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Shaulov A, Gross Even-Zohar N, Aumann S, Haran A, Linetsky E. Nivolumab for CNS relapsed refractory primary mediastinal B-cell lymphoma: case report and review of the literature. Leuk Lymphoma 2024:1-5. [PMID: 39226454 DOI: 10.1080/10428194.2024.2396043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/18/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024]
Affiliation(s)
- Adir Shaulov
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Gross Even-Zohar
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shlomzion Aumann
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arnon Haran
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eduard Linetsky
- Department of Neuro-oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Vassilakopoulos TP, Panitsas F, Mellios Z, Apostolidis J, Michael M, Gurion R, Ferhanoglu B, Hatzimichael E, Karakatsanis S, Dimou M, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Giatra H, Kanellias N, Sayyed A, Tadmor T, Akay OM, Angelopoulou MK, Horowitz N, Bakiri M, Pangalis GA, Panayiotidis P, Papageorgiou SG. Incidence and risk factors for central nervous system relapse in patients with primary mediastinal large B-cell lymphoma in the rituximab era. Hematol Oncol 2023; 41:97-107. [PMID: 36314897 DOI: 10.1002/hon.3096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/15/2022] [Accepted: 10/22/2022] [Indexed: 11/04/2022]
Abstract
Central nervous system (CNS) involvement is rare in primary mediastinal large B-cell lymphoma (PMLBCL). We aimed to evaluate the incidence of CNS relapse as first treatment failure event and the effect of the induction chemotherapy regimen, central nervous system - international prognostic index (CNS-IPI) and other clinical and laboratory variables on the risk of CNS relapse in 564 PMLBCL patients treated with immunochemotherapy. Only 17 patients (3.0%) received CNS prophylaxis. During a 55-month median follow-up only 8 patients experienced CNS relapse as first event, always isolated. The 2-year cumulative incidence of CNS relapse (CI-CNSR) was 1.47% and remained unchanged thereafter. The CI-CNSR was not affected by the chemotherapy regimen (R-CHOP or R-da-EPOCH). None of the established International Prognostic Index factors for aggressive lymphomas predicted CNS relapse in PMLBCL. The 2-year CI-CNSR in patients with versus without kidney involvement was 13.3% versus 0.96% (p < 0.001); 14.3% versus 1.13% with versus without adrenal involvement (p < 0.001); and 10.2% versus 0.97% with versus without either kidney or adrenal involvement. CNS-IPI was also predictive (2-year CI-CNSR in high-risk vs. intermediate/low-risk: 10.37% vs. 0.84%, p < 0.001). However, this association may be driven mainly by kidney and/or adrenal involvement. In conclusion, in PMLBCL, CNS relapse is rare and appears to be strongly associated with kidney and/or adrenal involvement.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Fotios Panitsas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Zois Mellios
- Department of Haematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - John Apostolidis
- Department of Adult Hematology & Stem Cell Transplantation, Lymphoma Program, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Michalis Michael
- Department of Haematology, Nicosia General Hospital, Nicosia, Cyprus
| | - Ronit Gurion
- Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Burhan Ferhanoglu
- Hematology Department, Koç University, School of Medicine, Istanbul, Turkey
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Maria Dimou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Eirini Katodritou
- Department of Haematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Haematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Hara Giatra
- Department of Haematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Nick Kanellias
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Ayman Sayyed
- Department of Adult Hematology & Stem Cell Transplantation, Lymphoma Program, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | - Olga Meltem Akay
- Hematology Department, Koç University, School of Medicine, Istanbul, Turkey
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Bakiri
- Department of Haematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Department of Haematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Panayiotis Panayiotidis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Sotirios G Papageorgiou
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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Camus V, Bigenwald C, Ribrag V, Lazarovici J, Jardin F, Sarkozy C. Pembrolizumab in the treatment of refractory primary mediastinal large B-cell lymphoma: safety and efficacy. Expert Rev Anticancer Ther 2021; 21:941-956. [PMID: 34233557 DOI: 10.1080/14737140.2021.1953986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Primary mediastinal large B-cell lymphoma (PMBL) is a rare subtype of lymphoma, clinically and biologically distinct from diffuse large B-cell lymphoma (DLBCL) that shows overlapping features with classical Hodgkin lymphoma (cHL). If first-line strategies lead to 80-85% of curability, relapse occurs early with a chemo-refractory disease and a poor outcome. The presence of 9p24.1 rearrangement, conducting to the overexpression of the immune checkpoint molecules PDL1 and 2, has paved the way for immune checkpoint blockers development in these entities. Pembrolizumab, an anti PD-1 checkpoint antibody, was initially approved in solid cancer and later on in the lymphoma field in cHL.Areas covered: We summarize the biology and clinical need in PMBL, leading to the rationale for checkpoint inhibitors development, as well as pembrolizumab clinical studies in this entity. To do so, we performed a PubMed search using the terms: 'PMBCL,' 'lymphoma,' 'Immune checkpoint,' and 'Pembrolizumab.'Expert opinion: Pembrolizumab showed tolerable safety profile and efficacy data in patients with PMBL who have relapsed after, or are ineligible for autologous stem cell transplant (ASCT). Some combination strategies have shown promising preliminary results, while others are currently being conducted.
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Affiliation(s)
- Vincent Camus
- Département D'hématologie, Centre Henri Becquerel, Rouen, France
| | - Camille Bigenwald
- Département D'hématologie, Institut Gustave Roussy, Villejuif, France
| | - Vincent Ribrag
- Département D'hématologie, Institut Gustave Roussy, Villejuif, France.,Département d'Innovation Thérapeutique Et Des Essais Précoces (DITEP), Institut Gustave Roussy, Villejuif, France
| | - Julien Lazarovici
- Département D'hématologie, Institut Gustave Roussy, Villejuif, France
| | - Fabrice Jardin
- Département D'hématologie, Centre Henri Becquerel, Rouen, France
| | - Clémentine Sarkozy
- Département d'Innovation Thérapeutique Et Des Essais Précoces (DITEP), Institut Gustave Roussy, Villejuif, France
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Targeted Therapies and Immune Checkpoint Inhibitors in Primary CNS Lymphoma. Cancers (Basel) 2021; 13:cancers13123073. [PMID: 34203062 PMCID: PMC8234854 DOI: 10.3390/cancers13123073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 02/07/2023] Open
Abstract
This review article outlines the current development of emerging treatment strategies for primary central nervous system lymphoma, a rare brain tumor with, thus far, limited therapeutic options. Small molecule targeted tyrosine kinase inhibitors, immunomodulatory agents, and immune checkpoint inhibitors will be discussed. The mechanisms of action, results of completed clinical studies, ongoing clinical trials, and future perspectives are summarized. Among the most promising clinical developments in the field of CNS lymphomas is ibrutinib, an inhibitor of Bruton's tyrosine kinase, which relays activation of nuclear factor kappa B upon integration of constitutive B cell receptor and Toll-like receptor signals. Down-stream of nuclear factor kappa B, the thalidomide analogs lenalidomide and pomalidomide exert immunomodulatory functions and are currently explored against CNS lymphomas. Finally, immune checkpoint inhibitors, such as drugs targeting the PD-1 pathway, may become novel therapeutic options to unleash anti-tumor immunity in patients with primary CNS lymphoma.
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