
- Nuclear Medicine Department, Gulhane Training and Research Hospital, Ankara, Turquía
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222
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Abstract
Primary CNS lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that is typically confined to the brain, eyes, and cerebrospinal fluid without evidence of systemic spread. The prognosis of patients with PCNSL has improved during the last decades with the introduction of high-dose methotrexate. However, despite recent progress, results after treatment are durable in half of patients, and therapy can be associated with late neurotoxicity. PCNSL is an uncommon tumor, and only four randomized trials and one phase III trial have been completed so far, all in the first-line setting. To our knowledge, no randomized trial has been conducted for recurrent/refractory disease, leaving many questions unanswered about optimal first-line and salvage treatments. This review will give an overview of the presentation, evaluation, and treatment of immunocompetent patients with PCNSL.
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Affiliation(s)
| | - Lisa M DeAngelis
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
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223
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Checkpoint inhibition in CNS lymphoma. Blood 2017; 129:3045-3046. [PMID: 28596436 DOI: 10.1182/blood-2017-04-777797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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224
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Carnevale J, Rubenstein JL. The Challenge of Primary Central Nervous System Lymphoma. Hematol Oncol Clin North Am 2017; 30:1293-1316. [PMID: 27888882 DOI: 10.1016/j.hoc.2016.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary central nervous system (CNS) lymphoma is a challenging subtypes of aggressive non-Hodgkin lymphoma. Emerging clinical data suggest that optimized outcomes are achieved with dose-intensive CNS-penetrant chemotherapy and avoiding whole brain radiotherapy. Anti-CD20 antibody-based immunotherapy as a component of high-dose methotrexate-based induction programs may contribute to improved outcomes. An accumulation of insights into the molecular and cellular basis of disease pathogenesis is providing a foundation for the generation of molecular tools to facilitate diagnosis as well as a roadmap for integration of targeted therapy within the developing therapeutic armamentarium for this challenging brain tumor.
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Affiliation(s)
- Julia Carnevale
- Division of Hematology/Oncology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - James L Rubenstein
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, M1282 Box 1270, San Francisco, CA 94143, USA.
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225
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The prognostic role of CD68 and FoxP3 expression in patients with primary central nervous system lymphoma. Ann Hematol 2017; 96:1163-1173. [PMID: 28508176 DOI: 10.1007/s00277-017-3014-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/02/2017] [Indexed: 01/20/2023]
Abstract
The prognostic role of CD68 and FoxP3 in primary central nervous system lymphoma (PCNSL) has not been evaluated. Thus, we examined the prognostic significance of CD68 and FoxP3 expression in tumor samples of 76 newly diagnosed immunocompetent PCNSL patients. All patients were treated initially with high-dose methotrexate (HD-MTX)-based chemotherapy, and 16 (21.1%) patients received upfront autologous stem cell transplantation (ASCT) consolidation. High expression of CD68 (>55 cells/high-power field) or FoxP3 (>15 cells/high-power field) was observed in 10 patients, respectively. High CD68 expression was associated with inferior overall survival (OS) and progression-free survival (PFS) in multivariate analysis (P = 0.023 and P = 0.021, respectively). In addition, we performed subgroup analysis based on upfront ASCT. High CD68 expression was also associated with inferior OS and PFS in multivariate analysis (P = 0.013 and P < 0.001, respectively) among patients who did not receive upfront ASCT (n = 60), but not in patients who received upfront ASCT. The expression of FoxP3 was not significantly associated with survival. Therefore, we identified a prognostic significance of high CD68 expression in PCNSL, which suggests a need for further clinical trials and biological studies on the role of PCNSL tumor microenvironment.
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226
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Citterio G, Reni M, Gatta G, Ferreri AJM. Primary central nervous system lymphoma. Crit Rev Oncol Hematol 2017; 113:97-110. [DOI: 10.1016/j.critrevonc.2017.03.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/24/2017] [Accepted: 03/15/2017] [Indexed: 12/26/2022] Open
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227
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Impact of lymphopenia on prognosis of patients with primary central nervous system lymphoma. Eur J Cancer 2017; 75:280-283. [DOI: 10.1016/j.ejca.2016.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/30/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022]
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228
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Enblad G, Martinsson G, Baecklund E, Hesselager G, Sundström C, Amini RM, Hagberg H. Population-based experience on primary central nervous system lymphoma 2000-2012: the incidence is increasing. Acta Oncol 2017; 56:599-607. [PMID: 28084866 DOI: 10.1080/0284186x.2016.1270465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Primary central nervous system lymphomas (PCNSL) are rare lymphomas with a poor prognosis. Recently, an increased incidence has been reported. The present study is a population-based study of all patients with PCNSL in the Uppsala/Örebro region of middle Sweden. PATIENTS AND METHODS All patients diagnosed with a PCNSL at Uppsala University Hospital 2000-2012 were identified. Altogether, 96 patients (50 women and 46 men) were included. The median age at diagnosis was 66 years (17-95). RESULTS There was a statistically significant increase in age-standardized incidence during the study period, 30 patients were diagnosed in the first half and 66 in the second half of the period. No patient had an HIV-infection. Two patients had undergone kidney transplantation and were treated with immunosuppressive drugs. A high proportion of the patients, 29%, had a history of an autoimmune or inflammatory disease. The prognosis was poor with a median survival of only four months. In the 70 (73%) patients treated with curative intention the median survival was 12 months. Patients treated with high-dose methotrexate, radiotherapy and/or temozolomide appeared to have a better survival. There was no improvement in survival during the study period or after the introduction of rituximab. There also was no difference in any of the analyzed variables that could explain the increased incidence. CONCLUSION In this population-based study we could confirm the previously described increased incidence of PCNSL. The prognosis remains poor despite the inclusion of treatment with rituximab during the study period. A high proportion of the patients had a history of an autoimmune or inflammatory disease not previously described but there was no increase during the study period.
