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Nien JE, Chuang CC, Hsu PW, Huang YC, Tsai HC, Chen PY, Lee CC, Lu YJ, Lin YJ, Wei KC, Chen KT. The impact of tumor resection on survival and functional outcomes for patients with primary central nervous system lymphoma. Clin Neurol Neurosurg 2024; 246:108551. [PMID: 39288687 DOI: 10.1016/j.clineuro.2024.108551] [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: 07/21/2024] [Revised: 08/24/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE The role of tumor resection remains undetermined in treating primary central nervous system lymphomas (PCNSLs). This study aimed to clarify the impact of tumor resection on survival and functional outcomes, and to identify subgroups benefiting from resection. METHODS We retrospectively reviewed records from 2010 to 2021 for PCNSL diagnosed at Chang Gung Memorial Hospital, Linkou. Patients were categorized by extent of resection: gross total resection (GTR), partial resection (PR), and biopsy. Univariate and multivariate analyses were performed to identify prognostic factors for survival and functional outcomes. Subgroup analysis was conducted to characterize patients who benefit from tumor resection. RESULTS Of 88 patients, 12 had GTR, 25 had PR, and 51 received biopsy. GTR correlated with longer progression free survival (PFS) (HR 0.25, p=0.039), remaining significant in multivariate analysis (adjusted HR 0.09, p=0.004). In solitary PCNSLs, GTR also independently predicted longer PFS (adjusted HR 0.13, p= 0.023). Patients with dominant tumors measuring ≥ 3 cm trended towards improved overall survival (OS) with cytoreductive surgery versus biopsy (median survival 38.6 months vs 22.3 months, p=0.083). Age ≥ 60 years (adjusted OR 16.9, p = 0.008) and preoperative Karnofsky Performance Scale ≤ 70 (adjusted OR 4.97, p = 0.049) predicted poorer functional outcomes, while radiation therapy (adjusted OR 0.10, p = 0.033) was protective. CONCLUSIONS GTR significantly improved PFS in treating PCNSLs, particularly in solitary cases. For patients with dominant tumors measuring ≥ 3 cm, cytoreductive surgery may improve OS. Neither cytoreductive surgery nor GTR correlated with poor functional outcomes.
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Affiliation(s)
- Ju-En Nien
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Hong-Chieh Tsai
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Keelung, No. 222, Maijin Rd., Anle Dist., Keelung City 204201, Taiwan
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Yu-Jen Lu
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Ya-Jui Lin
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan; School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Ko-Ting Chen
- Department of Neurosurgery, Chang-Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan; School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan.
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Chávez EE, Arce JCD, Perea EDB, Pedraza AG, Ávila AIJ, Quezada DEA, Suárez PDG. Primary central nervous system lymphoma: A mirror type presentation in an immunocompetent patient. Surg Neurol Int 2024; 15:143. [PMID: 38741983 PMCID: PMC11090529 DOI: 10.25259/sni_65_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Background Primary central nervous system (CNS) lymphoma is a very rare extranodal non-Hodgkin lymphoma. The bilateral pattern, as we call it "mirror type", has been identified in other CNS lesions such as gliomas, metastases, and demyelinating lesions, so the differential diagnosis includes imaging studies such as magnetic resonance imaging contrasted with spectroscopy, ruling out immunodeficiency or metastatic disease. Case Description A 65-year-old female presented progressing headache, loss of memory and language alterations, as well as sensory alterations. Neuroimaging showed the presence of two equidistant periventricular lesions at the level of both ventricular atria, a spectroscopy study suggestive of malignancy. Serological studies showed no evidence of immunodeficiency or the presence of positive tumor markers; however, a biopsy was performed, which revealed a histopathological result of primary lymphoma of the CNS. Conclusion In neuro-oncology, primary CNS tumors with multiple lesions are rare, even more, the "mirror type" lesions. Lymphomas are lesions that can present in different ways on imaging and clinical presentation. These tumors that present a vector effect due to their size, perilesional edema, or that lead to loss of neurological function are highly discussed in diagnostic and surgical treatment. Due to their prognosis, action on diagnosis and treatment must be taken as quickly as hospital resources allow.
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Affiliation(s)
- Elizabeth Escamilla Chávez
- Department of Neurosurgery, Arturo Montiel Rojas Medical Center, Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
| | - Julio César Delgado Arce
- Department of Neurosurgery, Arturo Montiel Rojas Medical Center, Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
| | - Edinson David Berrio Perea
- Department of Neurosurgery, Arturo Montiel Rojas Medical Center, Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
| | - Abraham Gallegos Pedraza
- Department of Neurosurgery, Arturo Montiel Rojas Medical Center, Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
| | - Ana Itiel Jimenez Ávila
- Department of Neurosurgery, Arturo Montiel Rojas Medical Center, Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
| | | | - Pablo David Guerrero Suárez
- Department of Neurosurgery, Arturo Montiel Rojas Medical Center, Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
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Qian H, Yang Z, Cai L, Chen H. Conditional survival of elderly primary central nervous system lymphoma. J Cancer Res Clin Oncol 2023; 149:13391-13401. [PMID: 37491638 DOI: 10.1007/s00432-023-05200-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Recent studies have reported that overall survival of elderly patients with primary central nervous system lymphoma (PCNSL), who have the highest incidence of this disease, had failed to benefit from the advancements in treatment strategies over the past decades. This highlights the necessity for intensified research to guide treatment decisions for this specific patient population. METHODS The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) was used to extract data of elderly PCNSL patients (age ≥ 60) who were divided into training and validation groups at the ratio of 7:3, for our analysis. Conditional survival [CS(y|x)] was defined as the probability at survival additional y years given that the patient had not died of PCNSL at a specified period of time (x years) after initial diagnosis. The CS pattern of elderly PCNSL patients was analyzed. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression analysis were applied to develop a novel CS-based nomogram. RESULTS A total of 3315 elderly patients diagnosed with CNS lymphoma between 2000 and 2019 were extracted from the SEER database, of whom 2320 patients were divided into the training group and 995 into the internal validation group. CS analysis revealed a noteworthy escalation in the 5-year survival rate among elderly PCNSL patients for every additional year of survival. The rates progressed from an initial 21-49%, 63%, and 75%, culminating in an impressive 88% and the survival improvement over time was nonlinear. The LASSO regression identified nine predictors and multivariate Cox regression was used to successfully construct the CS-based nomogram model with favorable prediction performance. CONCLUSION CS of elderly PCNSL patients was dynamic and increased over time. Our newly-established CS-based nomogram can provide a real-time dynamic survival estimation, allowing clinicians to better guide treatment decision for these patients.
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Affiliation(s)
- Hui Qian
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China
| | - Zhihao Yang
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China
| | - Linqiang Cai
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China
| | - Huawei Chen
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China.
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4
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Jiang Q, Zhan G, Jiang W, Xu Y, Zheng G, Jiang C, Lin D, Wang K, Zhu H. Prognostic model and treatment choices for patients with primary intracranial central nervous system lymphoma: A population-based study. Clin Neurol Neurosurg 2023; 233:107912. [PMID: 37531751 DOI: 10.1016/j.clineuro.2023.107912] [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: 04/04/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin lymphoma that occurs in the CNS. With the advancement of medical care, its prognosis and treatment have also undergone tremendous changes. This study aimed to construct a prognostic model and compare the effects of different treatments for intracranial PCNSL. METHODS Cases diagnosed as PCNSL between 2004 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Data were analyzed using Kaplan-Meier method and Cox regression analysis. Nomogram was built and validated using the R program. RESULTS A total of 2861 PCNSL patients were included in the analysis. Age, year of diagnosis, surgery and chemotherapy were independent predictors for both overall survival (OS) and cancer-specific survival (CSS). A nomogram was established to predict 3-, 5- and 10-year OS and CSS for patients. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) showed the nomogram had good predictive performance and clinical application value. We also revealed that gross total resection had significantly better OS and CSS than biopsy alone (P < 0.001). Patients who received only chemotherapy had the best prognosis and did not benefit from additional radiotherapy. CONCLUSION We developed a nomogram to predict patient survival rates based on independent predictors. It is an effective tool to help clinicians make survival predictions. Our results showed that patients can benefit from gross total resection of tumor, if it is feasible, and chemotherapy. The role of radiotherapy remained to be further assessed.
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Affiliation(s)
- Qingsong Jiang
- Department of Neurosurgery, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Guoyong Zhan
- Department of Neurosurgery, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Wenhong Jiang
- Department of Medical Records Information Technology, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Yafeng Xu
- Department of Nursing, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Guofu Zheng
- Department of Neurosurgery, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Cai Jiang
- Department of Neurosurgery, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Dongdong Lin
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kang Wang
- Department of Neurosurgery, KeCheng People's Hospital, Quzhou, Zhejiang, China
| | - Huiwu Zhu
- Brain Center, KeCheng People's Hospital, Quzhou, Zhejiang, China.
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5
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Ebrahimi H, Esfandbod M, Ketabchi SM, Yarandi KK, Shirani M, Amirjamshidi A, Alimohamadi M. Prognostic Factors of the Primary Central Nervous System Lymphoma: Clinical Experience from a Tertiary Care Center in the Middle East. Asian J Neurosurg 2023; 18:36-39. [PMID: 37056898 PMCID: PMC10089763 DOI: 10.1055/s-0043-1761229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Aim Primary central nervous system lymphoma (PCNSL) is a rare extra nodal non-Hodgkin's lymphoma. The optimal treatment for PCNSL is still unclear. In this study, we present our experience with management of PCNSL in a tertiary care center in Iran.
Methods In this retrospective study, 58 patients with tissue diagnosis of PCNSL were studied. All patients were treated with chemotherapy including intravenous high-dose methotrexate, rituximab and temozolomide and radiotherapy by the same oncologist. Statistical analysis was performed using SPSS.
Results The mean overall survival (OS) in this study was 37.4 ± 13.6 months and the mean progression free survival (PFS) was 35.1 ± 9.8 months. The mean time to progression was 15.2 ± 8.79 months among 8 patients who experienced progression in this series. Finding of a positive CSF cytology was not linked with disease progression, while HIV infection and multifocal involvement at initial presentation were strongly linked to a lower PFS. The single most important factor affecting the OS was the histopathologic type of the PCNSL; two of the three patients who died from their disease in this series had non-B cell PCNSL, whereas only one patient with DLBCL died because of brainstem involvement.
Conclusion The results of this study show a lower rate of HIV-infection in patients with PCNSL as compared to the series from the western countries. Non-B cell histopathology and HIV-infection were found to be associated with the dismal prognosis.
