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Zhang Y, Liu Z, Gao C, Bian H, Ma Y, Jing F, Zhao X. Role of Rituximab in Treatment of Patients With Primary Central Nervous System Lymphoma (PCNSL): A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:733-741. [PMID: 37453867 DOI: 10.1016/j.clml.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin's lymphoma involving the brain, cerebrospinal fluid, spinal cord and eyes. Rituximab has played a prominent role in the treatment of non-Hodgkin's B-cell lymphomas, including aggressive diffuse large B lymphoma. However, as a macromolecular drug, the role of rituximab in the treatment of PCNSL has been controversial. In this systematic review and meta-analysis, we evaluated the role of rituximab in the treatment of PCNSL. We searched articles in the following electronic databases including PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov until October 20, 2022.We included 11 studies (3 RCTS and 8 retrospective studies) with a total of 1182 patients. We extracted the baseline characteristics and outcomes of the studies and assessed the risk of bias, then used Review Manager 5.4 for this meta-analysis. The primary outcomes included complete response rate (CR), overall survival (OS), and progression-free survival (PFS). Odds ratios (ORS) and corresponding 95% confidence intervals (CIS) for the primary outcome were analyzed and compared. The results of our statistical analysis show that the use of rituximab was closely correlated with a higher CR(OR 1.70,95%CI 1.17-2.46, P = .005), 3-year OS (OR 2.40, 95%CI 1.53-3.77, P = .0001), 5-year OS (OR 2.75, 95%CI 1.68-4.49, P < .0001), 3-year PFS(OR 4.42, 95%CI 1.15-16.97, P < .0001), 5-year PFS(OR 1.97, 95%CI 1.39-2.78, P = .0001).These results suggest that rituximab may have a positive impact on the prognosis of patients with PCNSL, and may be helpful in the determination of treatment plan for patients with PCNSL.
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Affiliation(s)
- Yuhang Zhang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Zhihe Liu
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Chengwen Gao
- Laboratory of Medical Biology, Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Haiyan Bian
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Yushuo Ma
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Fanjing Jing
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xia Zhao
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
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Ollila TA, Taher R, Moku P, Olszewski AJ. Immunochemotherapy or chemotherapy alone in primary central nervous system lymphoma: a National Cancer Database analysis. Blood Adv 2023; 7:5470-5479. [PMID: 37459209 PMCID: PMC10515309 DOI: 10.1182/bloodadvances.2023010352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/06/2023] [Indexed: 09/16/2023] Open
Abstract
Debate remains over the role of rituximab, a large molecule with reduced central nervous system (CNS) penetration, in therapy for primary CNS lymphoma (PCNSL). Since 2013, the National Cancer Database has distinguished between chemotherapy and immunotherapy for frontline treatment. In this setting, rituximab would be the only standard frontline immunotherapy. We examined factors associated with the receipt of immunotherapy using a multivariate regression model for relative risk, with a random intercept to account for the hospital-specific treatment selection process. Patients were matched using a 1:1 propensity score to limit possible confounders, and overall survival (OS) was compared in the matched cohort. We identified 4691 patients with PCNSL diagnosed between 2013 and 2018. The use of immunotherapy has increased from 45% in 2013 to 76% in 2018. Immunotherapy use was associated with sociodemographic variables and local (hospital level) preference rather than clinical factors. The main factors associated with reduced use of immunotherapy included male sex, Black race or Hispanic ethnicity (compared with White non-Hispanic), HIV+ status, treatment in a lower-volume hospital, and earlier year of diagnosis. We matched 2830 patients for the survival analysis. Receipt of immunotherapy was associated with a significantly better OS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.67-0.83). There was heterogeneity according to age, because the advantage of immunotherapy was more pronounced for patients aged ≤75 years (HR, 0.71; 95% CI, 0.63-0.80) than for those older than 75 years (HR, 0.87; 95% CI, 0.70-1.08). Overall, our findings support the current trend toward rituximab use, although a nuanced approach should be adopted when treating older patients.
