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Liu Z, Wang G, Liu H, Ding K, Song J, Fu R. ACT001 inhibits primary central nervous system lymphoma tumor growth by enhancing the anti-tumor effect of T cells. Biomed Pharmacother 2024; 178:117133. [PMID: 39024837 DOI: 10.1016/j.biopha.2024.117133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a group of malignant brain tumors with a poor prognosis, and new therapeutic approaches for this tumor urgently need to be investigated. Formulated from a long-standing anti-inflammatory drugs, ACT001 has demonstrated in clinical research to be able to pass through the blood-brain barrier (BBB) and affect the central nervous system. The effects of ACT001 on PCNSL cell apoptosis, proliferation and immune-related indexes were detected by flow cytometry, and the efficacy of ACT001 was verified in vivo by constructing a mouse PCNSL tumor model. ACT001 significantly inhibited PCNSL cell proliferation and induced apoptosis in vitro. In addition, ACT001 can significantly inhibit the PD-1/PD-L1 expression and restore the function of T cells, so that the immune system cannot allow tumor cells to escape. In vivo experiments show that co-infusion of ACT001 and T cells effectively inhibits PCNSL tumor growth in NSG mice. Our work describes the inhibitory effect of ACT001 on the PCNSL cell line and demonstrated the inhibitory effect of ACT001 on immune checkpoints.
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Affiliation(s)
- Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control,Tianjin 300052, PR China; Tianjin Institute of Hematology, Tianjin 300052, PR China.
| | - Guanrou Wang
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control,Tianjin 300052, PR China; Tianjin Institute of Hematology, Tianjin 300052, PR China
| | - Hui Liu
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control,Tianjin 300052, PR China; Tianjin Institute of Hematology, Tianjin 300052, PR China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control,Tianjin 300052, PR China; Tianjin Institute of Hematology, Tianjin 300052, PR China
| | - Jia Song
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control,Tianjin 300052, PR China; Tianjin Institute of Hematology, Tianjin 300052, PR China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, PR China; Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control,Tianjin 300052, PR China; Tianjin Institute of Hematology, Tianjin 300052, PR China.
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Xu Z, Bai H, Liu X, Shen J, Su Y, Wang Y. Case report: Intraretinal hyperflow microinfiltration lesions on swept-source optical coherence tomography angiography as a potential biomarker of primary vitreoretinal lymphoma. Front Med (Lausanne) 2024; 11:1386979. [PMID: 38737759 PMCID: PMC11082336 DOI: 10.3389/fmed.2024.1386979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is often associated with central nervous system involvement, contributing to a heightened mortality rate, thus imaging features that are characteristic enough to be potential biomarkers of PVRL are important, either in diagnosis or in assessment of disease activity. This report details the case of a 68-year-old male who presented with blurred vision in both eyes persisting for 2 months. Fundus examination demonstrated vitreous opacity and multiple subretinal yellow nodular lesions of varying sizes in the peripheral fundus of both eyes. Multiple vertical hyperreflective lesions in the neural retina of posterior pole, indistinct outer retina borders in the fovea, and hyperreflective lesions in the sub-retinal pigment epithelium (RPE) space of the peripheral retina were demonstrated on swept-source optical coherence tomography (SS-OCT) of the left eye. Hyperflow signals corresponding to the vertical hyperreflective lesions were detected on swept-source optical coherence tomography angiography (SS-OCTA) images of retinal deep capillary plexus (DCP) layer. Notably, the hyperflow signals, precisely located around retinal vessels from the nerve fiber layer to the outer plexiform layer, were postulated to stem from the dilation of infiltrated retinal vessels. Vitreous pathological results of the left eye confirmed the diagnosis of PVRL. Treatments with intravitreal methotrexate injections led to a marked improvement of best-corrected visual acuity (BCVA) and regression of the hyperflow microinfiltration lesions demonstrated on SS-OCTA. In conclusion, SS-OCTA effectively delineated the vertical hyperreflective lesions and corresponding hyperflow signals in the posterior pole macular region of a patient with PVRL. These lesions significantly diminished following intravitreal methotrexate injections. We speculated that the specific hyperflow signals on SS-OCTA could act as a potential biomarker of PVRL, and SS-OCTA holds promise in facilitating early diagnosis and monitoring therapeutic responses in PVRL cases.
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Affiliation(s)
- Zhangxing Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
- Department of Ophthalmology, Ningbo Medical Center LiHuiLi Hospital, Ningbo, Zhejiang Province, China
| | - Haixia Bai
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Junhui Shen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Yongchao Su
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
- Department of Ophthalmology, Haiyan People's Hospital, Jiaxing, Zhejiang Province, China
| | - Yao Wang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
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3
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Jin Q, Jiang H, Yue N, Zhang L, Li C, Dong C, Zeng P, Yue L, Wu C. The prognostic value of CD8 + CTLs, CD163 + TAMs, and PDL1 expression in the tumor microenvironment of primary central nervous system lymphoma. Leuk Lymphoma 2024; 65:472-480. [PMID: 38198635 DOI: 10.1080/10428194.2023.2296364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
To explore immune cell infiltration and PDL1 expression in the tumor microenvironment (TME) of primary central nervous system lymphoma (PCNSL), we performed immunohistochemical staining on paraffin-embedded tumor tissues from 34 patients diagnosed with PCNSL. CD8 and CD163 positive cells were manually counted, and PDL1 expression was quantified by the H-score scoring method in the tumor center and around the tumor. The Kaplan-Meier method was used to analyze the prognostic value of the TME. We found obvious infiltration of CD8+ CTLs and CD163+ TAMs in the TME of PCNSL patients. And PDL1 was expressed in the tumor center as well as around the tumor. Survival analysis showed that high CD8+ CTLs levels and high intratumoral PDL1 expression were significantly correlated with longer OS. High CD8+ CTLs and CD163+ TAMs levels were associated with longer PFS.