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Zhou J, Zuo M, Li L, Li F, Ke P, Zhou Y, Xu Y, Gao X, Guan Y, Xia X, Yi X, Zhang X, Huang Y. PIM1 and CD79B Mutation Status Impacts the Outcome of Primary Diffuse Large B-Cell Lymphoma of the CNS. Front Oncol 2022; 12:824632. [PMID: 35223507 PMCID: PMC8864287 DOI: 10.3389/fonc.2022.824632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022] Open
Abstract
Primary diffuse large B cell lymphoma of the central nervous system (CNS DLBCL) is a rare malignancy with a distinct genetic profile. The clinicopathological significance of the mutation patterns remains unknown. Forty cases of primary CNS DLBCL were subjected to targeted exome sequencing covering 413 genes, including MYD88, CD79B and PIM1. Mutational analysis recognized two groups. The CDP (including CD79B and/or PIM1mutations) group was identified in 27 cases (67.5%), and the non-CDP (without CD79B and PIM1 mutations) group was identified in 13 cases 32.5%). The CDP group tended to occur in older patients (median age 57.0 vs. 48.4 years, p=0.015). Patients in the CDP group had a significantly longer 2-year overall survival (OS) (76% and 40%, p=0.0372) than those in the non-CDP group. Multivariate analysis revealed that age less than 60 years, no MYC and BCL2 double expression, and CDP group were three independent risk factors indicating favorable OS. PyClone analysis revealed the subcloning heterogeneity between the groups. In addition, transcriptional sequencing was successfully performed in 8 cases. A total of 131 genes were significantly differentially expressed between these two groups. The major categories of biological processes that were significantly altered between these two groups related to intracellular metabolism mechanisms. We developed a new molecular classification to divide CNS DLBCL into CDP and non-CDP groups based on CD79B and PIM1 mutational status. Patients with PIM1 and/or CD79B mutations had favorable long-term survival after high-dose methotrexate-based polychemotherapy.
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Affiliation(s)
- Jihao Zhou
- Department of Hematology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Min Zuo
- Department of Pathology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Lifeng Li
- Medical Center, Geneplus-Beijing, Beijing, China
| | - Fang Li
- Geneplus-Beijing Institute, Beijing, China
| | - Peng Ke
- Department of Hematology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yangying Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Yaping Xu
- Medical Center, Geneplus-Beijing, Beijing, China
| | - Xuan Gao
- Medical Center, Geneplus-Beijing, Beijing, China
| | - Yanfang Guan
- Medical Center, Geneplus-Beijing, Beijing, China
| | - Xuefeng Xia
- Medical Center, Geneplus-Beijing, Beijing, China
| | - Xin Yi
- Medical Center, Geneplus-Beijing, Beijing, China
| | - Xinyou Zhang
- Department of Hematology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yuhua Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
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Abstract
OPINION STATEMENT Primary central nervous system lymphomas (PCNSLs) are very rare neoplasms and continue to be challenging to treat. While high-dose methotrexate (HD-MTX)-based regimens are the currently accepted standard first-line therapy for newly diagnosed patients, the optimal induction therapies are still unknown. The role of consolidation therapies continues to evolve with a variety of chemotherapy regimens, including high-dose chemotherapy with stem cell rescue and reduced or deferred whole brain radiotherapy being used. Importantly, several recent advances have been made in the treatment of PCNSL. The incorporation of targeted therapy and immune therapy remain promising strategies. Several agents, successfully used in treatment of systemic lymphomas, have shown activity in PCNSL, frequently leading to durable responses in the relapsed/refractory patients. Many ongoing studies will likely lead to a better understanding of the roles of these treatments, especially as the first line and potentially also as maintenance. In addition, the use of molecular profiling to predict disease response to targeted agents and understand relapse patterns will become increasingly important. Clinical trials in PCNSL are critical yet frequently challenging to conduct given the rarity of the condition and lack of suitable subjects. Therefore, multi-institutional and international collaboration is of utmost importance to accelerate progress in understanding the biology and design better treatments for this disease. It is critical to consider patients of all demographics in the design and study of future treatment algorithms to have the largest impact on patient care and outcomes.
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Lv C, Wang J, Zhou M, Xu JY, Chen B, Wan Y. Primary central nervous system lymphoma in the United States, 1975–2017. Ther Adv Hematol 2022; 13:20406207211066166. [PMID: 35096360 PMCID: PMC8793121 DOI: 10.1177/20406207211066166] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Primary central nervous system lymphoma (PCNSL) has received more attention because of an inferior prognosis. Less is known about the incidence rate, histological type, and survival rate of PCNSL, especially in the 2010s. Methods: Data of PCNSL from the Surveillance, Epidemiology, and End Results (SEER) registry database (SEER 9 registries and SEER 18 registries) were used. Incidence was estimated by age, gender, race, site, and histological type. Trends were analyzed using joinpoint regression and described as annual percent change (APC) and average annual percent change (AAPC). Five-year overall survival estimates were compared using log-rank tests. Results: Most PCNSL occurred in the brain, followed by the spinal cord. The most frequent histological type of PCNSL was diffuse large B-cell lymphoma, followed by marginal zone lymphoma. Incidence rate increased from 0.1/100,000 to 0.5/100,000 with an AAPC of 5.3% from 1975 to 2017. Incidence rates varied greatly between the younger and older age population. The 5-year overall survival rates in SEER 9 registries and SEER 18 registries were 30.5% and 37.4%, respectively. Even though the 5-year overall survival rate significantly increased from 27.9% for the 1975–1979 time period to 44.8% for the 2010–2017 time period, survival benefit could not be expected for patients ⩾60 years. The 5-year survival rate for elderly patients was about 30% in the 2010s. Conclusion: With aging, the incidence of PCNSL in the elderly is increased. Over the past decade, no advances have been made in the treatment of elderly PCNSL. Prospective trials with PCNSL are warranted to improve the survival of elderly patients.
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Affiliation(s)
- Chenglan Lv
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Jing Wang
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, P.R China
| | - Min Zhou
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Jing-Yan Xu
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Bing Chen
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, P.R. China
| | - Yuan Wan
- The Pq Laboratory of BiomeDx/Rx, Department of Biomedical Engineering, Binghamton University State University of New York, Binghamton, NY, USA
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9
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Ke B, Cai X, Peng X. Survival prediction and conditional survival of primary central nervous system lymphoma: A population-based study. J Clin Neurosci 2021; 93:188-194. [PMID: 34656246 DOI: 10.1016/j.jocn.2021.09.026] [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: 06/05/2021] [Revised: 08/18/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma is a rare and highly aggressive type of non-Hodgkin lymphoma. This study used population-based data to evaluate the clinical characteristics and prognostic factors of primary central nervous system lymphoma and develop a prediction model to estimate survival. METHODS Patients' data were extracted from the Surveillance, Epidemiology, and End Results database. Significant prognostic factors were identified using univariate and multivariate Cox regression analyses. Conditional survival estimates were calculated as CS(x y) = S(x + y)/S(X), and a nomogram was built to predict patient prognosis. RESULTS In total, 2563 patients with primary central nervous system lymphoma were included. Multivariate Cox analysis showed that age at diagnosis, sex, histology, tumor site, surgery, chemotherapy, and marital status were independent prognostic factors of overall survival. The 1-year conditional survival increased with time, and our nomogram model showed favorable discriminative ability. CONCLUSION At the population level, our study found that gross total resection and chemotherapy improved the prognosis of patients with primary central nervous system lymphoma. However, the prognosis of black patients was poor. Conditional survival provided a more accurate and dynamic survival estimate. Moreover, our nomogram had a good performance and could help predict the overall survival of these patients.
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Affiliation(s)
- Boxi Ke
- Taizhou Central Hospital (Taizhou University Hospital), Department of Neurology, China
| | - Xueli Cai
- Lishui Municipal Central Hospital, Department of Neurology, China
| | - Xiao Peng
- Lishui Municipal Central Hospital, Department of Neurology, China.
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10
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Chen C, Sun P, Sun XQ, Chen SY, Hang Yang, Wang Y, Li ZM. Primary treatment and recent survival trends in patients with primary diffuse large B-cell lymphoma of central nervous system, 1995-2016: A population-based SEER analysis. Hematol Oncol 2021; 41:248-256. [PMID: 34472655 DOI: 10.1002/hon.2918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/11/2022]
Abstract
This retrospective cohort study aimed to evaluate primary treatment and recent survival trends in patients with primary diffuse large B-cell lymphoma of central nervous system (CNS) from 1995 to 2016. Using the SEER data, patients diagnosed with non-HIV-associated primary central nervous system lymphoma (PCNSL)-diffuse large B-cell lymphoma (DLBCL) aged ⩾18 years between 1995 and 2016 were identified. The year of diagnosis was divided into the time period-1 (1995-2002), the time period-2 (2003-2012), and the time period-3 (2013-2016). Chi-square tests, the Kaplan-Meier method, log-rank test, and Cox regression model were used in the analysis. Overall, 3760 patients were included. Both the use of radiotherapy alone and the application of combined chemoradiotherapy decreased significantly, following the wider use of chemotherapy alone during 1995-2016. There was a significant improvement in PCNSL cause-specific survival (CSS) (period-1: 13 months vs. period-2: 19 months vs. period-3: 41 months, p < 0.001). Survival of patients aged above 70 years did not change from the time period-1 to the time period-2 (p = 0.101). However, there was an increase in CSS from the time period-2 to the time period-3 in the elderly patients (period-2: 5 months vs. period-3: 9 months, p < 0.001). On multivariable analyses, diagnosed in the time period-3 was significantly and independently associated with better CSS (hazard ratio 0.577, 95% confidence interval 0.506-0.659, p < 0.001). Our analysis shows the use of radiotherapy in the treatment of PCNSL has waned over the study span. There was a significant improvement in CSS during 1995-2016, which reflected developments in treatment over time. The elderly patient population also gained a significant CSS benefit in the most recent period.