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Affiliation(s)
- Thomas A. Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Rashida Taher
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Prashanth Moku
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
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Schorb E, Isbell LK, Illerhaus G, Ihorst G, Meerpohl JJ, Grummich K, Nagavci B, Schmucker C. Treatment Regimens for Immunocompetent Elderly Patients with Primary Central Nervous System Lymphoma: A Scoping Review. Cancers (Basel) 2021; 13:cancers13174268. [PMID: 34503078 PMCID: PMC8428349 DOI: 10.3390/cancers13174268] [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: 07/02/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 01/17/2023] Open
Abstract
Simple Summary Most patients diagnosed with primary central nervous system lymphoma (PCNSL) are 60 years or older and tend to have a poor prognosis. Evidence to guide and optimize treatment choices for these vulnerable patients is limited. We performed a scoping review to identify and describe all relevant clinical studies investigating chemotherapies and combinations of chemotherapies (including high-dose chemotherapy followed by autologous stem cell transplantation (HCT-ASCT)) in elderly PCNSL patients. In total, we identified six randomized controlled trials, 26 prospective and 24 retrospective studies (with/without control group). While most studies investigated protocols based on ‘conventional’ chemotherapy treatment, data evaluating HCT-ASCT in the elderly were scarce, and the generalizability of the only RCT published is questionable. Considering the poor prognosis of these patients and their need for more effective treatment options, a thoroughly planned randomized controlled trial comparing HCT-ASCT with ‘conventional’ chemoimmunotherapy is urgently needed to evaluate the efficacy of HCT-ASCT. Abstract Background: Most patients diagnosed with primary central nervous system lymphoma (PCNSL) are older than 60 years. Despite promising treatment options for younger patients, prognosis for the elderly remains poor and efficacy of available treatment options is limited. Materials and Methods: We conducted a scoping review to identify and summarize the current study pool available evaluating different types and combinations of (immuno) chemotherapy with a special focus on HCT-ASCT in elderly PCNSL. Relevant studies were identified through systematic searches in the bibliographic databases Medline, Web of Science, Cochrane Library and ScienceDirect (last search conducted in September 2020). For ongoing studies, we searched ClinicalTrials.gov, the German study register and the WHO registry. Results: In total, we identified six randomized controlled trials (RCT) with 1.346 patients, 26 prospective (with 1.366 patients) and 24 retrospective studies (with 2.629 patients). Of these, only six studies (one completed and one ongoing RCT (with 447 patients), one completed and one ongoing prospective single arm study (with 65 patients), and two retrospective single arm studies (with 122 patients)) evaluated HCT-ASCT. Patient relevant outcomes such as progression-free and overall survival and (neuro-)toxicity were adequately considered across almost all studies. The current study pool is, however, not conclusive in terms of the most effective treatment options for elderly. Main limitations were (very) small sample sizes and heterogeneous patient populations in terms of age ranges (particularly in RCTs) limiting the applicability of the results to the target population (elderly). Conclusions: Although it has been shown that HCT-ASCT is probably a feasible and effective treatment option, this approach has never been investigated within a RCT including a wide range of elderly patients. A RCT comparing conventional (immuno) chemotherapy with HCT-ASCT is crucial to evaluate benefit and harms in an un-biased manner to eventually provide older PCNSL patients with the most effective treatment.
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Affiliation(s)
- Elisabeth Schorb
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (L.K.I.); (G.I.)
- Correspondence: ; Tel.: +49-(0)761-270-35360
| | - Lisa Kristina Isbell
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (L.K.I.); (G.I.)
| | - Gerald Illerhaus
- Department of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Gabriele Ihorst
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (L.K.I.); (G.I.)
- Clinical Trials Unit, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (J.J.M.); (K.G.); (B.N.); (C.S.)
- Cochrane Germany, Cochrane Germany Foundation, 79110 Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (J.J.M.); (K.G.); (B.N.); (C.S.)
- Cochrane Germany, Cochrane Germany Foundation, 79110 Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (J.J.M.); (K.G.); (B.N.); (C.S.)
| | - Christine Schmucker
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (J.J.M.); (K.G.); (B.N.); (C.S.)
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The Role of Rituximab in the Treatment of Primary Central Nervous System Lymphoma. Cancers (Basel) 2021; 13:cancers13081920. [PMID: 33923396 PMCID: PMC8074001 DOI: 10.3390/cancers13081920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Simple Summary Primary central nervous system lymphoma (PCNSL) is a rare form of cancer and the treatment of newly diagnosed patients is challenging. Many chemotherapy regimens are being used, and methotrexate is an important component in most. The role of the immunotherapy rituximab is not as clear. This review focuses on the available evidence for the use of this monoclonal antibody in the treatment of patients with PCNSL. Abstract Primary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin lymphoma limited to the central nervous system. It has a poor prognosis. Consensus has been reached on the treatment of newly diagnosed patients with high-dose methotrexate-based chemotherapy, but whether the addition of the monoclonal anti-CD20 antibody rituximab improves survival, as it does in systemic B-cell non-Hodgkin lymphoma, remains disputed. In this review, we reflect on the available evidence of the use of rituximab in PCNSL. Whether rituximab has any beneficial effect remains uncertain.