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Affiliation(s)
- Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Gustaf Martinsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Sweden
| | | | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Rosie-Marie Amini
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Hans Hagberg
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
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229
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Primary central nervous system lymphoma: essential points in diagnosis and management. Med Oncol 2017; 34:61. [PMID: 28315229 DOI: 10.1007/s12032-017-0920-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is an extra-nodal non-Hodgkin lymphoma. PCNSL is defined as lymphoma involving the brain, leptomeninges, eyes, or spinal cord without evidence of lymphoma outside the CNS. Treatment includes induction with chemotherapy and consolidation with whole-brain radiotherapy or high-dose chemotherapy supported by autologous stem cell transplantation. High-dose methotrexate is the most important drug in cases with PCNSL, and this drug will be used in combination with small molecules, BTK inhibitors, new monoclonal antibodies, and checkpoint blockers.
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230
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Korfel A, Schlegel U, Johnson DR, Kaufmann TJ, Giannini C, Hirose T. Case-based review: primary central nervous system lymphoma. Neurooncol Pract 2017; 4:46-59. [PMID: 31386044 DOI: 10.1093/nop/npw033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 11/14/2022] Open
Abstract
Primary CNS lymphoma (PCNSL) is a rare diffuse large B-cell lymphoma originating within the central nervous system. The overall incidence of PCNSL is rising, particularly in the elderly population. Immunosuppression is a strong risk factor, but most patients with this tumor are apparently immunocompetent. Diagnosis of PCNSL can be challenging. Non-invasive or minimally invasive tests such as ophthalmological evaluation and spinal fluid analysis may be useful, but the majority of patients require tumor biopsy for definitive diagnosis. Our knowledge concerning optimum treatment of PCNSL is fragmentary due to paucity of adequately sized trials. Most patients are now initially treated with high-dose-methotrexate-based chemotherapy alone, as the addition of whole-brain radiotherapy at standard doses has not been shown to increase survival and does increase the risk of neurological toxicity. Ongoing trials are addressing issues such as the roles of reduced-dose radiotherapy, the addition of the CD20 antibody rituximab to chemotherapy, high-dose chemotherapy followed by autologous stem cell transplantation, and maintenance therapy in the primary management of PCNSL.
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Affiliation(s)
- Agnieszka Korfel
- Department of Hematology, Oncology and Tumor Immunology, Charite University Medicine, Berlin, Germany (A.K.)
| | - Uwe Schlegel
- Department of Neurology, University Hospital Bochum Knappschaftskrankenhaus, Bochum, Germany (U.S.)
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.K.)
| | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (C.G.)
| | - Takanori Hirose
- Department of Pathology, Kobe University Hospital, Kobe City, Japan (T.H.)