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Affiliation(s)
- Cui Chen
- Department of Medical Oncology, SunYat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Peng Sun
- Department of Medical Oncology, SunYat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-Qing Sun
- Department of Medical Oncology, SunYat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shao-Yong Chen
- Department of Data Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, China
| | - Hang Yang
- Department of Medical Oncology, SunYat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu Wang
- Department of Medical Oncology, SunYat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Ming Li
- Department of Medical Oncology, SunYat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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11
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Yang C, Ren X, Cui Y, Jiang H, Yu K, Li M, Zhao X, Zhu Q, Lin S. Nomograms for predicting cancer-specific survival in patients with primary central nervous system lymphoma: a population-based analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1055. [PMID: 34422967 PMCID: PMC8339814 DOI: 10.21037/atm-21-753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Background This study identified the risk factors for survival in patients with primary central nervous system lymphoma (PCNSL). Nomograms were developed and validated to predict individualized overall survival (OS) and cancer-specific survival (CSS) in this particular cohort. Methods Patients diagnosed with PCNSL between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database for this study. The Cox regression model, the Fine and Grey's model, and the backward method were applied to determine the risk factors for OS and CSS. Nomograms were established accordingly. Internal and external validation was performed in an Asian population to examine the accuracy of the nomograms. Results A total of 5,900 patients with PCNSL were identified from the SEER database. A further 163 patients with PCNSL from the Beijing Tiantan Hospital between 2004 and 2018 were included. Age at diagnosis, tumor site, pathological subtype, surgery, chemotherapy, coexisting malignancies, and HIV infection were independent risk factors of CSS. In addition to the risk factors of CSS, gender, marital status, and radiation were also independent factors of OS. Nomograms were developed to estimate the 1-, 3-, and 5-year OS and CSS. The discrimination and calibration of the nomograms performed well. The C-indexes of the nomograms for OS and CSS prediction were 0.728 [95% confidence interval (CI): 0.703-0.753] and 0.726 (95% CI: 0.696-0.756), respectively. In addition, compared with previously published OS nomograms, the newly established nomograms displayed superior prediction for OS. Conclusions Nomograms predicting the 1-, 3- and 5-year OS and CSS of patients with PCNSL were established in this study. The validated nomograms showed relatively good performance and may be used clinically to evaluate patients' individualized risk and prognosis with PCNSL. Free software for individualized survival prediction is provided at http://www.pcnsl-survivalprediction.cn.
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Affiliation(s)
- Chuanwei Yang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Kefu Yu
- Department of Pharmacy, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Xuzhe Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Qinghui Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
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12
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Callovini GM, Sherkat S, Sperduti I, Crispo F, Raus L, Gazzeri R, Telera S. Hemorrhagic Attitude in Frameless and Frame-Based Stereotactic Biopsy for Deep-Seated Primary Central Nervous System Lymphomas in Immunocompetent Patients: A Multicentric Analysis of the Last Twenty Years. World Neurosurg 2021; 149:e1017-e1025. [PMID: 33476784 DOI: 10.1016/j.wneu.2021.01.035] [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] [Received: 11/11/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare manifestation of aggressive extranodal non-Hodgkin lymphoma. In patients with deep-seated lesions, stereotactic brain biopsy (SBB) is an accepted diagnostic procedure to obtain histopathologic confirmation. OBJECTIVE The aim of this study was to assess the feasibility, diagnostic yield, safety, and complications of stereotactic procedures in midline and deep-seated PCNSLs. METHODS Patients selected had received a histopathologic diagnosis of PCNSL localized in deep-seated midline structures, obtained by SBB. The intraoperative frozen section was executed as an integral part of the procedure. Computed tomography scan was performed after surgery. RESULTS A total of 476 SBBs were performed between January 2000 and December 2019 . Of these SBBs, 91 deep-seated lesions had a histologic diagnosis of PCNSL. A significant increase of the incidence of PCNSL compared with all other diseases was observed (P < 0.0001). Eight patients (8.7%) showed a symptomatic hemorrhage, 4 of whom required craniotomy. There were 4 deaths and 2 cases of permanent morbidity. The hemorrhage risk in the PCNSL group was statistically significant (P = 0.0003) compared with other histotypes. CONCLUSIONS In suspected cases of PCNSL, a histopathologic diagnosis is necessary to distinguish it from glioblastoma or other, nonmalignant conditions. Deep-seated PCNSLs present a higher risk of biopsy-related morbidity and mortality. Intraoperative frozen section increases the diagnostic yield and reduces the number of sampling procedures. Postoperative computed tomography seems to be warranted in patients with suspected PCNSL.
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Affiliation(s)
| | - Shahram Sherkat
- Department of Neurosurgery, San Filippo Neri Hospital, Rome, Italy
| | - Isabella Sperduti
- Departments of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Crispo
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Raus
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy; Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Telera
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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13
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Marcus C, Maragkos GA, Alterman RL, Uhlmann E, Pihan G, Varma H. GCB-type is a favorable prognostic factor in primary CNS diffuse large B-cell lymphomas. J Clin Neurosci 2020; 83:49-55. [PMID: 33339691 DOI: 10.1016/j.jocn.2020.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/08/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
Primary CNS lymphomas (PCNSLs) are aggressive diffuse large B-cell lymphomas (DLBCLs) limited to the CNS that generally have a poor prognosis. Classification of DLBCL into germinal center B-cell (GCB) and activated B-cell (non-GCB) subtypes has prognostic value in systemic DLBCL, with GCB-type having a better prognosis. The aim of this study was to determine whether GCB versus non-GCB classification in PCNSLs has similar prognostic value. We analyzed clinical, radiological and histologic data from 24 patients with biopsy confirmed DLBCL of the CNS with classification into GCB versus non-GCB subtypes. We found that after a median follow-up of 15 months, only 39% of patients with non-GCB-type PCNS DLBCL were alive, whereas all patients with GCB-type were alive. Non-GCB-type had a median survival of 11 months, whereas all GCB-type patients were alive after a median follow-up of 22 months. As previously reported, we also found that patients younger than 70 years had longer survival (median 29 months) compared to older patients (median 8.8 months). There was no statistically significant difference between the ages, gender, focality, size or location of lesions, or treatment of non-GCB and GCB-type patients. Our findings suggest that classifying PCNSLs into GCB versus non-GCB subtype using the Hans algorithm may help stratify patients into two groups with different prognosis.
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Affiliation(s)
- Chelsea Marcus
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Georgios A Maragkos
- Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States
| | - Ron L Alterman
- Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Erik Uhlmann
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - German Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States.
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14
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Lurain K, Uldrick TS, Ramaswami R, Polizzotto MN, Goncalves PH, Widell A, Steinberg SM, Jaffe ES, Pittaluga S, Wang HW, Yuan CM, Tamula MA, Martin S, Wolters PL, George J, Little RF, Yarchoan R. Treatment of HIV-associated primary CNS lymphoma with antiretroviral therapy, rituximab, and high-dose methotrexate. Blood 2020; 136:2229-2232. [PMID: 32609814 PMCID: PMC7645985 DOI: 10.1182/blood.2020006048] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Hao-Wei Wang
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Constance M Yuan
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Mary Anne Tamula
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Frederick, MD
| | - Staci Martin
- Pediatric Oncology Branch, CCR, NCI, NIH, Bethesda, MD; and
| | | | - Jomy George
- Clinical Pharmacokinetics Research Laboratory, Clinical Center Pharmacy, NIH, Bethesda, MD
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15
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Central nervous system lymphoma and radiofrequency radiation – A case report and incidence data in the Swedish Cancer Register on non-Hodgkin lymphoma. Med Hypotheses 2020; 144:110052. [DOI: 10.1016/j.mehy.2020.110052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022]
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16
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Long H, Li S, Zhang Y, Li R, Fong T, Yang C, Wang H, Xu N, Xu Y, Wang K, Yang K, Qi S, Wang J. Primary central nervous system T-cell lymphoma: An analysis from the surveillance, epidemiology, and end results program. J Clin Neurosci 2020; 79:74-79. [PMID: 33070923 DOI: 10.1016/j.jocn.2020.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Primary central nervous system T-cell lymphoma (PCNSTCL) is a rare neoplasm with few data regarding its common features and survival characteristics. OBJECTIVE To explore the Surveillance, Epidemiology, and End Results 18 (SEER 18) database to determine the epidemiology of PCNSTCL. METHODS The SEER 18 registry database was queried to identify patients diagnosed with PCNSTCL from 1973 to 2014 and extract their information. Age-specific rates and Kaplan-Meier overall survival (OS) were calculated. A Cox proportional hazards model was applied to investigate relationships between various demographic/treatment variables and OS. RESULTS The age-specific incidence rates were higher in the older population (≥60 years). Among 59 PCNSTCL cases from the SEER 18, the mean age at presentation was 55.8 years (SD, ±17.95), with a male predominance (1.36:1.00). The median follow-up was 8 months, and the median OS was 8 months (SE, ±4.162). The 1-, 3-, and 5-year OS was 46.3% [95% CI, 33.4%-59.2%], 32.8% [20.3%-45.3%], and 32.8% [20.3%-45.3%], respectively. Seventeen of the 59 patients survived at last follow-up. Patients < 60 years had a greater 3-year OS compared with patients ≥ 60 years (52.6% [33.6%-71.6%] vs 13.9% [1.4%-26.4%]. Multivariate analysis has demonstrated that only age at diagnosis (≥60/<60 years) exhibited a significant relationship with OS (HR, 3.495 [1.688-7.235];p = 0.001). Sex (female/male) was observed to have a doubted trend towards significance (HR, 0.487 [0.231-1.030]; p = 0.060). CONCLUSIONS PCNSTCL is generally of poor prognosis but younger age at diagnosis (<60 years) predicts a better prognosis.
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Affiliation(s)
- Hao Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Siyi Li
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Yuzhen Zhang
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Ruqi Li
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Tszhei Fong
- Neural Networks Surgery Team, Southern Medical University, China; School of Basic Medical Science, Southern Medical University, China
| | - Chen Yang
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Hai Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Nan Xu
- The First Clinical Medicine College, Southern Medical University, China
| | - Yuan Xu
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Kewan Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Kaijun Yang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Jun Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China.
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17
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Yang H, Xun Y, Yang A, Liu F, You H. Advances and challenges in the treatment of primary central nervous system lymphoma. J Cell Physiol 2020; 235:9143-9165. [PMID: 32420657 DOI: 10.1002/jcp.29790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Abstract
Primary central nervous system lymphoma (PCNSL), a rare variant of non-Hodgkin's lymphoma, is characterized by distinct biological characteristics and clinical behaviors, and patient prognosis is not satisfactory. The advent of high-dose (HD) methotrexate (HD-MTX) therapy has significantly improved PCNSL prognosis. Currently, HD-MTX-based chemotherapy regimens are recognized as first-line treatment. PCNSL is sensitive to radiotherapy, and whole-brain radiotherapy (WBRT) can consolidate response to chemotherapy; however, WBRT-associated delayed neurotoxicity leads to neurocognitive impairment, especially in elderly patients. Other effective approaches include rituximab, temozolomide, and autologous stem-cell transplantation (ASCT). In addition, new drugs against PCNSL such as those targeting the B-cell receptor signaling pathway, are undergoing clinical trials. However, optimal therapeutic approaches in PCNSL remain undefined. This review provides an overview of advances in surgical approaches, induction chemotherapy, radiotherapy, ASCT, salvage treatments, and novel therapeutic approaches in immunocompetent patients with PCNSL in the past 5 years. Additionally, therapeutic progress in elderly patients and in those with relapsed/refractory PCNSL is also summarized based on the outcomes of recent clinical studies.