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Liu Y, Yao Q, Zhang F. Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review). Int J Oncol 2021; 58:371-387. [PMID: 33650642 PMCID: PMC7864151 DOI: 10.3892/ijo.2021.5180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 12/14/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma that is unique and different from systemic diffuse large B-cell lymphomas. The median age at diagnosis of PCNSL is 65 years and its incidence is rising rapidly in the elderly population. A total of ≥20% of all patients with PCNSL are ≥80 years old. Notably, age has been identified as an independent poor prognostic factor for PCNSL. Elderly patients have an inferior prognosis to that of younger patients and are more severely affected by iatrogenic toxicity; therefore, elderly patients represent a unique and vulnerable treatment subgroup. The present review summarized the available literature to provide an improved understanding of the epidemiology, clinical characteristics, diagnosis, prognosis and management of PCNSL in the elderly population. Notably, the incidence of PCNSL in immunocompetent elderly patients, predominantly in men, is increasing. For the diagnosis of CNSL, imaging-guided stereotactic biopsy is considered the gold standard. When stereotactic biopsy is not possible or conclusive, certain biomarkers have been described that can help establish a diagnosis. PCNSL has a very poor prognosis in the elderly, even though several prognostic scoring systems exist and several prognostic markers have been reported in patients with PCNSL. Furthermore, the treatment of elderly patients remains challenging; it is unlikely that a novel agent could be used as a curative monotherapy; however, a combination of novel agents with polychemotherapy or its combination with other novel drugs may have therapeutic potential.
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Affiliation(s)
- Yanxia Liu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Qingmin Yao
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Feng Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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El Dirani A, Hachem Z, Mohanna A, Zaylaa AJ. Traditional and Advanced Neuroimaging Contributions to the Diagnosis and Differential Diagnosis of Central Nervous System Lymphoma Patients Visiting a Comprehensive Medical Center. Open Neuroimag J 2020. [DOI: 10.2174/1874440002013010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The diagnosis of Central Nervous System Lymphoma, especially the Primary Central Nervous System Lymphoma is carried out based on brain imaging, thus avoiding an unnecessary extend of surgery. But the traditional imaging techniques, such as Computed Tomography and Magnetic Resonance Imaging, were not satisfactory.
Aims:
This study was conducted to characterize the spectrum of advanced Neuroimaging, such as the advanced Magnetic Resonance Imaging features in the Central Nervous System Lymphoma patients in a comprehensive medical center in Lebanon, and compare them to what has been described in the literature review.
Methods:
It is a retrospective exploratory study of the clinical data and imaging features for patients admitted to the emergency and radiology departments with ages above 10 years, and who were diagnosed histopathologically with intracranial lymphoma. This study may be the first to make a Radiological evaluation of Central Nervous System Lymphoma on the local population of patients over 9 years .
Results:
Results showed that the study of the Computed Tomography and Magnetic Resonance Imaging data of 10 immunocompetent patients with Central Nervous System Lymphoma concurs with the previously described patient populations, except for the gender parameter. Tumors were mostly presented in the fifth or Sixth decade and they could be solitary or multi-focal. Lesions were typically located Preprint submitted to The Open Neuroimaging Journal May 14, 2020 in the supratentorial compartment. On the brain Computed Tomography, the lesions were hyperdense, and in pre-contrast Magnetic Resonance images, the lesions appeared hypointense on T1 and hyperintense on T2-Weighted images, but hypointense with respect to the grey matter. The lesions were also surrounded with a mild to moderate edema as compared to other intracranial neoplasms, such as glioblastomas. Evaluation results showed that on post-contrast Magnetic Resonance images, the majority of lesions exhibited a homogeneous enhancement of 50%. Majority of the lesions also showed a less common heterogeneous ring-like enhancement of 40%, and revealed the uncommon absence of enhancement of 10%. Calcifications, hemorrhage, and necrosis were rare findings and were present in only one patient.