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231
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Karmali R, Nabhan C, Petrich AM, Raizer J, Peace D, Lukas R, Gordon LI, Basu S, Chukkapalli V, Venugopal P. Impact of treatment variability on survival in immuno-competent and immuno-compromised patients with primary central nervous lymphoma. Br J Haematol 2017; 177:72-79. [DOI: 10.1111/bjh.14522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Reem Karmali
- Division of Hematology, Oncology and Cell Therapy; Rush University Medical Center; Chicago IL USA
| | - Chadi Nabhan
- Section of Hematology/Oncology; University of Chicago; Chicago IL USA
| | - Adam M. Petrich
- Division of Hematology/Oncology; Northwestern University; Chicago IL USA
- AbbVie; Chicago IL USA
| | - Jeffrey Raizer
- The Ken & Ruth Davee Department of Neurology; Northwestern University; Chicago IL USA
| | - David Peace
- Division of Hematology/Oncology; University of Illinois at Chicago; Chicago IL USA
| | - Rimas Lukas
- Department of Neurology; University of Chicago; Chicago IL USA
| | - Leo I. Gordon
- Division of Hematology/Oncology; Northwestern University; Chicago IL USA
| | - Sanjib Basu
- Rush University Cancer Center; Rush University; Chicago IL USA
| | | | - Parameswaran Venugopal
- Division of Hematology, Oncology and Cell Therapy; Rush University Medical Center; Chicago IL USA
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232
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Kerbauy MN, Moraes FY, Lok BH, Ma J, Kerbauy LN, Spratt DE, Santos FPS, Perini GF, Berlin A, Chung C, Hamerschlak N, Yahalom J. Challenges and opportunities in primary CNS lymphoma: A systematic review. Radiother Oncol 2017; 122:352-361. [PMID: 28104300 DOI: 10.1016/j.radonc.2016.12.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Historically, high-dose methotrexate (HD-MTX) plus consolidation chemotherapy and/or whole brain radiotherapy (WBRT) has been the gold standard on Primary Central Nervous System Lymphoma (PCNSL) management. We sought to examine and summarize the data, on clinical trial (CT) setting, investigating multi-modality treatment to PCNSL. METHODS We performed a systematic review of electronic databases (Medline, EMBASE, Cochrane Database and clinicaltrials.gov) and a manual search to identify original PCNSL phase 2 and phase 3 CT from the last 10years. After a 4stage Prisma based selection process, 32 published (3 Randomized CT and 29 phases 2 CT) studies ultimately were selected for review. Four ongoing clinical trials found on clinicaltrial.gov were reviewed. Two investigators reviewed titles, abstracts, and articles independently. Two investigators abstracted data sequentially and evaluated each study independently. FINDINGS Treatment of PCNSL requires a multidisciplinary approach. HD-MTX represents the most accepted standard of care induction therapy for newly diagnosed PCNSL. When HD-MTX is given with WBRT for consolidation delayed neurotoxicity can be an important complication, particularly in elderly patients. Studies have suggested that WBRT may be deferred until relapse without compromising survival and deferring WBRT may be the best approach in elderly patients. Results from dose-reduced WBRT and consolidative HD-Ara-C are encouraging. High-dose chemotherapy in combination with autologous stem cell transplantation (HDC-ASCT) as chemotherapy alone has emerged as an important consolidative treatment for selected population. The optimal salvage therapy is still to be defined. CONCLUSION WBRT for consolidation is a well-studied modality; however emerging options to selected population such as HDC-ASCT, dose-reduced WBRT or chemotherapy alone are associated with similar survival outcome and less neurotoxicity in selected series. Ongoing and future clinical trials will better define the best approach on this rare disease.
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Affiliation(s)
- Mariana N Kerbauy
- Department of Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Fabio Y Moraes
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Department of Radiation Oncology, University of Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Benjamin H Lok
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jennifer Ma
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Lucila N Kerbauy
- Department of Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, USA
| | - Fabio P S Santos
- Department of Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Guilherme F Perini
- Department of Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nelson Hamerschlak
- Department of Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
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233
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Radiation Therapy in Primary Central Nervous System (CNS) Lymphoma. Radiat Oncol 2017. [DOI: 10.1007/978-3-319-52619-5_28-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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234
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Shin SM, Silverman JS, Bowden G, Mathieu D, Yang HC, Lee CC, Tam M, Szelemej P, Kaufmann AM, Cohen-Inbar O, Sheehan J, Niranjan A, Lunsford LD, Kondziolka D. Relapsed or refractory primary central nervous system lymphoma radiosurgery: Report of the International Gamma Knife Research Foundation. JOURNAL OF RADIOSURGERY AND SBRT 2017; 4:247-253. [PMID: 29296450 PMCID: PMC5658820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/03/2016] [Indexed: 06/07/2023]
Abstract
Stereotactic radiosurgery (SRS) can be used as part of multimodality management for patients with primary central nervous system lymphoma (PCNSL). The objective of this study is to evaluate outcomes of SRS for this disease. The International Gamma Knife Research Foundation identified 23 PCNSL patients who underwent SRS for either relapsed (intracerebral in-field or out-of-field tumor recurrences) or refractory disease from 1995-2014. All 23 patients presented with RPA Class I or II PCNSL, and were initially treated with a median of 7 cycles of methotrexate-based chemotherapy regimens (range, 3-26 cycles). Ten received prior whole brain radiation (WBRT) to a median dose of 43 Gy (range, 24-55 Gy). Sixteen presented with relapsed PCNSL, and seven presented with refractory disease. Twenty-three received 26 procedures of SRS. The median tumor volume was 4 cm3 (range, 0.1-26 cm3), and the median margin dose was 15 Gy (range, 8-20 Gy). Median follow-up from SRS was 11 months (interquartile range, 5.7-33.2 months). Twenty presented with treatment response to twenty-three tumors (12 complete, 11 partial). Fourteen patients relapsed or were refractory to salvage SRS, and local control was 95%, 91%, and 75% at 3, 6, and 12 months post SRS. Intracranial (in-field and out-of-field) and distant (systemic) PFS was 86%, 81%, and 55% at 3, 6, and 12 months post SRS. Toxicity of SRS was low, with one developing an adverse radiation effect requiring no additional intervention. Although methotrexate-based chemotherapy regimens with or without WBRT is the first-line management option for PCNSL, SRS may be used as an alternative option in properly selected patients with smaller relapsed or refractory PCNSL tumors.