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Affiliation(s)
- Qiqi Jin
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Haoyun Jiang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ningning Yue
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Litian Zhang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Cuicui Li
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Chi Dong
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, China
| | - Pengyun Zeng
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Lingling Yue
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Chongyang Wu
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
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Tang Z, Wu G, Tan F, Long Y, Hong J, Lyu Z, Wei R. Survival outcomes and treatment experience of 124 patients with primary central nervous system lymphoma. Strahlenther Onkol 2024:10.1007/s00066-024-02219-5. [PMID: 38466403 DOI: 10.1007/s00066-024-02219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/11/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare malignancy of the central nervous system with high invasiveness. There is little consensus on the treatment of PCNSL. This study retrospectively studied data from PCNSL patients in a single center to summarize treatment experience and explore prognostic factors. METHODS Survival curves were drawn using the Kaplan-Meier method and prognostic factors were analyzed using Cox's hazards model. RESULTS In multivariate analysis, cerebrospinal fluid lactic acid dehydrogenase (CSF LDH; p = 0.005 and p = 0.002), neutrophil to lymphocyte ratio (NLR; p = 0.014 and p = 0.038), and completion of four cycles of induction therapy (p < 0.001and p < 0.001) were significant and independent predictors of overall survival (OS) and progression-free survival (PFS), respectively. CONCLUSION On the basis of this study, we propose that PCNSL patients should receive early induction therapy with sufficient cycles. Subsequent consolidation therapy can prevent relapses and improve survival. In patients with PCNSL, the independent prognostic factors for OS and PFS were CSF LDH level, NLR, and full cycles of induction therapy.
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Affiliation(s)
- Ziqing Tang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Geting Wu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Tan
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Long
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiping Lyu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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5
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Balikov DA, Conway K, Brown NA, Camelo-Piragua S, Rao RC. Molecular Analysis of Liquid Vitreous Biopsy Reveals Occult Lymphoma Following Cytology-Negative Biopsies of the Brain and Vitreous. Ocul Immunol Inflamm 2023:1-9. [PMID: 38109211 PMCID: PMC11182886 DOI: 10.1080/09273948.2023.2287061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare but deadly malignancy that principally affects adults in the fifth and sixth decades of life. Despite diagnostic advances in analyses of cerebral spinal fluid and neuroimaging, definitive diagnosis of PCNSL requires primary brain tissue biopsy. While small neurosurgical biopsy volumes are pursued to minimize removal of normal brain tissue, the spatial margins to precisely biopsy pathologic tissue are narrow and can result in missed diagnoses. Furthermore, prior steroid treatment can significantly reduce tumor burden increasing the likelihood of a non-diagnostic biopsy. METHODS A retrospective case report from a tertiary referral center using a combination of neuroradiological studies, sterotactic tissue biopsy, and molecular testing for genome mutations. RESULTS A 72-year-old woman with strong suspicion for PCNSL clinically and radiologically, but cerebral spinal fluid and primary brain tissue biopsy were negative for tumor. However, vitreous liquid biopsy molecular testing for a MYD88 mutation as well as B-cell clonality (IGH/IGK rearrangement) were positive, indicating the presence of secondary vitreoretinal lymphoma from PCNSL. Only after autopsy of her brain was histopathological and immunohistochemical evidence of PCNSL confirmed. CONCLUSION This case illustrates the unique contribution of liquid biopsy neuropathology-oriented molecular testing in a challenging case with high clinical suspicion of PCNSL in which gold-standard diagnostic testing failed to yield a diagnosis.
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Affiliation(s)
- Daniel A. Balikov
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Kyle Conway
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Noah A. Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rajesh C. Rao
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Center for RNA Biomedicine, University of Michigan, Ann Arbor, MI, USA
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MI, USA
- Division of Ophthalmology, Surgical Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Mosteiro A, Hoyos JA, Ferres A, Topczewski T, Rivero A, Rivas A, Aldecoa I, Caballero GA, Morcos R, Balague O, Enseñat J, González JJ. The ghost tumour revisited. Corticosteroids in primary central nervous system lymphoma: diagnostic, prognostic and therapeutic implications. Br J Neurosurg 2023:1-8. [PMID: 37997350 DOI: 10.1080/02688697.2023.2283130] [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: 11/17/2021] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The cytolytic effect of corticosteroids on primary central nervous system lymphoma (PCNSL) has established the clinical dogma of avoiding steroid therapy prior to surgery for diagnostic purposes. However, since steroids are very useful during the initial management of intracranial lesions with vasogenic oedema, it was our aim to determine whether they cause a drawback in the diagnosis and prognosis of PCNSL. METHODS A retrospective cohort study of patients diagnosed with PCNSL between 2000 and 2020 in our tertiary neurosurgical centre. Data on steroid administration, surgery type and complications, haematopathological findings and prognostic factors were compiled. A second cohort was used as a control group to compare the ratio of non-diagnostic biopsies; this series comprised patients who underwent stereotactic brain biopsy for any reason between 2019 and 2020. RESULTS Forty patients with PCNSL were included in the study, of which 28 (70%) had received steroids before surgery. The use of steroids was more prevalent in patients with poorer performance status at diagnosis. No relevant differences were found in the diagnostic accuracy regardless of steroid exposure (93% under steroids vs 100% without steroids) or type of surgery performed. Furthermore, steroid withdrawal did not seem to augment the diagnostic ratio. The notable diagnostic delay was not influenced by the use of steroids. CONCLUSIONS Novel imaging and surgical techniques might obviate the need to withhold corticosteroids from patients suffering from PCNSL prior to biopsy. Moreover, when steroids have been given, tapering them and delaying the surgery might not be justified. This could hold relevant therapeutic implications in the early clinical stages.