Conclusion:
As a future prospect, studying whether the advanced imaging techniques may provide not only non-invasive and morphological characteristics but also non-invasive biological characteristics and thus accurate diagnosis could be considered.
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The Role of Rituximab in Primary Central Nervous System Lymphoma. Curr Oncol Rep 2020; 22:78. [PMID: 32602069 PMCID: PMC7324418 DOI: 10.1007/s11912-020-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose of Review The treatment of primary central nervous system lymphoma (PCNSL) is still under debate. One of the issues is the role of rituximab in improving the outcome. Here, we summarize the existing evidence, and comment on the literature on this topic. Recent Findings Two randomized controlled studies have been published recently, with conflicting results. Although the evidence of the benefit of rituximab is limited, it is already incorporated into many treatment regimens, both in studies and in standard clinical practice. Summary The use of rituximab in PCNSL is still a matter of debate. A positive effect on the outcome is uncertain. However, there are no clinical signs of significantly increased toxicity. The uncertain positive effect should therefore be weighed against the increased costs of the treatment.
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Martinez‐Calle N, Poynton E, Alchawaf A, Kassam S, Horan M, Rafferty M, Kelsey P, Scott G, Culligan DJ, Buckley H, Lim YJ, Ngu L, McCulloch R, Rowntree C, Wright J, McKay P, Fourali S, Eyre TA, Smith J, Osborne W, Yallop D, Linton K, Fox CP, Cwynarski K. Outcomes of older patients with primary central nervous system lymphoma treated in routine clinical practice in the UK: methotrexate dose intensity correlates with response and survival. Br J Haematol 2020; 190:394-404. [PMID: 32232989 DOI: 10.1111/bjh.16592] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Nicolás Martinez‐Calle
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Edward Poynton
- University College of London Hospitals NHS Foundation Trust London UK
| | | | | | - Matthew Horan
- Newcastle Upon Tyne Hospitals NHS Trust Newcastle UK
| | - Mark Rafferty
- Department of Haematology Beatson West of Scotland Cancer Centre Glasgow UK
| | | | | | | | | | - Yeong J. Lim
- Aintree University Hospital NHS Trust Liverpool UK
| | - Loretta Ngu
- Royal Devon & Exeter NHS Foundation Trust Exeter UK
| | | | | | - Josh Wright
- Sheffield Teaching Hospitals NHS Trust Sheffield UK
| | - Pamela McKay
- Department of Haematology Beatson West of Scotland Cancer Centre Glasgow UK
| | - Samih Fourali
- Department of Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Toby A. Eyre
- Department of Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | | | - Wendy Osborne
- Newcastle Upon Tyne Hospitals NHS Trust Newcastle UK
| | | | - Kim Linton
- The Christie NHS Foundation Trust Manchester UK
| | - Christopher P. Fox
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Kate Cwynarski
- University College of London Hospitals NHS Foundation Trust London UK
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Mao C, Chen F, Li Y, Jiang X, Liu S, Guo H, Huang L, Wei X, Liang Z, Li W, Tang K. Characteristics and Outcomes of Primary Central Nervous System Lymphoma: A Retrospective Study of 91 Cases in a Chinese Population. World Neurosurg 2018; 123:e15-e24. [PMID: 30326304 DOI: 10.1016/j.wneu.2018.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare disease affecting the brain, leptomeninges, spinal cord, cerebrospinal fluid, or vitreoretinal compartment, without evidence of systemic disease. Prognosis is still poor after intensive methotrexate-based chemotherapy. METHODS Clinical data of 91 patients treated in a tertiary referral center during a 13-year period were retrospectively reviewed. RESULTS The estimated median progression-free survival and overall survival (OS) for the entire cohort were 39.1 months (95% confidence interval [CI], 14.1-64.0 months) and 54.5 months (95% CI, 28.9-80.1 months), respectively. Estimated 5-year progression-free survival and OS were 37.0% ± 6.5% and 47.5% ± 7.5%. Survival was associated with cycles of methotrexate only in multivariate analysis. Seventy-four patients received methotrexate-based chemotherapy after diagnosis. Thirty-nine patients experienced disease progression. Patients with relapsed/refractory disease had a poor survival, with median second OS (calculated from the date of first disease progression to the time of death from any cause) being 7.2 months (95% CI, 2.5-12.00 months). Three patients responded to ibrutinib after disease progression and incurred no fungal infection. CONCLUSIONS The outcomes of patients with PCNSL treated in our cohort are still poor. Relapse or refractory PCNSL and those not tolerating aggressive chemotherapy urgently require new approaches to improve their still dismal prognosis. Novel agents such as ibrutinib have shown promising clinical activity. Future studies should focus on the predictive biomarkers for the treatment of PCNSL with novel agents to provide precision medicine for PCNSL.