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Affiliation(s)
- Samuel M Shin
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, NY 10016, USA
| | - Joshua S Silverman
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, NY 10016, USA
| | - Greg Bowden
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Sherbrooke, QC, Canada, J1K 2R1
| | - Huai-Che Yang
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan 112
| | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan 112
| | - Moses Tam
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, NY 10016, USA
| | - Paul Szelemej
- Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada, R3A 1R9
| | - Anthony M Kaufmann
- Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada, R3A 1R9
| | - Or Cohen-Inbar
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Douglas Kondziolka
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, NY 10016, USA
- Department of Neurosurgery, New York University School of Medicine and Langone Medical Center, New York, NY 10016, USA
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235
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Radiation Therapy in Primary Lymphoma of the CNS. Radiat Oncol 2017. [DOI: 10.1007/978-3-319-52619-5_9-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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236
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Puligundla CK, Bala S, Karnam AK, Gundeti S, Paul TR, Uppin MS, Maddali LS. Clinicopathological Features and Outcomes in Primary Central Nervous System Lymphoma: A 10-year Experience. Indian J Med Paediatr Oncol 2017; 38:478-482. [PMID: 29333016 PMCID: PMC5759068 DOI: 10.4103/ijmpo.ijmpo_202_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Primary central nervous system lymphoma (PCNSL) is a variant of extranodal lymphoma, accounting for 4% of primary central nervous system tumors. PCNSL was more common in immunocompetent individuals. International Extranodal Lymphoma Study Group (IELSG) scoring was used for prognostication. High-dose methotrexate regimens along with radiotherapy improved outcomes in PCNSL. Aims The aim of this study is to analyze the clinical and pathological features, progression-free survival (PFS), and overall survival (OS) in patients with PCNSL. Materials and Methods Data of patients with PCNSL between 2005 and 2016 were retrospectively analyzed. Outcome was analyzed in patients who received chemotherapy. GraphPad Prism software for Windows Version 6 was used to plot the Kaplan-Meier curves for PFS and OS. Log-rank test was used to calculate P values. P < 0.05 was considered as statistically significant. Results A total of 42 patients were available for analysis. Of these, 34 patients who received chemotherapy were evaluable for outcome parameters. The median age at presentation was 46 years (range, 10-75) with male-to-female ratio of 2.2:1. Only 2 (4.7%) patients were HIV positive. Diffuse large B-cell lymphoma (DLBCL) was the most common histology seen in 41 (97.6%) patients. Using IELSG risk scoring, scores of 8 (19%), 19 (45.2%), and 15 (35.8%) were stratified into low, intermediate, and high risk. The median PFS and OS were 11 months (range, 2-72) and 15.9 months (2.4-80.4), respectively. The median OS was 36.2 months (range, 8.8-72), 15.6 months (2-36), and 6.1 months (2.6-12.7) in low-, intermediate-, and high-risk groups, respectively, which was statistically significant (P = 0.0002). Conclusions Immunocompetent patients with PCNSL outnumber immunocompromised patients. DLBCL was the most common histology, and IELSG risk stratification significantly predicts the outcome in PCNSL.
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Affiliation(s)
| | - Stalin Bala
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Ashok Kumar Karnam
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Tara Roshni Paul
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Lakshmi Srinivas Maddali
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
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237
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Four M, Cacheux V, Tempier A, Platero D, Fabbro M, Marin G, Leventoux N, Rigau V, Costes-Martineau V, Szablewski V. PD1 and PDL1 expression in primary central nervous system diffuse large B-cell lymphoma are frequent and expression of PD1 predicts poor survival. Hematol Oncol 2016; 35:487-496. [PMID: 27966264 DOI: 10.1002/hon.2375] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/28/2016] [Accepted: 11/13/2016] [Indexed: 01/02/2023]
Abstract
Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is a rare and aggressive type of diffuse large B-cell lymphoma (DLBCL) whit poorly understood pathogenesis. Finding biomarkers associated with patient survival may be important for understanding its physiopathology and to develop new therapeutic approaches. We investigated 32 PCNS-DLBCL from immunocompetent patients for BCL2, CMYC, LMO2, and P53 expression and for cytogenetic aberrations of BCL2, BCL6, and MYC genes, all known for their prognostic value in systemic DLBCL (s-DLBCL). We analyzed PD1 and PDL1 protein expression in both tumor infiltrating lymphocytes (TILs) and tumor cells. Finally, we searched for correlation between biological data and clinical course. The PCNS-DLBCL expressed BCL2, CMYC, LMO2, and P53 at similar frequency than s-DLBCL but without significant prognostic on survival. None cases harbored aberrations involving BCL2 and MYC gene whereas BCL6 abnormalities were present in 20.7% of cases but without value on survival. Expression of PD1 in TILs and PDL1 in tumor cells was observed at higher rates than in s-DLBCL (58% and 37%, respectively). The PD1 expression in TILs correlated with PDL1 expression in tumor cells (P = .001). Presence of PD1 positive TILs was associated with poorer overall survival (P = .011). Patients with PDL1 overexpression tended to better response to chemotherapy (P = .23). In conclusion PCNS-DLBCL pathogenesis differs from s-DLBCL without prognostic value of the phenotypic and cytogenetic parameters known for their pejorative impact in the latter. The PD1/PDL1 pathway plays a strong role in PCNS-DLBCL and represents an attractive target for this aggressive lymphoma.