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Affiliation(s)
- Alejandra Mosteiro
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jhon A Hoyos
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Abel Ferres
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Thomaz Topczewski
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Department of Haematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Alfredo Rivas
- Department of Haematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Ricardo Morcos
- Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Olga Balague
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jose Juan González
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
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Lv K, Chen H, Cao X, Du P, Chen J, Liu X, Zhu L, Geng D, Zhang J. Development and validation of a machine learning algorithm for predicting diffuse midline glioma, H3 K27-altered, H3 K27 wild-type high-grade glioma, and primary CNS lymphoma of the brain midline in adults. J Neurosurg 2023; 139:393-401. [PMID: 36681946 DOI: 10.3171/2022.11.jns221544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Preoperative diagnosis of diffuse midline glioma, H3 K27-altered (DMG-A) and midline high-grade glioma without H3 K27 alteration (DMG-W), as well as midline primary CNS lymphoma (PCNSL) in adults, is challenging but crucial. The aim of this study was to develop a model for predicting these three entities using machine learning (ML) algorithms. METHODS Thirty-three patients with DMG-A, 35 with DMG-W, and 35 with midline PCNSL were retrospectively enrolled in the study. Radiomics features were extracted from contrast-enhanced T1-weighted MR images. Two radiologists evaluated the conventional MRI features of the tumors, such as shape. Patient age, tumor volume, and conventional MRI features were considered clinical features. The data set was randomly stratified into 70% training and 30% testing cohorts. Predictive models based on the clinical features, radiomics features, and integration of clinical and radiomics features were established through ML. The performances of the models were evaluated by calculating the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity. Subsequently, 10 patients with DMG-A, 10 with DMG-W, and 12 with PCNSL were enrolled from another institution to validate the established models. RESULTS The predictive models based on clinical features, radiomics features, and the integration of clinical and radiomics features through the support vector machine algorithm had the optimal accuracies in the training, testing, and validation cohorts, and the accuracies in the testing cohort were 0.871, 0.892, and 0.903, respectively. Age, 2 radiomics features, and 3 conventional MRI features were the 6 most significant features in the established integrated model. CONCLUSIONS The integrated prediction model established by ML provides high discriminatory accuracy for predicting DMG-A, DMG-W, and midline PCNSL in adults.
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Affiliation(s)
- Kun Lv
- Departments of1Radiology and
| | - Hongyi Chen
- 2Academy for Engineering and Technology, Fudan University, Shanghai
| | - Xin Cao
- Departments of1Radiology and
| | - Peng Du
- Departments of1Radiology and
| | - Jiawei Chen
- 3Neurosurgery, Huashan Hospital, Fudan University, Shanghai
| | - Xiao Liu
- 4School of Computer and Information Technology, Beijing Jiaotong University, Beijing; and
| | - Li Zhu
- 5Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Daoying Geng
- Departments of1Radiology and
- 2Academy for Engineering and Technology, Fudan University, Shanghai
| | - Jun Zhang
- Departments of1Radiology and
- 2Academy for Engineering and Technology, Fudan University, Shanghai
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Cornell I, Al Busaidi A, Wastling S, Anjari M, Cwynarski K, Fox CP, Martinez-Calle N, Poynton E, Maynard J, Thust SC. Early MRI Predictors of Relapse in Primary Central Nervous System Lymphoma Treated with MATRix Immunochemotherapy. J Pers Med 2023; 13:1182. [PMID: 37511795 PMCID: PMC10381964 DOI: 10.3390/jpm13071182] [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: 04/15/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Primary Central Nervous System Lymphoma (PCNSL) is a highly malignant brain tumour. We investigated dynamic changes in tumour volume and apparent diffusion coefficient (ADC) measurements for predicting outcome following treatment with MATRix chemotherapy in PCNSL. Patients treated with MATRix (n = 38) underwent T1 contrast-enhanced (T1CE) and diffusion-weighted imaging (DWI) before treatment, after two cycles and after four cycles of chemotherapy. Response was assessed using the International PCNSL Collaborative Group (IPCG) imaging criteria. ADC histogram parameters and T1CE tumour volumes were compared among response groups, using one-way ANOVA testing. Logistic regression was performed to examine those imaging parameters predictive of response. Response after two cycles of chemotherapy differed from response after four cycles; of the six patients with progressive disease (PD) after four cycles of treatment, two (33%) had demonstrated a partial response (PR) or complete response (CR) after two cycles. ADCmean at baseline, T1CE at baseline and T1CE percentage volume change differed between response groups (0.005 < p < 0.038) and were predictive of MATRix treatment response (area under the curve: 0.672-0.854). Baseline ADC and T1CE metrics are potential biomarkers for risk stratification of PCNSL patients early during remission induction therapy with MATRix. Standard interim response assessment (after two cycles) according to IPCG imaging criteria does not reliably predict early disease progression in the context of a conventional treatment approach.
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Affiliation(s)
- Isabel Cornell
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
| | - Ayisha Al Busaidi
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
- Neuroradiology Department, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Stephen Wastling
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Mustafa Anjari
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
- Radiology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Kate Cwynarski
- Haematology Department, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Christopher P Fox
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | | | - Edward Poynton
- Haematology Department, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - John Maynard
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Steffi C Thust
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Precision Imaging Beacon, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Neuroradiology Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
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9
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Bazer DA, Zabrocka E, Koroneos N, Kowalska A. Central Nervous System Lymphoma: The Great Mimicker-A Single-Institution Retrospective Study. Case Rep Oncol Med 2023; 2023:8815502. [PMID: 37228706 PMCID: PMC10205403 DOI: 10.1155/2023/8815502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) is a rare, aggressive form of non-Hodgkin lymphoma contained in the brain and the spinal cord as well as the meninges, cranial nerves, eyes, and cerebrospinal fluid (CSF). Due to its variable presentation and lack of associated B-symptoms, it is quite challenging to diagnose PCNSL, if there is not a high level of suspicion. Methods This is a retrospective case series examining 13 human immunodeficiency virus- (HIV-) negative patients with PCNSL and DLBCL type, with a median age of 75 years old. Results The most common presenting symptom was altered mental status. The frontal lobes, basal ganglia, cerebellum, and corpus callosum were most affected. Prior to brain biopsy, 4/13 patients were on steroids, which did not affect biopsy results and the average time to diagnosis was 1 month. 9/13 patients who did not receive steroids had an average time to diagnosis of less than 1 month. Conclusion Although steroid administration did not appear to diminish the yield of the biopsy, it is a best practice to withhold steroids prior to biopsy to decrease the time to diagnose PCNSL.