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Affiliation(s)
- Chengliang Mao
- Division of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Feili Chen
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yanwen Li
- Division of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xinmiao Jiang
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Sichu Liu
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hanguo Guo
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ling Huang
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiaojuan Wei
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zhanli Liang
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wenyu Li
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Kai Tang
- Division of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
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10
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Da Broi M, Jahr G, Beiske K, Holte H, Meling TR. Efficacy of the Nordic and the MSKCC chemotherapy protocols on the overall and progression-free survival in intracranial PCNSL. Blood Cells Mol Dis 2018; 73:25-32. [PMID: 30217760 DOI: 10.1016/j.bcmd.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To compare the Nordic and the Memorial Sloan-Kettering Cancer Center (MSKCC) chemotherapy protocols for Overall Survival (OS) and Progression-Free Survival (PFS) for intracranial primary CNS lymphoma (PCNSL). METHODS A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003-2014). RESULTS Overall, 79 patients with PCNSL were identified, of whom 57 received chemotherapy. MSKCC with Rituximab (RTX) was used in 18 patients (32%) who had median OS of 46.3 months [9.8-131.9] and median PFS of 34.6 months [6.4-131.9]. The Nordic protocol was used in 14 patients (25%) who had median OS of 30.9 months [2.7-106.3] and PFS of 14.3 months [0.0-106.3]. The MSKCC was used without RTX in 25 patients (44%) who had OS of 15.2 months [0.7-136.5] and PFS of 12.0 months [0.0-117.0]. MSKCC with RTX had a significantly longer median OS (p < 0.05) compared to the other regimens in univariate analysis. In multivariate analysis, the only prognostic factor for OS and PFS of significance was deep brain involvement (p < 0.005). CONCLUSIONS In univariate analysis, the MSKCC with RTX achieved significantly longer median OS compared to the Nordic protocol. However, in multivariate analysis, the only prognostic factor for survival of statistical significance was deep brain involvement.
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Affiliation(s)
- Michele Da Broi
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Guro Jahr
- Department of Neurosurgery, 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
| | - Harald Holte
- Department of Oncology, 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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11
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Farhi J, Laribi K, Orvain C, Hamel JF, Mercier M, Sutra Del Galy A, Clavert A, Rousselet MC, Tanguy-Schmidt A, Hunault-Berger M, Moles-Moreau MP. Impact of front line relative dose intensity for methotrexate and comorbidities in immunocompetent elderly patients with primary central nervous system lymphoma. Ann Hematol 2018; 97:2391-2401. [PMID: 30091022 DOI: 10.1007/s00277-018-3468-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/31/2018] [Indexed: 12/16/2022]
Abstract
Primary central nervous system lymphomas (PCNSL) are non-Hodgkin lymphomas strictly localized to the CNS, occurring mainly in elderly patients with comorbidities. Current treatment in fit patients relies on high-dose methotrexate and high-dose cytarabine. The aim of this study was to evaluate the efficacy and feasibility of this treatment in elderly patients and to assess potential prognostic factors associated with survival. We conducted a retrospective study in two centers between January 2008 and September 2015 including 35 elderly immunocompetent patients who received first-line treatment with high-dose methotrexate. With a median follow-up of 19.8 months (range: 1.7-73.4 months), median overall survival (OS) was 39.5 months (95% confidence interval (95% CI): 18.3-60.7) and median progression-free survival (PFS) was 25.8 months (95% CI: 5.2-46.4). In univariate analysis, administration of high-dose cytarabine and achieving a relative dose intensity for methotrexate > 75% were associated with increased OS (p = 0.006 and p = 0.003, respectively) and PFS (p = 0.003 and p = 0.04, respectively) whereas comorbidities, defined by a CIRS-G score ≥ 8, were associated with decreased OS and PFS (p = 0.02 and p = 0.04, respectively). A high MSKCC score was associated with decreased OS (p = 0.02). In multivariate analysis, administration of high-dose cytarabine was associated with increased OS and PFS (p = 0.02 and p = 0.007, respectively). Comorbidities and relative dose intensity for methotrexate are important for the prognosis of elderly patients with PCNSL. These results must be confirmed in prospective trials.