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Affiliation(s)
- Marion Four
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Valère Cacheux
- Département d' Hématologie biologique, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
| | - Ariane Tempier
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Dolorès Platero
- Département d' Hématologie biologique, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Michel Fabbro
- Département d' Oncologie Médicale, Institut du Cancer de Montpellier, Montpellier, France
| | - Grégory Marin
- Département d' Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Nicolas Leventoux
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Valérie Rigau
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
| | - Valérie Costes-Martineau
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
| | - Vanessa Szablewski
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
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238
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Batchelor TT. Primary central nervous system lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:379-385. [PMID: 27913504 PMCID: PMC6142465 DOI: 10.1182/asheducation-2016.1.379] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma (NHL) confined to the brain, leptomeninges, eyes, or spinal cord. The majority of PCNSL cases occur in the immunocompetent host, the focus of this review. The prognosis of PCNSL is inferior to that of other NHL subtypes including other organ-specific subtypes of extranodal NHL. The 5- and 10-year survival proportions for PCNSL are 29.3% and 21.6%, respectively. The diagnosis and management of PCNSL differs from that of other primary brain cancers and NHL in other parts of the body.
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Affiliation(s)
- Tracy T Batchelor
- Departments of Neurology and Radiation Oncology, Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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239
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Therapy and outcomes of primary central nervous system lymphoma in the United States: analysis of the National Cancer Database. Blood Adv 2016; 1:112-121. [PMID: 29296804 DOI: 10.1182/bloodadvances.2016000927] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/21/2016] [Indexed: 11/20/2022] Open
Abstract
Although the role of radiation therapy and chemotherapy in primary central nervous system lymphoma (PCNSL) has evolved considerably over the past decade, the application of treatment modalities in the community has not been evaluated. We analyzed the use of chemotherapy, radiation therapy, and associated overall survival, among 9165 HIV-negative PCSNL cases reported to the US National Cancer Database in 2004-2013. During this time, the proportion of patients receiving chemotherapy significantly increased from 65.6% to 78.8% (P for trend <.0001), whereas the proportion receiving radiation therapy decreased from 37.6% to 18.8% (P < .0001). Adjusting for the varying distribution of clinical and sociodemographic characteristics by type of treating facility, the risk of not receiving chemotherapy was significantly lower in academic/research cancer programs compared with community programs (adjusted relative risk, 0.69; 95% confidence interval [CI], 0.62-0.76; P < .0001). Furthermore, omission of chemotherapy was associated with increasing age, comorbidities, black race, and indicators of poor socioeconomic status. Overall survival at 3 years was 37.7% (95% CI, 36.6-38.8) and ranged from 14.1% for patients treated with radiation therapy alone to 51.8% for those who received multiagent chemotherapy. There was evidence of improved survival over time (P for trend =.0002). The disparities in application of chemotherapy for PCNSL underscore the need to provide access to expert management for this rare disease and improve safe delivery of systemic treatment in the community setting, where most older patients receive their care.
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240
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Kim J, Kim YZ. A Case of Primary Central Nervous System Lymphoma Located at Brain Stem in a Child. Brain Tumor Res Treat 2016; 4:155-159. [PMID: 27867930 PMCID: PMC5114190 DOI: 10.14791/btrt.2016.4.2.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an extranodal Non-Hodgkin's lymphoma that is confined to the brain, eyes, and/or leptomeninges without evidence of a systemic primary tumor. Although the tumor can affect all age groups, it is rare in childhood; thus, its incidence and prognosis in children have not been well defined and the best treatment strategy remains unclear. A nine-year old presented at our department with complaints of diplopia, dizziness, dysarthria, and right side hemiparesis. Magnetic resonance image suggested a diffuse brain stem glioma with infiltration into the right cerebellar peduncle. The patient was surgically treated by craniotomy and frameless stereotactic-guided biopsy, and unexpectedly, the histopathology of the mass was consistent with diffuse large B cell lymphoma, and immunohistochemical staining revealed positivity for CD20 and CD79a. Accordingly, we performed a staging work-up for systemic lymphoma, but no evidence of lymphoma elsewhere in the body was obtained. In addition, she had a negative serologic finding for human immunodeficient virus, which confirmed the histopathological diagnosis of PCNSL. She was treated by radiosurgery at 12 Gy and subsequent adjuvant combination chemotherapy based on high dose methotrexate. Unfortunately, 10 months after the tissue-based diagnosis, she succumbed due to an acute hydrocephalic crisis.