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Affiliation(s)
- Danielle A. Bazer
- Department of Neurology, Stony Brook University Hospital, Health Sciences Tower T12/020, Stony Brook, New York 11794-8121, USA
- Department of Neurology, Johns Hopkins University, 201 N Broadway, 9th Floor Mailbox #3, Baltimore, MD 21287, USA
| | - Ewa Zabrocka
- Department of Radiation Oncology, Stony Brook University Hospital, Level 2, Stony Brook, New York 11794-8121, USA
| | - Nicholas Koroneos
- Department of Neurology, Stony Brook University Hospital, Health Sciences Tower T12/020, Stony Brook, New York 11794-8121, USA
| | - Agnieszka Kowalska
- Department of Neurology, Stony Brook University Hospital, Health Sciences Tower T12/020, Stony Brook, New York 11794-8121, USA
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10
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Hu X, Zhao L, Zheng S, Wang S. Giant marginal zone B-cell lymphoma masquerading as meningioma: A case report and review of literature. Asian J Surg 2023; 46:1481-1482. [PMID: 36266139 DOI: 10.1016/j.asjsur.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Xiaofang Hu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China; Department of Neurosurgery, the 900th Hospital, Fuzhou, 350025, China
| | - Lin Zhao
- Department of Neurosurgery, the 900th Hospital, Fuzhou, 350025, China
| | - Shaorui Zheng
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China
| | - Shousen Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China; Department of Neurosurgery, the 900th Hospital, Fuzhou, 350025, China.
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11
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Ohba S, Murayama K, Teranishi T, Kumon M, Nakae S, Yui M, Yamamoto K, Yamada S, Abe M, Hasegawa M, Hirose Y. Three-Dimensional Amide Proton Transfer-Weighted Imaging for Differentiating between Glioblastoma, IDH-Wildtype and Primary Central Nervous System Lymphoma. Cancers (Basel) 2023; 15:cancers15030952. [PMID: 36765909 PMCID: PMC9913574 DOI: 10.3390/cancers15030952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Distinguishing primary central nervous system lymphoma (PCNSL) from glioblastoma, isocitrate dehydrogenase (IDH)-wildtype is sometimes hard. Because the role of operation on them varies, accurate preoperative diagnosis is crucial. In this study, we evaluated whether a specific kind of chemical exchange saturation transfer imaging, i.e., amide proton transfer-weighted (APTw) imaging, was useful to distinguish PCNSL from glioblastoma, IDH-wildtype. A total of 14 PCNSL and 27 glioblastoma, IDH-wildtype cases were evaluated. There was no significant difference in the mean APTw signal values between the two groups. However, the percentile values from the 1st percentile to the 20th percentile APTw signals and the width1-100 APTw signals significantly differed. The highest area under the curve was 0.796, which was obtained from the width1-100 APTw signal values. The sensitivity and specificity values were 64.3% and 88.9%, respectively. APTw imaging was useful to distinguish PCNSL from glioblastoma, IDH-wildtype. To avoid unnecessary aggressive surgical resection, APTw imaging is recommended for cases in which PCNSL is one of the differential diagnoses.
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Affiliation(s)
- Shigeo Ohba
- Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
- Correspondence: ; Tel.: +81-562-93-9253; Fax: +81-562-93-3118
| | - Kazuhiro Murayama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Takao Teranishi
- Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Masanobu Kumon
- Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Shunsuke Nakae
- Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara 324-8550, Tochigi, Japan
| | - Kaori Yamamoto
- Canon Medical Systems Corporation, Otawara 324-8550, Tochigi, Japan
| | - Seiji Yamada
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Masato Abe
- Department of Pathology, Fujita Health University School of Health Sciences, Toyoake 470-1192, Aichi, Japan
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
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12
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Liu Y, Sun J, Tuo K. Zanubrutinib in the Maintenance Treatment of Elderly People with Primary Central Nervous System Lymphoma: A Report of 2 Cases. Case Rep Oncol 2023; 16:227-233. [PMID: 37069896 PMCID: PMC10105325 DOI: 10.1159/000529315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/17/2023] [Indexed: 04/19/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal non-Hodgkin lymphoma. The predominant subtype is diffuse large B-cell lymphoma (DLBCL), and no systematic lesion is identified at diagnosis. BTKi (Bruton's tyrosine kinase inhibitor) has demonstrated significant clinical activity in DLBCL. We retrospectively reported on 2 patients who began with memory deterioration or right limb movement disabilities. A cranial magnetic resonance imaging (MRI) scan and a brain biopsy were used to diagnose PCNSLs. Middle-dose methotrexate (MD-MTX) regimens were initiated for induction treatment. Zanubrutinib was chosen as the maintenance regimen due to the patients' inability to tolerate continuous MTX regimens. For 1 patient, he achieved sustained complete remission (CR) demonstrated by MRI. Another patient achieved partial remission (PR). The two patients are both alive until now. We successfully extended the PFS and OS in elderly PCNSL patients treated with zanubrutinib.
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Affiliation(s)
- Ying Liu
- The Second People's Hospital of Guiyang, The Second Guiyang Hospital Affiliated to Guizhou Medical University, Guiyang, China
| | - Jie Sun
- The Second People's Hospital of Guiyang, The Second Guiyang Hospital Affiliated to Guizhou Medical University, Guiyang, China
| | - Kangxin Tuo
- The Second People's Hospital of Guiyang, The Second Guiyang Hospital Affiliated to Guizhou Medical University, Guiyang, China
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13
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Primary central nervous system lymphoma in a patient with multiple sclerosis using fingolimod. Neurol Sci 2023; 44:361-363. [PMID: 36031684 DOI: 10.1007/s10072-022-06367-3] [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: 06/27/2022] [Accepted: 08/24/2022] [Indexed: 01/10/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is an uncommon lymphoproliferative disease associated with immunosuppression. Here, we report the case of a patient with multiple sclerosis, under treatment with fingolimod (FTY720, Gilenya) for 4 years, who developed this condition. Although the causal relationship cannot be established, there are cases in the literature that describe the appearance of lymphoma after the use of this medication. Considering the high mortality of PCNSL, epidemiological studies are necessary to establish a relationship between its arising and the use of immunosuppressants.