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Affiliation(s)
- Jonathan Farhi
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France. .,Service d'Hématologie Clinique, CH Le Mans, Le Mans, France.
| | - Kamel Laribi
- Service d'Hématologie Clinique, CH Le Mans, Le Mans, France
| | - Corentin Orvain
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | - Mélanie Mercier
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | - Aline Clavert
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | - Aline Tanguy-Schmidt
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
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12
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Albano D, Bertoli M, Battistotti M, Rodella C, Statuto M, Giubbini R, Bertagna F. Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma. Ann Nucl Med 2018; 32:532-541. [PMID: 29982990 DOI: 10.1007/s12149-018-1274-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/03/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Primary brain lymphoma is an aggressive extranodal non-Hodgkin lymphoma with poor prognosis. Many possible prognostic factors are investigated with controversial results, but possible prognostic role of 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) features remains unclear. Our aim was to study the metabolic behavior of brain lymphoma at 18F-FDG PET/CT and the prognostic impact of qualitative and semiquantitative PET/CT parameters. METHODS Between 2006 and 2018, 52 patients (26 females and 26 males; mean age: 61 years) with histologically confirmed diagnosis of brain lymphoma who underwent 18F-FDG PET/CT for staging before any treatment were included. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The Kaplan-Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS) times. Cox regression models were performed to determinate the relation between qualitative and semiquantitative PET/CT features and OS and PFS. RESULTS Thirty-nine patients had positive 18F-FDG PET/CT showing 18F-FDG uptake (mean SUVbw of 18.2; SUVlbm of 13.9; SUVbsa of 5; MTV of 14.8; TLG of 153) at the corresponding cerebral lesion; the remaining 13 were not 18F-FDG avid. Relapse or progression of disease occurred in 22 patients with an average time of 9.7 months; death occurred in 18 patients with an average of 7.9 months. There was no difference in PFS and OS between baseline PET/CT positive and negative groups or considering SUVbw, SUVlbm, and SUVbsa. PFS and OS was significantly shorter in patients with MTV ≥ 9.8 cm3 (p = 0.037 and p = 0.022, respectively) and TLG ≥ 94 (p = 0.045 and p = 0.0430, respectively). CONCLUSIONS 18F-FDG avidity was noted in 75% of cases. Only metabolic tumor parameters (MTV and TLG) were independently correlated with PFS and OS.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Mattia Bertoli
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Marco Battistotti
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Carlo Rodella
- Health Physics Department, Spedali Civili, Brescia, Italy
| | - Massimo Statuto
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
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Is deep brain involvement in intracranial primary central nervous system lymphoma of importance for penetration of chemotherapeutic agents? Neuroradiology 2018; 60:703-713. [DOI: 10.1007/s00234-018-2038-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/16/2018] [Indexed: 12/14/2022]
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Sun X, Liu J, Wang Y, Bai X, Chen Y, Qian J, Zhu H, Liu F, Qiu X, Sun S, Ji N, Liu Y. Methotrexate-cytarabine-dexamethasone combination chemotherapy with or without rituximab in patients with primary central nervous system lymphoma. Oncotarget 2018; 8:49156-49164. [PMID: 28467782 PMCID: PMC5564757 DOI: 10.18632/oncotarget.17101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/02/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose High-dose methotrexate based chemotherapy is the standard treatment for patients with newly diagnosed primary central nervous system lymphoma (PCNSL). The role of rituximab is controversial because of its large size, which limits its penetration of the blood-brain barrier. In this study, we investigated the efficacy and tolerability of adding rituximab to methotrexate-cytarabine-dexamethasone combination therapy (RMAD regimen). Results The patients treated with RMAD had a complete remission rate of 66.7% after induction chemotherapy; this rate was only 33.3% in patients treated with MAD alone (p = .011). The most common grade 1–3 adverse events were similar and included hematologic toxicity, increased aminotransferase levels, and gastrointestinal reactions. Multivariate analysis revealed that rituximab treatment was associated with longer progression-free survival (PFS, p = .005) but not overall survival (OS). Additionally, we observed that elevated serum lactate dehydrogenase was associated with shorter OS and PFS. Materials and Methods We retrospectively analyzed 60 immunocompetent patients with newly diagnosed PCNSL at Beijing Tiantan Hospital, Capital Medical University from January 2010 to June 2016. Twenty-four patients received 3–6 courses of 3.5 g/m2 methotrexate on day 1; 0.5–1 g/m2 cytarabine on day 2; and 5–10 mg dexamethasone on days 1, 2 and 3. Thirty-six patients received the same combination plus rituximab 375 mg/m2 on day 0. All patients repeated the treatment every 3 weeks. Conclusions High-dose methotrexate based chemotherapy with rituximab yields a higher complete remission rate and does not increase serious toxicities. PFS benefits from the addition of rituximab. OS has an increasing trend in patients treated with rituximab without statistical significance.