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Affiliation(s)
- Jinho Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Division of Neurooncology and Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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241
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Vitolo U, Seymour J, Martelli M, Illerhaus G, Illidge T, Zucca E, Campo E, Ladetto M. Extranodal diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v91-v102. [DOI: 10.1093/annonc/mdw175] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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242
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Nguyen-Them L, Costopoulos M, Tanguy ML, Houillier C, Choquet S, Benanni H, Elias-Shamieh R, Armand M, Faivre G, Glaisner S, Malak S, Vargaftig J, Hoang-Xuan K, Ahle G, Touitou V, Cassoux N, Davi F, Merle-Béral H, Le Garff-Tavernier M, Soussain C. The CSF IL-10 concentration is an effective diagnostic marker in immunocompetent primary CNS lymphoma and a potential prognostic biomarker in treatment-responsive patients. Eur J Cancer 2016; 61:69-76. [DOI: 10.1016/j.ejca.2016.03.080] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/17/2016] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
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243
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Kim S, Nam SJ, Kwon D, Kim H, Lee E, Kim TM, Heo DS, Park SH, Kim CW, Jeon YK. MYC and BCL2 overexpression is associated with a higher class of Memorial Sloan-Kettering Cancer Center prognostic model and poor clinical outcome in primary diffuse large B-cell lymphoma of the central nervous system. BMC Cancer 2016; 16:363. [PMID: 27286976 PMCID: PMC4903010 DOI: 10.1186/s12885-016-2397-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/03/2016] [Indexed: 01/21/2023] Open
Abstract
Background Primary diffuse large B-cell lymphoma of the central nervous system (PCNS-DLBCL) is a distinct clinicopathological entity with a poor prognosis. Concurrent MYC and BCL2 overexpression predicts inferior prognosis in systemic DLBCLs. However, the prognostic significance of MYC and BCL2 in PCNS-DLBCL remains elusive. Methods Immunohistochemistry (IHC) of MYC, BCL2 and BCL6 was performed on tumor samples from 114 patients with PCNS-DLBCL. IHC score was assigned based on the proportion of immunostained cells. Results MYC, BCL2, and BCL6 IHC scores were 18.16 ± 19.58, 58.86 ± 35.07, and 39.39 ± 37.66 % (mean ± SD), respectively. Twenty-one cases (18.1 %) were designated as MYC-positive with a cutoff score of 40. BCL2 positivity was found in 87 cases (75.0 %) using a cutoff score of 30. MSKCC (Memorial Sloan-Kettering Cancer Center prognostic model) class 2 and 3 had higher rates of MYC and/or BCL2 positivity (MYC, P = 0.012; BCL2, P = 0.008; dual-positive, P = 0.022). Poor KPS (Karnofsky Performance Status score <70), multifocal disease, Nottingham-Barcelona score ≥2, and MSKCC class 2 and 3 were related to shorter progression-free survival (PFS) (P = 0.001, 0.037, 0.001, and 0.008, respectively). Patients with older age (>60 years) showed poorer overall survival (OS) (P = 0.020). MYC positivity was associated with poor PFS (P = 0.027), while patients with BCL2 positivity exhibited a shorter OS (P = 0.010). Concomitant MYC and BCL2 positivity was related to poor PFS (P = 0.041), while the lack of both MYC and BCL2 expression was related to prolonged OS (P = 0.014). MYC and BCL2 expression had no independent prognostic implication by multivariate analysis in overall patients with PCNS-DLBCL. However, among patients treated with combined high-dose methotrexate, vincristine and procarbazine and radiotherapy, dual MYC and BCL2 overexpression (a cutoff score of 60) was an independent poor prognostic indicator (P = 0.010). Conclusions Evaluation of MYC and BCL2 expression may be helpful for the determination of PCNS-DLBCL prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2397-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sehui Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Soo Jeong Nam
- The Tumor Immunity Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Pathology, Asan Medical Center, Seoul, Republic of Korea
| | - Dohee Kwon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hannah Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chul Woo Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,The Tumor Immunity Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, Republic of Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,The Tumor Immunity Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, Republic of Korea.