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Affiliation(s)
- Hua Yang
- Department of Basic Medicine and Biomedical Engineering, School of Stomatology and Medicine, Foshan University, Foshan, Guangdong, China
| | - Yang Xun
- Department of Basic Medicine and Biomedical Engineering, School of Stomatology and Medicine, Foshan University, Foshan, Guangdong, China
| | - Anping Yang
- Department of Basic Medicine and Biomedical Engineering, School of Stomatology and Medicine, Foshan University, Foshan, Guangdong, China
| | - Fang Liu
- Department of Basic Medicine and Biomedical Engineering, School of Stomatology and Medicine, Foshan University, Foshan, Guangdong, China
| | - Hua You
- Department of Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, China
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18
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Lin SY, Chuang CC, Tsan DL, Hung YS, Fu CJ, Shen YL, Chiang YY, Huang YC, Lu YJ, Yang CC. Maintenance of multi-domain neurocognitive functions in patients with newly-diagnosed primary CNS lymphoma after primary cranial radiotherapy combined with methotrexate-based chemotherapy: A preliminary case-series study. APPLIED NEUROPSYCHOLOGY. ADULT 2020; 29:432-441. [PMID: 32301346 DOI: 10.1080/23279095.2020.1749630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Conventional treatment for treating primary central nervous system lymphoma (PCNSL) has consisted of either whole-brain radiotherapy (WBRT) or methotrexate (MTX)-based combined modality therapy. However, delayed cognitive sequelae have emerged as a significant debilitating complication in PCNSL patients. A prospective observational case-series study with prospective assessments of neurocognitive functions (NCFs), neuroimaging, and activities of daily living in newly-diagnosed PCNSL patients was undertaken. A battery of neuropsychological measures, used to evaluate NCFs, is composed of ten standardized NCF tests, representing four domains sensitive to disease and treatment effects (executive function, attention, verbal memory, psychomotor speed), and activities of daily living. A total of 15 patients with newly-diagnosed PCNSL were consecutively enrolled in this study. Comparing the NCF scores between the baseline (before WBRT) and post-treatment (after combined chemoradiation therapy) intervals (Mean = 122.33 days, SD = 34.49, range = 77-196), neurobehavioral outcomes consistently remained improving or stable in almost each domain of NCF. Specifically, the scores on Paced Auditory Serial Addition Test-Revised (PASAT-R) were significantly improved between the baseline and post-chemoradiation assessment. Under the multidisciplinary treatment guidelines for treating patients with newly-diagnosed PCNSL, multi-domain NCF become stabilized and even improved after the course of conformal WBRT combined with or without MTX-based chemotherapy.
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Affiliation(s)
- Shinn-Yn Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Din-Li Tsan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chen-Ju Fu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yi-Liang Shen
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yin-Yin Chiang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Lu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan.,Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
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19
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Gessler F, Bernstock JD, Behmanesh B, Brunnberg U, Harter P, Ye D, Friedman GK, Hansmann ML, Wagner M, Seifert V, Weise L, Marquardt G. The Impact of Early Corticosteroid Pretreatment Before Initiation of Chemotherapy in Patients With Primary Central Nervous System Lymphoma. Neurosurgery 2020; 85:264-272. [PMID: 30016483 DOI: 10.1093/neuros/nyy272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/27/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The optimal timing of corticosteroid (CS) treatment in patients with primary central nervous system (CNS) lymphoma (PCNSL) remains controversial. While poor clinical presentation may justify early treatment with CS, this may ultimately result in reduced concentrations of chemotherapeutic agents via perturbations in the permeability of the blood-brain barrier. OBJECTIVE To investigate whether early CS exposure is associated with beneficial outcomes and/or reduced occurrence of adverse events as opposed to delayed/concomitant administration. METHODS Herein we performed a retrospective observational analysis using patients that were prospectively entered into a database. All patients whom were admitted to the University Hospital between 2009 and 2015 with newly diagnosed PCNSL were included within our study. RESULTS Our cohort included 50 consecutive patients diagnosed with PCNSL; of these, in 30 patients CS administration was initiated prior to chemotherapy (early), whilst in the remaining 20 patients CS administration was initiated concomitantly with their chemotherapeutic regimen (concomitant). Within the early vs concomitant CS administration groups, no significant differences were observed with regard to progression-free survival (PFS) (P = .81), overall survival (OS) (P = .75), or remission (P = .68; odds ratio 0.76 and confidence interval [95%] 0.22-2.71). Critically, the timing of CS initiation was not associated with either PFS (P = .81) or PFS (P = .75). CONCLUSION Early CS administration was not associated with a deterioration in response to chemotherapy, PFS, or OS. As such, administration of CS prior to initiation of chemotherapy is both reasonable and safe for patients with newly diagnosed PCNSL.
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Affiliation(s)
- Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, Maryland
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Uta Brunnberg
- Department of Internal Medicine II, Hematology/Oncology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Patrick Harter
- Institute of Neurology (Edinger-Institute), Goethe-University Frankfurt, Frankfurt, Germany
| | - Daniel Ye
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, Maryland
| | - Gregory K Friedman
- Neuro-Oncology Program, Department of Pediatrics, University of Alabama, Birmingham, Alabama
| | - Martin-Leo Hansmann
- Dr Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Lutz Weise
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
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20
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Soldan SS, Lieberman PM. Epstein-Barr Virus Infection in the Development of Neurological Disorders. ACTA ACUST UNITED AC 2020; 32:35-52. [PMID: 33897799 DOI: 10.1016/j.ddmod.2020.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epstein-Barr Virus (EBV) is a ubiquitous human herpesvirus that contributes to the etiology of diverse human cancers and auto-immune diseases. EBV establishes a relatively benign, long-term latent infection in over 90 percent of the adult population. Yet, it also increases risk for certain cancers and auto-immune disorders depending on complex viral, host, and environmental factors that are only partly understood. EBV latent infection is found predominantly in memory B-cells, but the natural infection cycle and pathological aberrations enable EBV to infect numerous other cell types, including oral, nasopharyngeal, and gastric epithelia, B-, T-, and NK-lymphoid cells, myocytes, adipocytes, astrocytes, and neurons. EBV infected cells, free virus, and gene products can also be found in the CNS. In addition to the direct effects of EBV on infected cells and tissue, the effect of chronic EBV infection on the immune system is also thought to contribute to pathogenesis, especially auto-immune disease. Here, we review properties of EBV infection that may shed light on its potential pathogenic role in neurological disorders.
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21
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Liu CJ, Lin SY, Yang CF, Yeh CM, Kuan AS, Wang HY, Tsai CK, Gau JP, Hsiao LT, Chen PM, Liu YC, Hong YC, Ko PS, Liu JH, Lin CH. A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma. Cancer Med 2020; 9:2134-2145. [PMID: 32011103 PMCID: PMC7064125 DOI: 10.1002/cam4.2872] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/14/2019] [Accepted: 12/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background Although various prognostic models for primary central nervous system lymphoma (PCNSL) have been developed, there is no consensus regarding the optimal prognostic index. We aimed to evaluate potential prognostic factors and construct a novel predictive model for PCNSL patients. Methods We enrolled newly diagnosed PCNSL patients between 2003 and 2015. The primary endpoint was progression‐free survival (PFS), and the secondary endpoint was overall survival (OS). The prognostic factors identified using multivariate Cox proportional hazards models were used to develop a predictive model. We subsequently validated the prognostic model in an independent cohort. We also evaluated the validity of the existing scores: the International Extranodal Lymphoma Study Group (IELSG), the Nottingham/Barcelona (NB), and the Memorial Sloan‐Kettering Cancer Center models (MSKCC). Results We identified 101 patients with newly diagnosed PCNSL at our center. Multivariate analysis showed that age ≥80, deep brain lesions, and ECOG ≥2 were independent risk factors of PFS. Assigning one point for each factor, we constructed a novel prognostic model, the Taipei Score, with four distinct risk groups (0‐3 points). The performances of the Taipei Score in discriminating both PFS and OS in the training cohort were significant, and the score was validated in the external validation cohort. The IELSG, NB and MSKCC models had insufficient discriminative ability for either PFS or OS in both cohorts. Conclusion The Taipei Score is a simple model that discriminates PFS and OS for PCNSL patients. The score may offer disease risk stratification and facilitate clinical decision‐making.
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Affiliation(s)
- Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Shinn-Yn Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Fen Yang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ai-Seon Kuan
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Hao-Yuan Wang
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Kuang Tsai
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Shen Ko
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Hsin Lin
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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22
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Kinslow CJ, Rae AI, Neugut AI, Adams CM, Cheng SK, Sheth SA, McKhann GM, Sisti MB, Bruce JN, Iwamoto FM, Sonabend AM, Wang TJC. Surgery plus adjuvant radiotherapy for primary central nervous system lymphoma. Br J Neurosurg 2020; 34:690-696. [PMID: 31931632 DOI: 10.1080/02688697.2019.1710820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: Recent studies of primary central nervous system lymphoma (PCNSL) have found a positive association between cytoreductive surgery and survival, challenging the traditional notion that surgery is not beneficial and potentially harmful. However, no studies have examined the potential added benefits of adjuvant treatment in the post-operative setting. Here, we investigate survival in PCNSL patients treated with surgery plus radiation therapy (RT).Methods: The Surveillance, Epidemiology, and End-Results Program was used to identify patients with PCNSL from 1995-2013. We retrospectively analyzed the relationship between treatment, prognostic factors, and survival using case-control design. Treatment categories were compared to biopsy alone.Results: We identified 5417 cases. Median survival times for biopsy alone (n = 1824, 34%), biopsy + RT (n = 1460, 27%), surgery alone (n = 1222, 27%), and surgery + RT (n = 911, 17%) were 7, 8, 20, and 27 months, respectively. On multivariable analysis, surgery + RT was associated with improved survival over surgery alone (hazard ratio [HR] = 0.58 [95% confidence interval = 0.53-0.64] vs. HR = 0.71 [0.65-0.77]). Adjuvant RT was associated with improved survival, regardless of the extent of resection. HR's for subtotal resection, gross-total resection, subtotal resection + RT, and gross-total resection + RT were 0.77 (0.66-0.89), 0.66 (0.57-0.76), 0.62 (0.52-0.72), and 0.54 (0.46-0.63), respectively. Survival improved after adjuvant RT in patients under and over 60 years old. All findings were confirmed by multivariable analysis of cause-specific survival.Conclusion: Adjuvant RT was associated with improved survival in PCNSL patients who underwent surgery. Although these data are hypothesis-generating, additional information on neurotoxicity, dosing, and concurrent chemotherapy will be necessary to validate these findings. Cytoreductive surgery for PCNSL is common in the general population, and more studies are needed to assess optimal treatment in the post-operative setting.