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Raunio F, Kelppe J, Hafrén L. Malignant lymphoma presenting as bilateral sensorineural hearing loss—A case report. Clin Case Rep 2022; 10:e6711. [PMCID: PMC9748227 DOI: 10.1002/ccr3.6711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Frida Raunio
- Department of Otorhinolaryngology Helsinki University Hospital Helsinki Finland
| | - Jetta Kelppe
- Department of Pathology, HUS Diagnostic Center Helsinki University Hospital Helsinki Finland
| | - Lena Hafrén
- Department of Otorhinolaryngology Helsinki University Hospital Helsinki Finland
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15
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Tang Y, Shi Y, Wang L, Qian ZT, Fan YW, Wu HM, Li X. Preliminary clinical application of multimodal imaging combined with frameless robotic stereotactic biopsy in the diagnosis of primary central nervous system lymphoma. Heliyon 2022; 8:e12162. [DOI: 10.1016/j.heliyon.2022.e12162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
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16
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Chojak R, Koźba-Gosztyła M, Polańska K, Rojek M, Chojko A, Bogacz R, Skorupa N, Więcław J, Czapiga B. Surgical resection versus biopsy in the treatment of primary central nervous system lymphoma: a systematic review and meta-analysis. J Neurooncol 2022; 160:753-761. [PMID: 36449256 PMCID: PMC9758097 DOI: 10.1007/s11060-022-04200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Despite the improvement in treatment and prognosis of primary central nervous system lymphoma (PCNSL) over the last decades, the 5-year survival rate is approximately 30%; thus, new therapeutic approaches are needed to improve patient survival. The study's aim was to evaluate the role of surgical resection of PCNSL. METHODS Primary outcomes were the overall survival (OS) and progression-free survival (PFS) of patients with PCNSL who underwent surgical resection versus biopsy alone. The meta-analysis was conducted to calculate pooled hazard ratios (HRs) under a random-effects model for the time-to-event variables. The odds ratios (ORs) were calculated for binary, secondary outcome parameters. RESULTS Seven studies (n = 1046) were included. We found that surgical resection was associated with significantly better OS (HR 0.63 [95% CI 0.51-0.77]) when compared with biopsy. PFS was also significantly improved (HR 0.64 [95% CI 0.49-0.85]) in patients who underwent resection compared with those who underwent biopsy. The heterogeneity for OS and PFS was low (I2 = 7% and 24%, respectively). We also found that patients who underwent biopsy more often had multiple (OR 0.38 [95% CI 0.19-0.79]) or deep-seated (OR 0.20 [95% CI 0.12-0.34]) lesions compared with those who underwent surgical resection. There were no significant differences in chemotherapy or radiotherapy use or the occurrence of postoperative complications between the two groups. CONCLUSION In selected patients, surgical resection of PCNSL is associated with significantly better overall survival and progression-free survival compared with biopsy alone.
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Affiliation(s)
- Rafał Chojak
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland.
- Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland.
| | | | - Karolina Polańska
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Marta Rojek
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Aleksandra Chojko
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Rafał Bogacz
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Natalia Skorupa
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Jakub Więcław
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
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Lopez G, Han K, Magaki SD, Song SX, Salamon N, Kahlon KS, Keselman I, Bari AA, Vinters HV. Low‐grade
B‐cell lymphoma of the central nervous system with plasmacytic differentiation and amyloid deposition. Neuropathology 2022. [PMID: 36451532 DOI: 10.1111/neup.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
A 65-year-old woman with a resolved history of epilepsy due to a motor vehicle accident and hippocampal sclerosis presented with recurrent de novo seizures. Brain imaging demonstrated enhancement in the left parieto-occipital lobe. At histopathological examination, the lesion displayed a diffuse lymphoid infiltrate comprised of small atypical lymphocytes, plasmacytoid lymphocytes, and scattered plasma cells with amyloid deposition. Pathology workup demonstrated a monotypic B-cell phenotype of the lymphoid infiltrate, expressing lambda light chain restriction and plasmacytic differentiation without MYD88 mutations. The patient had no systemic evidence of lymphoma, plasma cell dyscrasia, or amyloidosis. A diagnosis of low-grade B-cell lymphoma of the central nervous system with plasmacytic differentiation and amyloid deposition was made.
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Affiliation(s)
- Gianluca Lopez
- University of Milan Milan Italy
- Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Karam Han
- Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Shino D. Magaki
- Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Sophie X. Song
- Hematopathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Noriko Salamon
- Department of Radiology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Kanwarpal S. Kahlon
- Division of Hematology‐Oncology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Inna Keselman
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California, Los Angeles Los Angeles California USA
| | - Ausaf A. Bari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
| | - Harry V. Vinters
- Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California Los Angeles California USA
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine University of California, Los Angeles Los Angeles California USA
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18
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Holanda TSF, Pimentel IMF, Gosch GO, Tavora DGF, Bandeira LAB, Filho FL. Immunocompetent patient with isolated primary fourth ventricle lymphoma. Unusual diagnosis, their pitfalls, and challenges. Surg Neurol Int 2022; 13:463. [DOI: 10.25259/sni_584_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/24/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Primary central nervous system lymphoma (PCNSL) is an uncommon lesion and represent 4% of all central nervous system (CNS) cancers. There have been few reports of localized isolated lymphoma developing in the fourth ventricle, with only 8 previous cases described. We present a case of an immunocompetent patient with isolated fourth ventricle lymphoma who did not have diffusion-weighted imaging (DWI) restriction.
Case Description:
A 45-year-old man presented a history of headache, vomiting and weigh loss. Upon clinical examination, he presented bilateral papilledema, multidirectional nystagmus, and gait imbalance. Magnetic resonance imaging showed a solid tumor in fourth ventricle with 1.8 × 1.6 × 1.1 cm. The patient was submitted to a suboccipital telovelar approach. The pathological study showed a neoplasm composed of loose round cells. Immunohistochemistry showed positivity for CD-45 and CD-23. The diagnosis of primary CNS lymphoma of the fourth ventricle was certified. Patient was sent to complementary treatment with hematologist and radiotherapy and chemotherapy were started.
Conclusion:
PCNSL is a rare and aggressive pathology with high rates of mortality and recurrence. It requires a multidisciplinary team and multiple therapies to control the disease and deliver better quality of life and prognosis to the patient.