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Affiliation(s)
- Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, Navy General Hospital, Beijing, China
| | - Xueyan Bai
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuedan Chen
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Qian
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Zhu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fusheng Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Qiu
- Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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15
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Chanswangphuwana C, Rojnuckarin P, Cherdchoo N, Raiyawa T, Uaprasert N. Balancing relapses versus cognitive impairment in primary central nervous system lymphoma: a single-center experience. ACTA ACUST UNITED AC 2017; 23:385-390. [PMID: 29256330 DOI: 10.1080/10245332.2017.1418610] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The outcomes of primary central nervous system lymphoma (PCNSL) are much improved with multi-modality regimens. Unfortunately, in limited-resource countries, chemo-radiotherapy is the only option of curative-intent treatment. This study aimed to evaluate the effects of low-dose whole brain radiotherapy (WBRT) as a consolidation on disease control and long-term neurocognitive functions. METHODS We conducted a retrospective single-center study enrolling PCNSL patients from 2011 to May 2016 to evaluate the real-life treatment outcome and neurotoxicity from treatment especially radiotherapy. RESULTS Thirty-seven newly diagnosed immunocompetent PCNSL patients were treated with a high-dose methotrexate-based regimen with or without WBRT. The median age was 56 (range 16-78) years old. After chemotherapy, the overall response and complete response (CR) rates were 59.5% and 43.2%, respectively. All 6 partial response (PR) patients and 6 of 16 CR patients underwent radiotherapy. In 22 patients who achieved CR, the progression-free survival (PFS) of patients without WBRT was significantly inferior to the WBRT group with the hazard ratio of 4.7 (95% confidence interval 1.14-19.82, p = 0.03). The 3-year PFS were 35% and 78.75%, respectively, but there was no difference in overall survival. The serial Montreal Cognitive Assessment evaluations (20-72 months post chemotherapy) of 10 long-term CR patients revealed one dementia among three patients without WBRT and five mild cognitive impairments in seven patients with WBRT. Except for the dementia case, all the other patients can perform daily activities without assistance. CONCLUSION The low-dose WBRT consolidation is associated with lower PCNSL relapses with only mild neurocognitive toxicity.
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Affiliation(s)
- Chantiya Chanswangphuwana
- a Department of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Ponlapat Rojnuckarin
- a Department of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Naritsara Cherdchoo
- a Department of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Tassapong Raiyawa
- b Department of Radiology, Faculty of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Noppacharn Uaprasert
- a Department of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
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Song Y, Wen Y, Xue W, Zhang Y, Zhang M. Effect of rituximab on primary central nervous system lymphoma: a meta-analysis. Int J Hematol 2017; 106:612-621. [PMID: 28900847 DOI: 10.1007/s12185-017-2316-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
The effect of rituximab on primary central nervous system lymphoma (PCNSL) is controversial. We performed this meta-analysis to assess the efficacy of treatment with or without rituximab for PCNSL. We first conducted a search for qualified studies using PubMed, the Cochrane Library, and the Web of Science. The meta-analysis was conducted to compare odds ratios (ORs) with the corresponding 95% confidence interval (95% CI) for complete remission (CR) rate, progression-free survival (PFS), and overall survival (OS) using Review Manager 5.0. We included two randomized clinical trials and six retrospective studies in this meta-analysis. The results of our statistical analysis show that the use of rituximab was closely correlated with a higher CR (OR 1.70, 95% CI 1.17-2.46, P = 0.005), 2-year PFS (OR 2.11, 95% CI 1.08-4.11, P = 0.03), 5-year PFS (OR 2.54, 95% CI 1.64-3.93, P < 0.0001), 2-year OS (OR 2.40, 95% CI 1.73-3.34, P < 0.00001), and 5-year OS (OR 2.87, 95% CI 2.02-4.08, P < 0.00001). These results may help to inform therapeutic strategies including the use of rituximab and to improve therapeutic planning for PCNSL patients.