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Affiliation(s)
- Connor J Kinslow
- Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Ali I Rae
- Department of Neurological Surgery, Oregon Health & Sciences University, Portland, OR, USA
| | - Alfred I Neugut
- Department of Epidemiology, Mailman School of Public Health, and Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher M Adams
- Division of Biostatistics, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Simon K Cheng
- Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Guy M McKhann
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael B Sisti
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey N Bruce
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Fabio M Iwamoto
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M Sonabend
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tony J C Wang
- Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
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23
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Yuan XG, Huang YR, Yu T, Xu Y, Liang Y, Zhang XH, Sun CR, Zhao XY. Primary central nervous system lymphoma in China: a single-center retrospective analysis of 167 cases. Ann Hematol 2019; 99:93-104. [PMID: 31758262 DOI: 10.1007/s00277-019-03821-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma and a limited number of cases have been reported from China. This study aimed to investigate the clinicopathological features of newly diagnosed PCNSLs from a single center in eastern China and to identify the potential prognostic factors for overall survival (OS) and progression-free survival (PFS). All consecutive patients with histopathologically diagnosed PCNSLs at our center between January 2003 and October 2017 were recruited. Demographic and clinicopathological data were collected and reviewed retrospectively. The potential risk factors for OS and PFS were identified using the log-rank test and Cox regression analysis. A total of 167 immunocompetent cases were enrolled. The median age was 58 years (range 17-96 years), and the male:female ratio was 3:2. Headache (n = 65; 39%) and cerebral hemisphere (n = 96; 57%) were the most common presenting complaint and location, respectively. Out of 167 cases, 150 cases were diffuse large B cell lymphomas. With a median follow-up of 25 months (range 1-152 ), the median OS and PFS were 37 months (95% CI, 25-49) and 17 months (95% CI, 13-20), respectively. Residual tumor after operation, chemotherapy without HD-MTX and palliative treatment was revealed as independent prognostic markers. Moreover, ECOG > 3, multifocal lesions, and palliative treatment were revealed as unfavorable independent prognostic markers for PFS. In conclusion, Chinese patients with PCNSL have distinct characteristics. Further studies are warranted to confirm the prognostic value of these factors and to optimize treatments for these patients.
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Affiliation(s)
- Xiang-Gui Yuan
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Yu-Rong Huang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Teng Yu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Yang Xu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Yun Liang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Xiao-Hong Zhang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Chong-Ran Sun
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China.
| | - Xiao-Ying Zhao
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China.
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24
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25
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Neuhauser M, Roetzer T, Oberndorfer S, Kitzwoegerer M, Payer F, Unterluggauer JJ, Haybaeck J, Stockhammer G, Iglseder S, Moser P, Thomé C, Stultschnig M, Wuertz F, Brandner-Kokalj T, Weis S, Bandke D, Pichler J, Hutterer M, Krenosz KJ, Boehm A, Mayrbaeurl B, Hager-Seifert A, Kaufmann H, Dumser M, Reiner-Concin A, Hoenigschnabl S, Kleindienst W, Hoffermann M, Dieckmann K, Kiesel B, Widhalm G, Marosi C, Jaeger U, Hainfellner A, Hackl M, Hainfellner JA, Preusser M, Woehrer A. Increasing use of immunotherapy and prolonged survival among younger patients with primary CNS lymphoma: a population-based study. Acta Oncol 2019; 58:967-976. [PMID: 30994047 DOI: 10.1080/0284186x.2019.1599137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Primary CNS lymphoma is a highly aggressive and rare type of extranodal non-Hodgkin lymphoma. Although, new therapeutic approaches have led to improved survival, the management of the disease poses a challenge, practice patterns vary across institutions and countries, and remain ill-defined for vulnerable patient subgroups. Material and Methods: Using information from the Austrian Brain Tumor Registry we followed a population-based cohort of 189 patients newly diagnosed from 2005 to 2010 through various lines of treatment until death or last follow-up (12-31-2016). Prognostic factors and treatment-related data were integrated in a comprehensive survival analysis including conditional survival estimates. Results: We find variable patterns of first-line treatment with increasing use of rituximab and high-dose methotrexate (HDMTX)-based poly-chemotherapy after 2007, paralleled by an increase in median overall survival restricted to patients aged below 70 years. In the entire cohort, 5-year overall survival was 24.4% while 5-year conditional survival increased with every year postdiagnosis. Conclusion: In conclusion, we show that the use of poly-chemotherapy and immunotherapy has disseminated to community practice to a fair extent and survival has increased over time at least in younger patients. Annually increasing conditional survival rates provide clinicians with an adequate and encouraging prognostic measure.
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Affiliation(s)
- Magdalena Neuhauser
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Melitta Kitzwoegerer
- Department of Pathology, University Hospital St. Poelten Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Franz Payer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Julia J. Unterluggauer
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Johannes Haybaeck
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Graz, Austria
- Department of Pathology, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Günther Stockhammer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrizia Moser
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Franz Wuertz
- Institute of Pathology, State Hospital Klagenfurt, Klagenfurt, Austria
| | | | - Serge Weis
- Department of Neuropathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Dave Bandke
- Department of Neuropathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Markus Hutterer
- Department of Neurology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Karl J. Krenosz
- Department of Hematology and Oncology, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Alexandra Boehm
- Department of Internal Medicine, Hematology and Oncology, Hospital Elisabethinen, Linz, Austria
| | - Beate Mayrbaeurl
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - Andrea Hager-Seifert
- Department of Neurology, State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Hannes Kaufmann
- Department of Oncology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Martina Dumser
- Department of Pathology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | | | | | - Waltraud Kleindienst
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Hoffermann
- Department of Neurosurgery, State Hospital Feldkirch, Feldkirch, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jaeger
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Andreas Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
| | - Johannes A. Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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26
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Diagnostic performance of DWI for differentiating primary central nervous system lymphoma from glioblastoma: a systematic review and meta-analysis. Neurol Sci 2019; 40:947-956. [PMID: 30706241 DOI: 10.1007/s10072-019-03732-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this meta-analysis was to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) for differentiating primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM). MATERIALS AND METHODS A thorough search of the databases including PubMed, EMBASE, and Cochrane Library was carried out and the data acquired were up to November 1, 2017. The quality of the studies involved was evaluated using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies, revised version). Multiple analytic values including sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the summary receiver operating characteristic (SROC) curve were calculated and pooled for the statistical analysis. The subgroup analysis was also performed to explore the heterogeneity. RESULTS Eight retrospective studies (461 patients with 461 lesions) were included. The pooled SEN, SPE, PLR, NLR, and DOR with 95% confidence interval (CI) were 0.82 [95% CI 0.70-0.90], 0.84 [95% CI 0.75-0.90], 4.96 [95% CI 3.20-7.69], 0.22 [95% CI 0.13-0.37], and 22.85 [95% CI 10.42-50.11], respectively. The area under the curve (AUC) given by SROC curve was 0.90 [95% CI 0.87-0.92]. The subgroup analysis indicated the slice thickness of the images (> 3 mm versus ≤ 3 mm) was a significant factor affecting the heterogeneity. No existence of significant publication bias was confirmed with Deeks' test. CONCLUSIONS DWI showed moderate diagnostic performance for differentiating primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM). Moreover, it is of clinical significance using DWI combined with conventional MRI to differentiate PCNSL from GBM.
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27
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Mendez JS, Ostrom QT, Gittleman H, Kruchko C, DeAngelis LM, Barnholtz-Sloan JS, Grommes C. The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades. Neuro Oncol 2019; 20:687-694. [PMID: 29036697 DOI: 10.1093/neuonc/nox187] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There has been significant improvement in treatment outcomes of primary central nervous system lymphoma (PCNSL) at specialized centers over the past several decades; however, it is unclear if these changes have translated to benefits in the general population. Methods In this study, we utilized 2 national databases to examine survival trends over time for PCNSL: the Central Brain Tumor Registry of the United States (CBTRUS, 2000-2013) and 18 registries from the Surveillance, Epidemiology, and End Results program (SEER, 1973-2013). Results The annual incidence of PCNSL in 2013 was 0.4 per 100000 population (CBTRUS/SEER). Incidence increased from 0.1 per 100000 in the 1970s to 0.4 per 100000 in the 1980s, correlating with an increase in the diagnosis of patients ≥70 years (1973: 0.2 vs 2013: 2.1 [SEER]). Incidence rates differed greatly between young and elderly patients (age 20-29 y: 0.08 vs 70-79 y: 4.32 [CBTRUS]). Even though the median overall survival of all patients doubled from 12.5 months in the 1970s to 26 months in the 2010s, this survival benefit was limited to patients <70 years. Survival in the elderly population has not changed in the last 40 years (6 mo in the 1970s vs 7 mo in the 2010s, P = 0.1). Conclusion The poor outcome seen in the particularly vulnerable elderly patient population highlights the need for clinical trials targeting the elderly in hopes of improving treatment strategies and survival.
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Affiliation(s)
- Joe S Mendez
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Neurology, Weill Cornell Medical School, New York, New York
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Neurology, Weill Cornell Medical School, New York, New York
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28
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Zhou Y, Liu W, Xu Z, Zhu H, Xiao D, Su W, Zeng R, Feng Y, Duan Y, Zhou J, Zhong M. Analysis of Genomic Alteration in Primary Central Nervous System Lymphoma and the Expression of Some Related Genes. Neoplasia 2018; 20:1059-1069. [PMID: 30227305 PMCID: PMC6141698 DOI: 10.1016/j.neo.2018.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 02/05/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and special type of non-Hodgkin lymphoma. The treatment of PCNSL is comprehensive, combining surgery, radiotherapy, and chemotherapy. However, the outcome is poor because of its high invasiveness and rate of recurrence. We analyzed 22 cases of PCNSL using next-generation sequencing (NGS) to detect 64 candidate genes. We used immunohistochemical methods to analyze gene expression in 57 PCNSL samples. NGS showed that recurrent mutations in KMT2D and CD79B, components of the NF-κB pathway, accounted for 65% of total mutations in PCNSL samples. The most frequent mutated gene was PIM1 (77.27%, 17/22), followed by MYD88 (63.64%, 14/22), CD79B (69.09%, 13/22), and KMT2D (50.00%, 11/22). Mutations of the CD79B gene were associated with an inferior progression-free survival (PFS), and GNA13 gene mutations were associated with a shorter PFS and overall survival (OS) in PCNSL patients (P < .05). PIM1 and MYD88 were highly expressed in PCNSL patients and were related to their OS time. MYD88 overexpression might be an independent and poor prognostic predictor of OS time. In summary, we identified highly recurrent genetic lesions in CD79B and KMT2D, components of the NF-κB pathway, in PCNSL and validated the expression of PIM1 and MYD88 related to poor survival, thereby providing novel insights into the pathogenesis and precision medicine of PCNSL.