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Affiliation(s)
- Tiago S. F. Holanda
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil
| | | | | | | | | | - Flavio Leitao Filho
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil
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19
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Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report. J Clin Med 2022; 11:jcm11195548. [PMID: 36233415 PMCID: PMC9571497 DOI: 10.3390/jcm11195548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/25/2022] Open
Abstract
Background: Primary central nervous system lymphomas (PCNSLs) are sensitive to chemotherapy. The standard treatment is high-dose methotrexate (MTX)-based chemotherapy. There are no reports of successful treatment of acute uric acid nephropathy with rasburicase after MTX administration in PCNSLs. Case presentation: A 54-year-old man with a history of gout presented with a change in character and cognitive dysfunction. MRI showed a large enhancing mass spanning the bilateral frontal lobes and the right temporal lobe. After endoscopic biopsy, an MTX, procarbazine, and vincristine (MPV) regimen was initiated for the treatment of the PCNSL. After the initiation of chemotherapy, the patient experienced a gout attack, and blood examination revealed acute renal failure (ARF) and hyperuricemia. The considered causes of ARF included MTX toxicity and acute uric acid nephropathy. As the dramatic effect of MTX was observed, treatment was continued despite ARF, most probably due to acute hyperuricemia due to tumor lysis, which was treated in parallel. After an improvement in renal function, MTX was resumed, and rasburicase was initiated to control hyperuricemia. A complete response was obtained after induction chemotherapy. Hyperuricemia was controlled with rasburicase, and renal function was preserved. Conclusions: Acute uric acid nephropathy should be considered when ARF occurs after the initiation of MTX in PCNSLs, especially in newly diagnosed PCNSL patients with large tumors or hyperuricemia.
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20
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Du P, Chen H, Shen L, Liu X, Wu X, Chen L, Cao A, Geng D. Analysis of Key Factors Associated with Response to Salvage High-Dose Methotrexate Rechallenge in Primary Central Nervous System Lymphoma with First Relapse. Curr Oncol 2022; 29:6642-6656. [PMID: 36135091 PMCID: PMC9497740 DOI: 10.3390/curroncol29090522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin’s lymphoma that occurs in the central nervous system. Although sensitive to chemotherapy, 35–60% of PCNSL patients still relapse within 2 years after the initial treatment. High-dose methotrexate (HD-MTX) rechallenge is generally used in recurrent PCNSL, especially for patients who have achieved a response after initial methotrexate (MTX) treatment. However, the overall remission rate (ORR) of HD-MTX rechallenge is about 70–80%. Additionally, the side effects of HD-MTX treatment endanger the health of patients and affect their quality of life. Methods: This is a retrospective study of patients with first relapse PCNSL at Huashan Hospital, Fudan University between January 2000 and November 2020. By comparing the clinical characteristics and radiological manifestations of first relapsed PCNSL patients with remission and non-remission after receiving HD-MTX rechallenge, we screened out the key factors associated with HD-MTX rechallenge treatment response, to provide some help for the selection of salvage treatment strategies for patients with recurrent PCNSL. Additionally, patients with remission after HD-MTX rechallenge were followed up to identify the factors related to progression-free survival of the second time (PFS2) (time from the first relapse to second relapse/last follow-up). The Kruskal–Wallis and Pearson chi-square tests were performed to examine the univariate association. Further, multivariable logistic regression analysis was used to study the simultaneous effect of different variables. Results: A total of 207 patients were enrolled in the study based on the inclusion criteria, including 114 patients in the remission group (RG) and 81 patients in the non-remission group (nRG), and 12 patients were judged as having a stable disease. In Kruskal–Wallis and Pearson chi-square tests, progression-free survival rates for first time (PFS1) and whether the initial treatment was combined with consolidated whole brain radiotherapy (WBRT) were related to the response to HD-MTX rechallenge treatment, which was further validated in regression analysis. Further, after univariate analysis and regression analysis, KPS was related to PFS2. Conclusions: For PCNSL patients in their first relapse, HD-MTX rechallenge may be an effective salvage treatment. PFS1 and whether initial treatment was combined with consolidation WBRT were associated with HD-MTX rechallenge treatment response. In addition, patients with higher KPS at the time of the first relapse had a longer PFS2 after HD-MTX rechallenge treatment.
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Affiliation(s)
- Peng Du
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Radiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Hongyi Chen
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Li Shen
- Department of Radiology, Jiahui International Hospital, Shanghai 200233, China
| | - Xiao Liu
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China
| | - Xuefan Wu
- Department of Radiology, Shanghai Gamma Hospital, Shanghai 200235, China
| | - Lang Chen
- Department of Radiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Aihong Cao
- Department of Radiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Correspondence: (A.C.); (D.G.)
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- Correspondence: (A.C.); (D.G.)
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21
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Neganova ME, Aleksandrova YR, Sukocheva OA, Klochkov SG. Benefits and limitations of nanomedicine treatment of brain cancers and age-dependent neurodegenerative disorders. Semin Cancer Biol 2022; 86:805-833. [PMID: 35779712 DOI: 10.1016/j.semcancer.2022.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023]
Abstract
The treatment of central nervous system (CNS) malignancies, including brain cancers, is limited by a number of obstructions, including the blood-brain barrier (BBB), the heterogeneity and high invasiveness of tumors, the inaccessibility of tissues for early diagnosis and effective surgery, and anti-cancer drug resistance. Therapies employing nanomedicine have been shown to facilitate drug penetration across the BBB and maintain biodistribution and accumulation of therapeutic agents at the desired target site. The application of lipid-, polymer-, or metal-based nanocarriers represents an advanced drug delivery system for a growing group of anti-cancer chemicals. The nanocarrier surface is designed to contain an active ligand (cancer cell marker or antibody)-binding structure which can be modified to target specific cancer cells. Glioblastoma, ependymoma, neuroblastoma, medulloblastoma, and primary CNS lymphomas were recently targeted by easily absorbed nanocarriers. The metal- (such as transferrin drug-loaded systems), polymer- (nanocapsules and nanospheres), or lipid- (such as sulfatide-containing nanoliposomes)-based nano-vehicles were loaded with apoptosis- and/or ferroptosis-stimulating agents and demonstrated promising anti-cancer effects. This review aims to discuss effective nanomedicine approaches designed to overcome the current limitations in the therapy of brain cancers and age-dependent neurodegenerative disorders. To accent current obstacles for successful CNS-based cancer therapy, we discuss nanomedicine perspectives and limitations of nanodrug use associated with the specificity of nervous tissue characteristics and the effects nanocarriers have on cognition.