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244
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Abstract
The eye is a rare site for the development of malignant lymphoma. Based on cell type and involved intraocular structures, which as a whole represent an immune-privileged site, several subtypes of primary intraocular lymphoma need to be discerned. Primary vitreoretinal lymphoma (PVRL), the most common form, is an aggressive B-cell malignancy and considered a subtype of primary central nervous system (CNS) lymphoma. Ocular symptoms are non-specific and often mimic uveitis, frequently resulting in delayed diagnosis. Bilateral ocular involvement and dissemination/relapse in the CNS are common. Diagnosis of PVRL is usually based on the analysis of vitreous biopsy material. In addition to cytological and immunocytochemical examination, measurements of cytokine levels and molecular determination of B-cell clonality and recurrent mutations increase the diagnostic yield. Both systemic chemotherapy and exclusively local treatment, including ocular radiotherapy and intravitreal chemotherapy, are successful approaches for the management of PVRL, although it is currently not predictable which patients require systemic treatment in order to avoid cerebral dissemination, a complication associated with a considerably worse prognosis.
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Affiliation(s)
- Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
| | - Andrés J M Ferreri
- Department of Onco-Hematology, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
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245
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Hattori K, Sakata-Yanagimoto M, Okoshi Y, Goshima Y, Yanagimoto S, Nakamoto-Matsubara R, Sato T, Noguchi M, Takano S, Ishikawa E, Yamamoto T, Matsumura A, Chiba S. MYD88 (L265P) mutation is associated with an unfavourable outcome of primary central nervous system lymphoma. Br J Haematol 2016; 177:492-494. [PMID: 27161435 DOI: 10.1111/bjh.14080] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Keiichiro Hattori
- Department of Clinical and Experimental Haematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mamiko Sakata-Yanagimoto
- Department of Clinical and Experimental Haematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Okoshi
- Ibaraki Clinical Education and Training Centre, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.,Department of Haematology, Ibaraki Prefectural Central Hospital, Tsukuba, Ibaraki, Japan
| | - Yuki Goshima
- School of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shintaro Yanagimoto
- Division for Health Service Promotion, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rie Nakamoto-Matsubara
- Department of Clinical and Experimental Haematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taiki Sato
- Department of Pathology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shingo Takano
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eichi Ishikawa
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shigeru Chiba
- Department of Clinical and Experimental Haematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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246
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Jang JE, Kim YR, Kim SJ, Cho H, Chung H, Lee JY, Park H, Kim Y, Cheong JW, Min YH, Kim JS. A new prognostic model using absolute lymphocyte count in patients with primary central nervous system lymphoma. Eur J Cancer 2016; 57:127-35. [DOI: 10.1016/j.ejca.2016.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/10/2016] [Accepted: 01/20/2016] [Indexed: 01/09/2023]
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247
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Cho H, Chang JH, Kim YR, Kim SJ, Chung H, Park H, Lee JY, Jang JE, Kim Y, Kim SH, Yang WI, Suh CO, Cheong JW, Min YH, Kim JS. The role of upfront autologous stem cell transplantation in high-risk younger patients with primary central nervous system lymphoma. Br J Haematol 2016; 174:444-53. [DOI: 10.1111/bjh.14069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Hyunsoo Cho
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Jong Hee Chang
- Department of Neurosurgery; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Yu Ri Kim
- Department of Internal Medicine; Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Soo-Jeong Kim
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Haerim Chung
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Hyunsung Park
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Jung Yeon Lee
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Ji Eun Jang
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Yundeok Kim
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Se Hoon Kim
- Department of Pathology; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Woo Ick Yang
- Department of Pathology; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - June-Won Cheong
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Yoo Hong Min
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Jin Seok Kim
- Division of Haematology; Department of Internal Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
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248
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Yu X, Li Z, Shen J, Chan MTV, Wu WKK. Role of microRNAs in primary central nervous system lymphomas. Cell Prolif 2016; 49:147-53. [PMID: 26990358 DOI: 10.1111/cpr.12243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSL) are extranodal non-Hodgkin lymphomas arising exclusively inside the CNS, and account for about 3% of primary intracranial tumours. This tumour lacks systemic manifestations and prognosis of patients with PCNSL remains poor despite recent advancement of chemoradiotherapy. MicroRNAs are small non-coding RNAs that post-transcriptionally downregulate gene expression by binding to target mRNAs, inducing their degradation or translational repression. MicroRNAs play significant roles in almost all malignancy-related biological processes, including cell proliferation, differentiation, apoptosis and metabolism. Many deregulated miRNAs has been identified in PCNSL but their biological significance remains to be fully elucidated. In this review, we summarize current evidence regarding the pathogenic role of PCNSL-associated microRNAs and their potential applications for diagnosis and prognostication of this deadly disease.