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Affiliation(s)
- Yangying Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wei Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Desheng Xiao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Weiping Su
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Ruolan Zeng
- Hunan Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 410013, Hunan, China
| | - Yuhua Feng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yumei Duan
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Jianhua Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
| | - Meizuo Zhong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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29
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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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30
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Prognostic Factors and Survival in Primary Central Nervous System Lymphoma: A Population-Based Study. DISEASE MARKERS 2018; 2018:7860494. [PMID: 30050595 PMCID: PMC6046161 DOI: 10.1155/2018/7860494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/20/2018] [Accepted: 06/05/2018] [Indexed: 12/26/2022]
Abstract
Objective This study sought to explore the prognostic factors in a large retrospective cohort of patients with primary central nervous system lymphoma (PCNSL) from the Surveillance, Epidemiology, and End Results database. Methods There were 5903 patients with PCNSL who had complete clinical information and were identified in the Surveillance, Epidemiology, and End Results program between 1973 and 2014. The epidemiology, therapeutic measures, and clinical characteristics were listed as descriptive statistics. They were grouped into 4 categories: immunocompetent individual with diffuse large B cell lymphoma (DLBCL), immunocompetent individual with non-DLBCL, immunocompromised individual with DLBCL, and immunocompromised individual with non-DLBCL based on different subtypes and immunological status. Survival analysis was conducted with Cox regression models. Results Different demographics and clinical characteristics were identified as independent factors in different groups. In survival analysis, for patients with DLBCL, chemotherapy involving treatments was associated with the most favorable survival. Received-only radiation could be considered as a primary treatment in immunocompetent patients with non-DLBCL. These differences were statistically significant (P < 0.05). Conclusion PCNSL patients treated with appropriate chemotherapy treatments may receive stable tumor control.
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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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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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Mahale P, Shiels MS, Lynch CF, Engels EA. Incidence and outcomes of primary central nervous system lymphoma in solid organ transplant recipients. Am J Transplant 2018; 18:453-461. [PMID: 28805292 PMCID: PMC5790603 DOI: 10.1111/ajt.14465] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/14/2017] [Accepted: 08/06/2017] [Indexed: 01/25/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) risk is greatly increased in immunosuppressed human immunodeficiency virus-infected people. Using data from the US transplant registry linked with 17 cancer registries (1987-2014), we studied PCNSL and systemic non-Hodgkin lymphoma (NHL) in 288 029 solid organ transplant recipients. Transplant recipients had elevated incidence for PCNSL compared with the general population (standardized incidence ratio = 65.1; N = 168), and this elevation was stronger than for systemic NHL (standardized incidence ratio=11.5; N = 2043). Compared to kidney recipients, PCNSL incidence was lower in liver recipients (adjusted incidence rate ratio [aIRR] = 0.52), similar in heart and/or lung recipients, and higher in other/multiple organ recipients (aIRR = 2.45). PCNSL incidence was higher in Asians/Pacific Islanders than non-Hispanic whites (aIRR = 2.09); after induction immunosuppression with alemtuzumab (aIRR = 3.12), monoclonal antibodies (aIRR = 1.83), or polyclonal antibodies (aIRR = 2.03); in recipients who were Epstein-Barr virus-seronegative at the time of transplant and at risk of primary infection (aIRR = 1.95); and within the first 1.5 years after transplant. Compared to other recipients, those with PCNSL had increased risk of death (adjusted hazard ratio [aHR] = 11.79) or graft failure/retransplantation (aHR = 3.24). Recipients with PCNSL also had higher mortality than those with systemic NHL (aHR = 1.48). In conclusion, PCNSL risk is highly elevated among transplant recipients, and it carries a poor prognosis.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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The role of surgery in intracranial PCNSL. Neurosurg Rev 2018; 41:1037-1044. [PMID: 29383600 DOI: 10.1007/s10143-018-0946-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
This aimed to evaluate the effect of surgery for overall survival (OS) and progression-free survival (PFS) in intracranial primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center. A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003-2014). Seventy-nine patients with intracranial PCNSL were identified. Deep brain involvement was shown in 63 patients. Thirty-two patients underwent craniotomy with resection, while all other patients had a biopsy. Fifty-seven patients were given chemotherapy: 18 were treated with the MSKCC (Memorial Sloan-Kettering Cancer Center) with rituximab, 21 with the MSKCC without rituximab, and 14 within a Nordic prospective phase II protocol. Forty-four patients achieved complete response (CR) and had OS of 46.3 months. Patients who underwent resection had a median OS of 28.6 versus 11.7 months for those who had a biopsy performed. Resection showed an insignificant prolongation of OS. Multivariate analysis confirmed statistical significance of deep brain involvement only (p < 0.005). Neither chemotherapy regimen, Karnofsky Performance Status (KPS), type of surgery, nor patient age was significant factors for OS or PFS. Resective surgery played no role in significantly improving either OS or PFS and therefore it is not recommended as treatment for PCNSL.
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Verheul C, Kleijn A, Lamfers MLM. Cerebrospinal fluid biomarkers of malignancies located in the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2018; 146:139-169. [PMID: 29110768 DOI: 10.1016/b978-0-12-804279-3.00010-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CNS malignancies include primary tumors that originate within the CNS as well as secondary tumors that develop as a result of metastatic cancer. The delicate nature of the nervous systems makes tumors located in the CNS notoriously difficult to reach, which poses several problems during diagnosis and treatment. CSF can be acquired relatively easy through lumbar puncture and offers an important compartment for analysis of cells and molecules that carry information about the malignant process. Such techniques have opened up a new field of research focused on the identification of specific biomarkers for several types of CNS malignancies, which may help in diagnosis and monitoring of tumor progression or treatment response. Biomarkers are sought in DNA, (micro)RNA, proteins, exosomes and circulating tumor cells in the CSF. Techniques are rapidly progressing to assess these markers with increasing sensitivity and specificity, and correlations with clinical parameters are being investigated. It is expected that these efforts will, in the near future, yield clinically relevant markers that aid in diagnosis, monitoring and (tailored) treatment of patients bearing CNS tumors. This chapter provides a summary of the current state of affairs of the field of biomarkers of different types of CNS tumors.
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Affiliation(s)
- Cassandra Verheul
- Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anne Kleijn
- Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Martine L M Lamfers
- Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands.
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Eloranta S, Brånvall E, Celsing F, Papworth K, Ljungqvist M, Enblad G, Ekström-Smedby K. Increasing incidence of primary central nervous system lymphoma but no improvement in survival in Sweden 2000-2013. Eur J Haematol 2017; 100:61-68. [PMID: 28983970 DOI: 10.1111/ejh.12980] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aims to characterize the epidemiology of immunocompetent Primary central nervous system lymphoma (PCNSL) diagnosed 2000-2013 in Sweden. METHODS Cases were identified in the population-based Swedish Lymphoma Register. Incidence per 100 000 person-years and 95% confidence intervals (CI) were calculated, and PCNSL-specific survival was estimated using relative survival. Tests for temporal trends were performed using Poisson regression. Population incidence of all brain tumors was retrieved for comparison. RESULTS With 359 identified PCNSL cases (median age 66 years), overall incidence was 0.26 (95% CI: 0.24-0.29) and the average annual increase 4% (P = .002). The increasing trend was primarily observed among elderly individuals (70+ years). Similarly, an increase in incidence of all brain tumors was noted only among the elderly. There was no significant improvement in relative survival across the study period although, among fit patients (with Eastern Cooperative Oncology Group, EGOC 0), survival plateaued 6 years after diagnosis. CONCLUSION The increasing PCNSL incidence in the elderly was consistent with an increasing incidence of brain tumors of any type and may in part be attributable to improved diagnostics and reporting in this group. New treatment options have not yet translated into general survival improvements in a population-based setting, although the presence of long-term survivors among fit patients is encouraging.
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Affiliation(s)
- Sandra Eloranta
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Elsa Brånvall
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Celsing
- Department of Medicine, Division of Hematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Karin Papworth
- Department of Oncology, Norrlands University Hospital, Umeå, Sweden
| | - Maria Ljungqvist
- Department of Medicine, Division of Hematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Karin Ekström-Smedby
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Division of Hematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Fan N, Zhang L, Xu X, Chen B, Zhu C, Li P, Chen Z, Ding T, Ma Y, Yuan Y, Lin Z. Methotrexate plus idarubicin improves outcome of patients with primary central nervous system lymphoma. Oncotarget 2017; 8:53701-53713. [PMID: 28881844 PMCID: PMC5581143 DOI: 10.18632/oncotarget.15899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/07/2017] [Indexed: 01/12/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma with poor long-term survival. This study assessed methotrexate (MTX) plus idarubicin (IDA) in treating patients of PCNSL comparing to MTX alone therapy. A total of 100 patients were retrospectively enrolled and subjected to MTX alone (n = 52) and MTX plus IDA (n = 48). The completed response (CR) rate in patients treated with MTX plus IDA was 62.50%, and overall response (OR) rate was 79.17%, which in MTX alone cohort were 42.31% and 63.46% respectively. Median progression-free survival (PFS) of patients treated with MTX plus IDA was significantly better than those treated with MTX alone (18.35 months vs.8.45months, P = 0.000). The MTX plus IDA regimen exhibited a significantly better control of PCNSL. Further studies would be needed to confirm these results.
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Affiliation(s)
- Ni Fan
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lu Zhang
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoping Xu
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Zhu
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Pei Li
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zi Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianling Ding
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Yuan
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiguang Lin
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
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Moulignier A, Lamirel C, Picard H, Lebrette MG, Amiel C, Hamidi M, Polivka M, Mikol J, Cochereau I, Pialoux G. Long-term AIDS-related PCNSL outcomes with HD-MTX and combined antiretroviral therapy. Neurology 2017; 89:796-804. [PMID: 28747447 DOI: 10.1212/wnl.0000000000004265] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/30/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the characteristics and outcomes of patients with AIDS-related primary CNS lymphoma (AR-PCNSL) in the combined antiretroviral therapy (cART) era systematically treated with high-dose methotrexate (HD-MTX). METHODS We retrospectively analyzed (intention-to-treat analysis) 51 consecutive patients with AR-PCNSL (median age 39 years) who were diagnosed from 1996 to 2014 and treated with a median of 6 (range 1-15) infusions of HD-MTX (3 g/m2) combined with cART. RESULTS Median all-patients' and survivors' follow-up lasted 23 (range 0-186) and 76 (range 23-186) months, respectively. At PCNSL diagnosis, 83% of the patients were on cART, median plasma HIV load was 175,600 copies/mL, and median CD4+ T-cell count was 24/μL. Median Eastern Cooperative Oncology Group performance status was 2 (range 1-4). Median overall survival (OS) was 5.7 years, with 5- and 10-year rates of 48% and 41%. Median time to progression was not reached (69% at 10 months). PCNSL was the direct cause of 14 deaths, all observed within the 10 months after its diagnosis: 6 patients died before HD-MTX could be administered, 4 had refractory disease, and 4 relapsed. Multivariate analyses retained time interval between AIDS diagnosis and PCNSL diagnosis, age at AR-PCNSL diagnosis, and deep brain structure involvement as independent OS-predictive factors. To restore effective immune function, cART tailored to HIV genotypes was started and combined with HD-MTX; no interactions and no immune reconstitution inflammatory syndrome occurred. No patient died of acute treatment-related toxicity, and 21 of 51 (41%) patients experienced grade 3/4 toxicity. CONCLUSIONS Combined short-term HD-MTX monochemotherapy and optimal cART simply and effectively treat AR-PCNSL, achieving long-term survival with few relapses. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that short-term HD-MTX monochemotherapy improves long-term survival of patients with AIDS with primary CNS lymphoma receiving cARTs.