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Affiliation(s)
- Margarita E Neganova
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, 1, Severnii pr., Chernogolovka, 142432, Russia
| | - Yulia R Aleksandrova
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, 1, Severnii pr., Chernogolovka, 142432, Russia
| | - Olga A Sukocheva
- School of Health Sciences, Flinders University of South Australia, Bedford Park, SA 5042, Australia.
| | - Sergey G Klochkov
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, 1, Severnii pr., Chernogolovka, 142432, Russia
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22
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Vilela-Filho O, Porfírio J, Goulart LC. Indicators of correct targeting in stereotactic biopsy of intracranial lesions. Surg Neurol Int 2022; 13:251. [PMID: 35855128 PMCID: PMC9282734 DOI: 10.25259/sni_246_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/29/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting.
Methods:
Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers.
Results:
Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified.
Conclusion:
This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.
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23
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Cheng L, Zhu H, Wang J, Wang G, Ma X, Zhao K, Wang J, Shu K. Clinical Features, Diagnosis, and Treatment of Primary Intraventricular Lymphoma: Insights From a Monocentric Case Series. Front Neurol 2022; 13:920505. [PMID: 35734472 PMCID: PMC9207404 DOI: 10.3389/fneur.2022.920505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Primary ventricular lymphoma (PVL) is an extremely rare and commonly misdiagnosed disease. Previous studies were predominantly case reports, and literature regarding the diagnosis and treatment of PVL is limited. Therefore, this study aimed to evaluate the characteristics of patients with PVL. Methods The data of patients with pathologically confirmed PVL were assessed. Epidemiological data, imaging findings, surgery, pathological results, and prognosis were retrospectively analyzed. A systematic review of relevant literature was also conducted. Results A total of eight patients with PVL were identified. The main symptom was increased intracranial pressure. Radiographically, five patients had single lesion and three had multiple lesions; typical findings on magnetic resonance imaging included hypointensity on T1- and T2-weighted imaging, adjacent brain edema, and homogeneous enhancement on contrast-enhanced T1-weighted images. Preoperatively, six cases were misdiagnosed and two cases did not get a definite diagnosis. Craniotomy was performed on all patients, and four achieved gross total resection. Hydrocephalus was relieved after surgical resection in four patients. Pathology revealed diffuse large B-cell lymphoma in all patients. Only one patient had a severe complication. A total of three patients received concomitant adjuvant treatment, whereas five patients refused any adjuvant therapy. At the time of follow-up, the median survival time of patients was 15 months. Conclusion Primary ventricular lymphoma mainly presented with symptoms of increased intracranial pressure and had several imaging characteristics for the diagnosis, but the condition still tends to be misdiagnosed. Surgical resection is a feasible treatment for patients with isolated nodules, especially those with acute obstructive hydrocephalus.
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Zhu Q, Wang J, Zhang W, Zhu W, Wu Z, Chen Y, Chen M, Zheng L, Tang J, Zhang S, Wang D, Wang X, Chen G. Whole-Genome/Exome Sequencing Uncovers Mutations and Copy Number Variations in Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System. Front Genet 2022; 13:878618. [PMID: 35646048 PMCID: PMC9133733 DOI: 10.3389/fgene.2022.878618] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background/objective: Identification of key genetic alterations is of importance in the targeted therapies of primary central nervous system lymphoma (PCNSL). However, only a small number of studies have been carried out in PCNSL. In this study, we further described the genetic mutations and copy number variations (CNVs) in PCNSL patients using whole-genome/exome sequencing (WGS/WES), as well as revealed their associations with patients’ clinicopathological features and prognosis. Methods: Tumor specimens from 38 patients with primary diffuse large B-cell lymphoma of the central nervous system (CNS DLBCL) were enrolled to WGS (n = 24) or WES (n = 14). The CNVs and mutations of 24 samples (WGS) and 38 samples (WGS/WES) were characterized, respectively. The associations between CNVs and mutations with the overall survival rates of PCNSL patients were also evaluated. Results: The most common mutations were identified in IGLL5 (68%), PIM1 (63%), MYD88 (55%), CD79B (42%), BTG2 (39%), PCLO (39%), KMT2D (34%), and BTG1 (29%) genes. Among the mutated genes, EP300, ETV6, and HIST1H1E mutations were exclusively detected in the elderly, while DUSP2 mutations were associated with the immune microenvironment indicators. In addition, KMT2D mutation was associated with a poor prognosis. In addition, 488 CNVs including 91 gains and 397 deletions were observed across 24 samples from WGS results. Notably, 1q31.3 amplification was closely associated with the poor prognosis of PCNSL patients. Conclusion: This study further characterizes the genomic landscape of primary CNS DLBCL using WGS/WES, which provides insight into understanding the pathogenesis of PCNSL and fosters new ideas for the targeted treatment of PCNSL.