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Affiliation(s)
- Yue Song
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Street (East), Erqi District, Zhengzhou, 450000, Henan, China.,Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yibo Wen
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China.,Department of Urodynamics Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Weili Xue
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Street (East), Erqi District, Zhengzhou, 450000, Henan, China.,Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yanjie Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Street (East), Erqi District, Zhengzhou, 450000, Henan, China.,Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Mingzhi Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Street (East), Erqi District, Zhengzhou, 450000, Henan, China. .,Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, 450000, Henan, China.
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Koeller KK, Shih RY. Extranodal Lymphoma of the Central Nervous System and Spine. Radiol Clin North Am 2016; 54:649-71. [DOI: 10.1016/j.rcl.2016.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Mocikova H, Pytlik R, Sykorova A, Janikova A, Prochazka V, Vokurka S, Berkova A, Belada D, Campr V, Buresova L, Trneny M. Role of rituximab in treatment of patients with primary central nervous system lymphoma: a retrospective analysis of the Czech lymphoma study group registry. Leuk Lymphoma 2016; 57:2777-2783. [PMID: 27087066 DOI: 10.3109/10428194.2016.1167203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We have investigated whether the addition of rituximab to methotrexate, procarbazine, vincristine, radiotherapy and cytarabine was associated with improved outcome of primary central nervous system lymphomas (PCNSL). Of 164 patients, 49 received rituximab. Median age was 63 years, median Karnofsky performance score (KPS) was 60 and median follow-up of living patients was 59.5 months. 1- and 2-year PFS were 49.7 and 37.9%, 1- and 2-year OS were 57.0 and 45.3%. Median progression-free survival (PFS), but not overall survival (OS) was significantly better for patients treated with rituximab (22.9 vs. 10.9 months, p = 0.037). In multivariate analysis, age ≤70 years and KPS ≥90 were predictive for PFS and OS, rituximab was an independent prognostic factor for PFS only. In landmark analyses, rituximab was not found beneficial for long-term survivors and no group particularly benefited from rituximab. In conclusion, addition of rituximab was associated with improved PFS, but not OS in this unselected cohort of PCNSL patients.
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Affiliation(s)
- Heidi Mocikova
- a Department for Internal Medicine and Haematology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine , Charles University in Prague , Czech Republic
| | - Robert Pytlik
- b First Medical Department - Clinical Department of Haemato-oncology , First Faculty of Medicine and General Teaching Hospital, Charles University in Prague , Czech Republic
| | - Alice Sykorova
- c Fourth Department of Internal Medicine - Hematology , Charles University Hospital and Faculty of Medicine , Hradec Kralove , Czech Republic
| | - Andrea Janikova
- d Department of Internal Medicine and Hemato-oncology , University Hospital , Brno , Czech Republic
| | - Vit Prochazka
- e Department of Hemato-oncology, Faculty of Medicine and Dentistry , Palacky University and University Hospital Olomouc , Czech Republic
| | - Samuel Vokurka
- f Department of Hemato-oncology , University Hospital , Pilsen , Czech Republic
| | - Adela Berkova
- b First Medical Department - Clinical Department of Haemato-oncology , First Faculty of Medicine and General Teaching Hospital, Charles University in Prague , Czech Republic
| | - David Belada
- c Fourth Department of Internal Medicine - Hematology , Charles University Hospital and Faculty of Medicine , Hradec Kralove , Czech Republic
| | - Vit Campr
- g Institute of Pathology and Molecular Medicine, Second Faculty of Medicine , Charles University in Prague , Czech Republic
| | | | - Marek Trneny
- b First Medical Department - Clinical Department of Haemato-oncology , First Faculty of Medicine and General Teaching Hospital, Charles University in Prague , Czech Republic
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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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Zeremski V, Koehler M, Fischer T, Schalk E. Characteristics and outcome of patients with primary CNS lymphoma in a “real-life” setting compared to a clinical trial. Ann Hematol 2016; 95:793-9. [DOI: 10.1007/s00277-016-2602-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
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