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Affiliation(s)
- Antoine Moulignier
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France.
| | - Cédric Lamirel
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Hervé Picard
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Marie-Gisèle Lebrette
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Corinne Amiel
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Mohammed Hamidi
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Marc Polivka
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Jacqueline Mikol
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Isabelle Cochereau
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
| | - Gilles Pialoux
- From the Department of Neurology (A.M.), Department of Ophthalmology (C.L., I.C.), and Clinical Research Unit (H.P.), Fondation Adolphe de Rothschild, Paris; Department of Infectious and Tropical Diseases (A.M., M.-G.L., M.H., G.P.) and Department of Virology (C.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon-Université Paris 6; and Department of Pathology (M.P., J.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière-Université Paris 7, France
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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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40
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DeFilipp Z, Li S, El-Jawahri A, Armand P, Nayak L, Wang N, Batchelor TT, Chen YB. High-dose chemotherapy with thiotepa, busulfan, and cyclophosphamide and autologous stem cell transplantation for patients with primary central nervous system lymphoma in first complete remission. Cancer 2017; 123:3073-3079. [PMID: 28369839 DOI: 10.1002/cncr.30695] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND High-dose chemotherapy and autologous stem cell transplantation (HDC-ASCT) is a therapeutic option for patients with primary central nervous system lymphoma (PCNSL). To the authors' knowledge, data are limited regarding its use among patients in first complete remission (CR1) with the CNS-directed conditioning regimen of thiotepa, busulfan, and cyclophosphamide (TBC). METHODS A retrospective analysis of patients with PCNSL in CR1 who underwent transplantation using a TBC-based conditioning regimen at 2 academic institutions was performed. RESULTS Forty-six consecutive patients who underwent HDC-ASCT while in CR1 were identified. The most common induction regimen was high-dose methotrexate plus temozolomide and rituximab (59%). No patients received whole-brain radiotherapy. A total of 40 patients (87%) received cytarabine before undergoing ASCT as either induction intensification, early consolidation therapy, or mobilization. The median time from diagnosis to transplantation was 6 months (range, 4-15 months). The median age of the patients at the time of transplantation was 59 years (range, 27-69 years). With a median follow-up of 2.7 years after ASCT (range, 6 months-7.5 years), the Kaplan-Meier estimates of 2-year overall survival and progression-free survival were 95% (95% confidence interval [95% CI], 80%-99%) and 92% (95% CI, 77%-97%), respectively. The most common toxicities were severe mucositis (35%) and bacterial infections occurring within 100 days of transplantation (35%). The estimated 2-year nonrecurrence mortality rate was 2.9% (95% CI, 0.2%-13.4%). CONCLUSIONS HDC-ASCT with a CNS-directed conditioning regimen such as TBC should be considered for patients with PCNSL who are in CR1 because this approach is associated with encouraging disease control and survival in this select patient population. Cancer 2017;123:3073-79. © 2017 American Cancer Society.
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Affiliation(s)
- Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Shuli Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Areej El-Jawahri
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nancy Wang
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yi-Bin Chen
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
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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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Shiels MS, Pfeiffer RM, Besson C, Clarke CA, Morton LM, Nogueira L, Pawlish K, Yanik EL, Suneja G, Engels EA. Trends in primary central nervous system lymphoma incidence and survival in the U.S. Br J Haematol 2016; 174:417-24. [PMID: 27018254 PMCID: PMC4961566 DOI: 10.1111/bjh.14073] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/30/2016] [Indexed: 01/07/2023]
Abstract
It is suspected that primary central nervous system lymphoma (PCNSL) rates are increasing among immunocompetent people. We estimated PCNSL trends in incidence and survival among immunocompetent persons by excluding cases among human immunodeficiency virus (HIV)-infected persons and transplant recipients. PCNSL data were derived from 10 Surveillance, Epidemiology and End Results (SEER) cancer registries (1992-2011). HIV-infected cases had reported HIV infection or death due to HIV. Transplant recipient cases were estimated from the Transplant Cancer Match Study. We estimated PCNSL trends overall and among immunocompetent individuals, and survival by HIV status. A total of 4158 PCNSLs were diagnosed (36% HIV-infected; 0·9% transplant recipients). HIV prevalence in PCNSL cases declined from 64·1% (1992-1996) to 12·7% (2007-2011), while the prevalence of transplant recipients remained low. General population PCNSL rates were strongly influenced by immunosuppressed cases, particularly in 20-39 year-old men. Among immunocompetent people, PCNSL rates in men and women aged 65+ years increased significantly (1·7% and 1·6%/year), but remained stable in other age groups. Five-year survival was poor, particularly among HIV-infected cases (9·0%). Among HIV-uninfected cases, 5-year survival increased from 19·1% (1992-1994) to 30·1% (2004-2006). In summary, PCNSL rates have increased among immunocompetent elderly adults, but not in younger individuals. Survival remains poor for both HIV-infected and HIV-uninfected PCNSL patients.
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Affiliation(s)
- Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | | | - Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | | | - Elizabeth L. Yanik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Fukumura K, Kawazu M, Kojima S, Ueno T, Sai E, Soda M, Ueda H, Yasuda T, Yamaguchi H, Lee J, Shishido-Hara Y, Sasaki A, Shirahata M, Mishima K, Ichimura K, Mukasa A, Narita Y, Saito N, Aburatani H, Nishikawa R, Nagane M, Mano H. Genomic characterization of primary central nervous system lymphoma. Acta Neuropathol 2016; 131:865-75. [PMID: 26757737 DOI: 10.1007/s00401-016-1536-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/01/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare malignancy confined to the central nervous system (CNS), and majority of PCNSL is pathologically classified as diffuse large B-cell lymphoma (DLBCL). We have now performed whole-exome sequencing for 41 tumor tissues of DLBCL-type PCNSL and paired normal specimens and also RNA-sequencing for 30 tumors, revealing a very high frequency of nonsynonymous somatic mutations in PIM1 (100 %), BTG2 (92.7 %), and MYD88 (85.4 %). Many genes in the NF-κB pathway are concurrently mutated within the same tumors. Further, focal deletion or somatic mutations in the HLA genes are associated with poor prognosis. Copy number amplification and overexpression of genes at chromosome 7q35 were both found to predict short progression-free survival as well. Oncogenic mutations in GRB2 were also detected, the effects of which in cultured cells were attenuated by inhibitors of the downstream kinases MAP2K1 and MAP2K2. Individuals with tumors positive for MYD88 mutations also harbored the same mutations at a low frequency in peripheral blood mononuclear cells, suggesting that MYD88 mutation-positive precancerous cells originate outside of the CNS and develop into lymphoma after additional genetic hits that confer adaptation to the CNS environment.
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Iwabuchi M, Shibamoto Y, Sugie C, Ayakawa S, Ogino H, Baba F. Partial-brain radiotherapy for primary central nervous system lymphoma: multi-institutional experience. JOURNAL OF RADIATION RESEARCH 2016; 57:164-168. [PMID: 26661856 PMCID: PMC4795951 DOI: 10.1093/jrr/rrv085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 06/05/2023]
Abstract
Whole-brain radiotherapy (WBRT) has been an important component of treatment for primary central nervous system lymphoma (PCNSL), but delayed neurotoxicity has been a matter of concern. We have employed partial-brain radiotherapy (PBRT) with wide margins for PCNSL patients with a single lesion or a few lesions. In this study, we evaluated the treatment outcome in PCNSL patients undergoing PBRT. Between 2003 and 2014, 24 patients were treated with PBRT; 16 received high-dose-methotrexate (MTX) -containing chemotherapy before PBRT. Conventional fractionation with a median dose of 54 Gy was used. For reference, 15 patients undergoing MTX-based chemotherapy and WBRT were also analyzed. The 3-year overall survival rate was 60% for all 24 patients undergoing PBRT and 68% for the 16 patients undergoing MTX-based chemotherapy plus PBRT. The 3-year progression-free survival rate was 41% for all 24 patients undergoing PBRT and 36% for the 16 patients undergoing MTX-based chemotherapy. The in-field recurrence rate was 26% and the out-of-field recurrence rate was 15% at 3 years for all 24 patients undergoing PBRT. The rates for in-field recurrence and the out-of-field recurrence were 27% and 21%, respectively, for the 16 patients undergoing MTX-based chemotherapy. CNS-recurrence rates were similar in patients undergoing MTX-based chemotherapy and PBRT to the rates in those undergoing MTX-based chemotherapy and WBRT. Neurocognitive dysfunction developed in 3 of the 16 patients undergoing MTX + PBRT and in 4 of 15 patients undergoing MTX + WBRT (P = 0.68). PBRT seems to be a feasible treatment option for solitary PCNSL. Further investigations are warranted to evaluate the advantages of PBRT over WBRT.
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Affiliation(s)
- Michio Iwabuchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shiho Ayakawa
- Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjyou, Minami-ku, Nagoya, Aichi, 457-8510, Japan
| | - Hiroyuki Ogino
- Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Fumiya Baba
- Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
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45
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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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46
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da Rocha AJ, Sobreira Guedes BV, da Silveira da Rocha TMB, Maia Junior ACM, Chiattone CS. Modern techniques of magnetic resonance in the evaluation of primary central nervous system lymphoma: contributions to the diagnosis and differential diagnosis. Rev Bras Hematol Hemoter 2015; 38:44-54. [PMID: 26969774 PMCID: PMC4786762 DOI: 10.1016/j.bjhh.2015.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/30/2015] [Indexed: 11/05/2022] Open
Abstract
In addition to findings from conventional magnetic resonance imaging, modern magnetic resonance imaging techniques have provided important information about tumor metabolism, in vivo metabolite formation, water molecule diffusion, microvascular density, and blood-brain barrier permeability, all of which have improved the in vivo diagnostic accuracy of this method in the evaluation of primary central nervous system lymphoma. These nonconventional magnetic resonance techniques are useful in the clinical practice because they enhance conventional magnetic resonance imaging by reinforcing the possibility of a diagnosis and by allowing the early detection of disease recurrence. This report is a review of the most relevant contributions of nonconventional magnetic resonance techniques to the imaging diagnosis of primary central nervous system lymphoma, the differential diagnosis of this disease, and the prognosis of patients. This paper aims to describe a wide range of presentations of primary central nervous system lymphoma, their appearance in imaging, and the differential diagnoses of this disease.