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Affiliation(s)
- Xin Yu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100042, China
| | - Zheng Li
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100042, China
| | - Jianxiong Shen
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100042, China
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, 999077, China
| | - William Ka Kei Wu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, 999077, China.,State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, 999077, China
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249
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Korfel A, Schlegel U, Herrlinger U, Dreyling M, Schmidt C, von Baumgarten L, Pezzutto A, Grobosch T, Kebir S, Thiel E, Martus P, Kiewe P. Phase II Trial of Temsirolimus for Relapsed/Refractory Primary CNS Lymphoma. J Clin Oncol 2016; 34:1757-63. [PMID: 26976424 DOI: 10.1200/jco.2015.64.9897] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE In this phase II study (NCT00942747), temsirolimus was tested in patients with relapsed or refractory primary CNS lymphoma (PCNSL). PATIENTS AND METHODS Immunocompetent adults with histologically confirmed PCNSL after experiencing high-dose methotrexate-based chemotherapy failure who were not eligible for or had experienced high-dose chemotherapy with autologous stem-cell transplant failure were included. The first cohort (n = 6) received 25 mg temsirolimus intravenously once per week. All consecutive patients received 75 mg intravenously once per week. RESULTS Thirty-seven eligible patients (median age, 70 years) were included whose median time since their last treatment was 3.9 months (range, 0.1 to 14.6 months). Complete response was seen in five patients (13.5%), complete response unconfirmed in three (8%), and partial response in 12 (32.4%) for an overall response rate of 54%. Median progression-free survival was 2.1 months (95% CI, 1.1 to 3.0 months). The most frequent Common Toxicity Criteria ≥ 3° adverse event was hyperglycemia in 11 (29.7%) patients, thrombocytopenia in eight (21.6%), infection in seven (19%), anemia in four (10.8%), and rash in three (8.1%). Fourteen blood/CSF pairs were collected in nine patients (10 pairs in five patients in the 25-mg cohort and four pairs in four patients in the 75-mg cohort). The mean maximum blood concentration was 292 ng/mL for temsirolimus and 37.2 ng/mL for its metabolite sirolimus in the 25-mg cohort and 484 ng/mL and 91.1 ng/mL, respectively, in the 75-mg cohort. Temsirolimus CSF concentration was 2 ng/mL in one patient in the 75-mg cohort; in all others, no drug was found in their CSF. CONCLUSION Single-agent temsirolimus at a weekly dose of 75 mg was found to be active in relapsed/refractory patients with PCNSL; however, responses were usually short lived.
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Affiliation(s)
- Agnieszka Korfel
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany.
| | - Uwe Schlegel
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Ulrich Herrlinger
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Martin Dreyling
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Christian Schmidt
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Luisa von Baumgarten
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Antonio Pezzutto
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Thomas Grobosch
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Sied Kebir
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Eckhard Thiel
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Peter Martus
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
| | - Philipp Kiewe
- Agnieszka Korfel, Antonio Pezzutto, Eckhard Thiel, and Philipp Kiewe, Charité University Medicine Berlin; Thomas Grobosch, Labor Berlin - Charité Vivantes, Berlin; Uwe Schlegel, Ruhr-Universität Bochum, Bochum; Ulrich Herrlinger and Sied Kebir, University Hospital Bonn, Bonn; Martin Dreyling, Christian Schmidt, and Luisa von Baumgarten, Hospital of the Ludwig Maximilian University München, Munich; and Peter Martus, University Tuebingen, Tuebingen, Germany
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250
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Fraser E, Gruenberg K, Rubenstein JL. New approaches in primary central nervous system lymphoma. Chin Clin Oncol 2016; 4:11. [PMID: 25841718 DOI: 10.3978/j.issn.2304-3865.2015.02.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/30/2014] [Indexed: 12/19/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) has long been associated with an inferior prognosis compared to other aggressive non-Hodgkin's lymphomas (NHLs). However, during the past 10 years an accumulation of clinical experience has demonstrated that long-term progression-free survival (PFS) can be attained in a major proportion of PCNSL patients who receive dose-intensive consolidation chemotherapy and avoid whole brain radiotherapy. One recent approach that has reproducibly demonstrated efficacy for newly diagnosed PCNSL patients is an immunochemotherapy combination regimen used during induction that consists of methotrexate, temozolomide, and rituximab followed by consolidative infusional etoposide plus high-dose cytarabine (EA), administered in first complete remission (CR). Other high-dose chemotherapy-based consolidative regimens have shown efficacy as well. Our goal in this review is to update principles of diagnosis and management as well as data regarding the molecular pathogenesis of PCNSL, information that may constitute a basis for development of more effective therapies required to make additional advances in this phenotype of aggressive NHL.
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Affiliation(s)
- Eleanor Fraser
- Division of Hematology/Oncology, University of California, San Francisco, CA 94143, USA
| | - Katherine Gruenberg
- UCSF School of Pharmacy, University of California, San Francisco, CA 94143, USA
| | - James L Rubenstein
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143, USA.
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