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Affiliation(s)
- Antonio José da Rocha
- Fleury Medicina e Saúde, São Paulo, SP, Brazil; Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
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47
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Chang C, Lin CH, Cheng AL, Medeiros LJ, Chang KC. Primary central nervous system diffuse large B-cell lymphoma has poorer immune cell infiltration and prognosis than its peripheral counterpart. Histopathology 2015; 67:625-35. [PMID: 25829022 DOI: 10.1111/his.12706] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/27/2015] [Indexed: 01/21/2023]
Abstract
AIMS Primary central nervous system (CNS) diffuse large B-cell lymphoma (PCNSL) is an ominous disease with a poor prognosis. The brain is an immune-privileged sanctuary, and this may contribute to an ineffective host immune response and thus a poorer outcome. The aim of this study was therefore to study the difference in the immune composition in PCNSL and non-CNS diffuse large B-cell lymphoma (DLBCL), and the role of the immune response in PCNSL prognosis. METHODS AND RESULTS Thirty-two biopsy specimens of PCNSL and 30 specimens of low-stage non-CNS DLBCL from immunocompetent patients formed the study group. The density and distribution of immune cells, including dendritic cells (dendritic cell-specific lysosomal-associated membrane protein-positive and S100-positive), effector/memory T cells (CD45RO-positive), and cytotoxic T cells (granzyme B-positive), and the expression of HLA-DR by lymphoma cells, were evaluated immunohistochemically. PCNSL patients showed poorer overall survival (P = 0.032). On comparison of the PCNSL and DLBCL biopsy specimens, the PCNSL cells showed less HLA-DR expression (P = 0.003), and there were fewer S100-positive cells (P < 0.01), and effector T cells (P = 0.026) infiltrating PCNSL than infiltrating DLBCL. For PCNSL patients, fewer cytotoxic T cells in the background constituted a poor prognostic factor (P = 0.004). Intratumoral S100-positive cell infiltration was positively correlated with T-cell infiltration, and a T-cell rimming pattern. CONCLUSIONS In PCNSL, the baseline antitumour immune response is less as compared with non-CNS DLBCL, and this response may play a role in the poorer prognosis. Adjuvant dendritic cell and T-cell immunotherapy may further boost treatment responses in PCNSL patients.
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Affiliation(s)
- Chen Chang
- Department of Pathology, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Ching-Hung Lin
- Departments of Oncology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ann-Lii Cheng
- Departments of Oncology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kung-Chao Chang
- Department of Pathology, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
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48
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Bojic M, Berghoff AS, Troch M, Agis H, Sperr WR, Widhalm G, Wöhrer A, Kalhs P, Preusser M, Rabitsch W. Haematopoietic stem cell transplantation for treatment of primary CNS lymphoma: single-centre experience and literature review. Eur J Haematol 2015; 95:75-82. [DOI: 10.1111/ejh.12482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Marija Bojic
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - Anna S. Berghoff
- Department of Medicine I; Clinical Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Marlene Troch
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - Hermine Agis
- Department of Medicine I; Clinical Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Wolfgang R. Sperr
- Department of Medicine I; Clinical Division of Haematology and Hemostaseology; Medical University of Vienna; Vienna Austria
| | - Georg Widhalm
- Department of Neurosurgery; Medical University of Vienna; Vienna Austria
| | - Adelheid Wöhrer
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | - Peter Kalhs
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - Matthias Preusser
- Department of Medicine I; Clinical Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Werner Rabitsch
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
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Differential expression of Toll-like receptor (TLR) and B cell receptor (BCR) signaling molecules in primary diffuse large B-cell lymphoma of the central nervous system. J Neurooncol 2014; 121:289-96. [PMID: 25391967 DOI: 10.1007/s11060-014-1655-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/26/2014] [Indexed: 12/22/2022]
Abstract
Primary diffuse large B-cell lymphoma of the central nervous system (CNS DLBCL) is a distinct and aggressive lymphoma that is confined to CNS. Since, central nervous system is barrier-protected and immunologically silent; role of TLR/BCR signaling in pathogenesis and biology of CNS DLBCL is intriguing. Genomic mutations in key regulators of TLR/BCR signaling pathway (MYD88/CD79B/CARD11) have recently been reported in this disease. These observations raised possible implications in novel targeted therapies; however, expression pattern of molecules related to TLR/BCR pathways in this lymphoma remains unknown. We have analyzed the expression of 19 genes encoding TLR/BCR pathways and targets in CNS DLBCLs (n = 20) by Nanostring nCounter™ analysis and compared it with expression patterns in purified reactive B-lymphocytes and systemic diffuse large B cell lymphoma (DLBCL) (n = 20). Relative expression of TLR4, TLR5, TLR9, CD79B and BLNK was higher in CNS DLBCLs than in control B-lymphocytes; where as TLR7, MALT1, BCL10, CD79A and LYN was lower in CNS DLBCLs (P < 0.0001). When compared with systemic DLBCL samples, higher expression of TLR9, CD79B, CARD11, LYN and BLNK was noted in CNS DLBCL (>1.5 fold change; P < 0.01). The B cell receptor molecules like BLNK and CD79B were also associated with higher expression of MYD88 dependent TLRs (TLR4/5/9). In conclusion, we have shown over expression of TLR/BCR related genes or their targets, where genomic mutations have commonly been identified in CNS DLBCL. We have also demonstrated that TLR over expression closely relate with up regulation of genes associated with BCR pathway like CD79B/BLNK and CARD11, which play an important role in NF-kB pathway activation. Our results provide an important insight into the possibility of TLR and/or B-cell receptor signaling molecules as possible therapeutic targets in CNS DLBCL.
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50
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Dal Maso L, Suligoi B, Franceschi S, Braga C, Buzzoni C, Polesel J, Zucchetto A, Piselli P, Falcini F, Caldarella A, Zanetti R, Vercelli M, Guzzinati S, Russo A, Tagliabue G, Iachetta F, Ferretti S, Limina RM, Mangone L, Michiara M, Stracci F, Pirino DR, Piffer S, Giacomin A, Vitarelli S, Mazzoleni G, Iannelli A, Contrino ML, Fusco M, Tumino R, Fanetti AC, De Paoli P, Decarli A, Serraino D. Survival after cancer in Italian persons with AIDS, 1986-2005: a population-based estimation. J Acquir Immune Defic Syndr 2014; 66:428-35. [PMID: 24798769 DOI: 10.1097/qai.0000000000000184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cancer survival in persons with AIDS (PWA) after introduction of antiretroviral therapies remains poorly characterized. The aim is to provide population-based estimates of cancer survival, overall and for the most important cancer types in PWA, and a comparison with persons without AIDS (non-PWA) affected by the same cancer. METHODS PWA with cancer at AIDS diagnosis or thereafter were individually matched with non-PWA by type of cancer, sex, age, year of diagnosis, area of living, and, for lymphomas, histological subtype. Five-year observed survival and hazard ratios (HRs) of death in PWA versus non-PWA with 95% confidence intervals (CIs) were estimated. RESULTS We included 2262 Italian PWA and 4602 non-PWA with cancer diagnosed during 1986-2005. Between 1986 and 1995, and 1996 and 2005, 5-year survival for all cancers in PWA improved from 12% to 41% and the corresponding HR versus non-PWA decreased from 5.1 (95% CI: 4.3 to 6.1) to 2.9 (95% CI: 2.6 to 3.3). During 1996-2005, HRs were 2.0 (95% CI: 1.4 to 2.9) for Kaposi sarcoma, 3.4 (95% CI: 2.9 to 4.1) for non-Hodgkin lymphoma, and 2.4 (95% CI: 1.4 to 4.0) for cervical cancer. HRs were 2.5 (95% CI: 2.1 to 3.1) for all non-AIDS-defining cancers, 5.9 (95% CI: 3.1 to 11.2) for Hodgkin lymphoma, and 7.3 (95% CI: 2.8 to 19.2) for nonmelanoma skin cancer. A ≤3-fold survival difference was found for cancers of the stomach, liver, anus, lung, brain, and the most aggressive lymphoma subtypes. CONCLUSIONS The persisting, although narrowing, gap in cancer survival between PWA and non-PWA indicates the necessity of enhancing therapeutic approaches, so that PWA can be provided the same chances of survival observed in the general population, and improving cancer prevention and screening.
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Affiliation(s)
- Luigino Dal Maso
- *Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, Italy; †Istituto Superiore di Sanità, Rome, Italy; ‡International Agency for Research on Cancer, Lyon, France; §AIRTUM database, Florence, Italy; ‖Tuscany Cancer Registry, UO di epidemiologia clinica e descrittiva, Istituto per lo studio e la prevenzione oncologica, Florence, Italy; ¶Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; #Department of Epidemiology, INMI "L Spallanzani" IRCCS, Rome, Italy; **Romagna Cancer Registry, Cancer Institute of Romagna IRCCS, Meldola, Italy; ††Piedmont Cancer Registry, Oncology Prevention Center (CPO), Torino, Italy; ‡‡Registro Tumori Regione Liguria, IRCSS Azienda Università Ospedale San Martino-IST Istituto nazionale ricerca sul cancro e Dipartimento di scienze della salute, Genoa University, Genoa, Italy; §§Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS, Padua, Italy; ‖‖Milan Cancer Registry, Milan Health Authority, Epidemiology Unit, Milan, Italy; ¶¶Lombardia Cancer Registry, Varese Province, National Cancer Institute, Milan, Italy; ##Modena Cancer Registry, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy; ***Ferrara Cancer Registry, Ferrara University, Ferrara, Italy; †††Brescia Health Unit, Cancer Registry, Brescia, Italy; ‡‡‡S.C. Statistica, qualità e studi clinici IRCCS, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; §§§Parma Province Cancer Registry, University Hospital Parma, Parma, Italy; ‖‖‖Umbria Cancer Registry, Department of Medical and Surgical Specialties, and Public Health, Section of Public Health, Perugia University, Perugia, Italy; ¶¶¶Cancer Registry of Sassari, Sassari, Italy; ###Registro Tumori della Provincia di Trento, Servizio di Epidemiologia Clinica e Valutativa, Trento, Italy; ****Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy; †††
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