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Affiliation(s)
- Qiong Zhu
- Department of Molecular Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jianchao Wang
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Wenfang Zhang
- The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Weifeng Zhu
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Zaizeng Wu
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yanping Chen
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Musheng Chen
- The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Limei Zheng
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianqing Tang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Sheng Zhang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Di Wang
- Department of Molecular Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xingfu Wang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Gang Chen
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
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Ramadan S, Radice T, Ismail A, Fiori S, Tarella C. Advances in therapeutic strategies for primary CNS B-cell lymphomas. Expert Rev Hematol 2022; 15:295-304. [PMID: 35467473 DOI: 10.1080/17474086.2022.2061455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Primary CNS lymphoma (PCNSL) has traditionally been treated with induction HD-MTX-based chemotherapy, followed by consolidation whole-brain radiotherapy. However, this approach is associated with significant neurocognitive complications, especially in older patients. Therefore, different consolidation protocols have been evaluated. High-dose chemotherapy followed by autologous stem cell transplantation (HD-ASCT) has the best long-term survival outcomes in younger patients. AREAS COVERED In this review of the literature, we focus on the overall therapeutic strategy and advances in the management of the aggressive primary CNS B-cell lymphomas. EXPERT OPINION In young and fit PCNSL patients, HD-ASCT is the preferred consolidation strategy to achieve long-term survivals. Older patients with good performance status should also be evaluated for MTX-based induction polychemotherapy followed by ASCT. However, management of PCNSL patients remains challenging, and new avenues with targeted therapies are under investigation. To date, ibrutinib, lenalidomide, and immune checkpoint inhibitors appearto be promising in PCNSL. However, as monotherapy, durable responses are less likely to be achieved. Unfortunately, when combined with chemoimmunotherapy, considerable toxicity and mortality have been reported. Clinical trials on these molecules are aiming to reduce toxicity and maintain responses. CAR-T-cell therapy has recently emerged as a further option. It has shown efficacy in patients with secondary CNS lymphoma, with few but encouraging results in primary CNSL.
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Affiliation(s)
- Safaa Ramadan
- Division of Onco-Hematology, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Medical Oncology, NCI-Cairo University, Cairo, Egypt
| | - Tommaso Radice
- Division of Onco-Hematology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ahmed Ismail
- Hematology Department at Maadi Military Hospital, Armed Forces College of Medicine Cairo, Egypt.,Hematology Department, Maadi Military Hospital, Armed forces college of medicine, Cairo, Egypt
| | - Stefano Fiori
- Division of Diagnostic Hematopathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Corrado Tarella
- Division of Onco-Hematology, European Institute of Oncology, IRCCS, Milan, Italy.,Dipartimento Universitario di Scienze della Salute (DISS), Universita' di Milano, Milan, Italy
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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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27
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Kruse M, Olesen TB, Markovic L, Glintborg D, Andersen MS. Recurrent autoimmune hypophysitis treated with rituximab: a case report. J Med Case Rep 2021; 15:591. [PMID: 34906226 PMCID: PMC8672614 DOI: 10.1186/s13256-021-03146-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Autoimmune hypophysitis is a rare condition that often results in enlargement of the pituitary gland and hypopituitarism due to inflammatory infiltration. Management of autoimmune hypophysitis can include long-term hormonal replacement and close control of the inflammatory pituitary mass. Mass-related symptoms in patients with autoimmune hypophysitis are treated with anti-inflammatory therapy, surgery, and/or radiotherapy. Case presentation We present a 25-year-old White man with visual field defects of the right eye, headache, and weight loss. Magnetic resonance imaging showed a sellar mass, and the patient underwent transcranial surgery. Histopathology revealed autoimmune hypophysitis with predominantly CD20 positive B-cell infiltration. Progression of visual field defects necessitated postoperatively anti-inflammatory treatment with prednisolone. Azathioprine was initiated under gradual tapering of prednisolone with stable conditions at first, but relapse followed after dose reduction. Therefore, rituximab treatment was initiated, which resulted in regression of the pituitary mass. Rituximab treatment was discontinued after 25 months. The patient has continuously been in remission for 4 years after rituximab treatment was stopped. Conclusion This case illustrates that rituximab might be an effective alternative treatment in B-cell predominant autoimmune hypophysitis.
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Affiliation(s)
- Maria Kruse
- Department of Internal Medicine, Hospital of Littlebelt, Kolding, Denmark
| | | | - Ljubo Markovic
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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28
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Lu G, Li Y, Liang X, Zhao Z. Diagnosis and analysis of primary central nervous system lymphoma based on MRI segmentation algorithm. Pak J Med Sci 2021; 37:1585-1589. [PMID: 34712287 PMCID: PMC8520370 DOI: 10.12669/pjms.37.6-wit.4843] [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: 04/05/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: This paper summarizes the MRI imaging findings of primary central nervous system lymphoma (PCNSL) in the posterior cranial fossa to improve the accuracy of PCNSL diagnosis in the posterior cranial fossa. Methods: This study retrospectively analyzed the MRI imaging manifestations of 15 PCNSL posterior cranial fossa cases confirmed by puncture or surgical pathology from June 2017 to May 2018, including their occurrence sites, the number of lesions, MRI plain and enhanced manifestations, and diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy. Imaging (MRS) performance. Results: A total of 15 cases were enrolled, including 10 cases of single lesion and five cases of multiple lesions. The total number of lesions was 25, which were in the cerebellar hemisphere and cerebellar vermis, midbrain, fourth ventricle, and pontine cerebellum. The lesions were round, irregular, nodular, patchy, with low or medium signals on T1WI, equal or slightly higher signals on T2WI, and enhanced with 25 meningiomas-like gray matter signals. All of them were significantly strengthened. “Acupoint sign” and “umbilical depression sign” were seen in eight lesions. There were 17 massive and nodular enhancements, four striped enhancements, three patchy enhancements, and one circular enhancement. five cases of DWI showed homogeneous high signal, two cases showed uneven high signal, and 3 cases showed medium signal. The ADC value of tumor parenchyma in 10 patients was (0.62±0.095)×10-3mm2/s. MRS examination showed obvious Lip peak in two cases. Conclusion: PCNSL in posterior cranial fossa has certain characteristics. DWI, ADC value and MRS are helpful to improve the correct diagnosis rate of PCNSL.
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Affiliation(s)
- Guanping Lu
- Guanping Lu, Master of Medicine. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| | - Ying Li
- Ying Li, Master of Medicine. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| | - Xinqiang Liang
- Xinqiang Liang, Master of Medicine. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| | - Zhengjun Zhao
- Zhengjun Zhao, Bachelor's Degrees. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
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Balikov DA, Hu K, Liu CJ, Betz BL, Chinnaiyan AM, Devisetty LV, Venneti S, Tomlins SA, Cani AK, Rao RC. Comparative Molecular Analysis of Primary Central Nervous System Lymphomas and Matched Vitreoretinal Lymphomas by Vitreous Liquid Biopsy. Int J Mol Sci 2021; 22:9992. [PMID: 34576156 PMCID: PMC8471952 DOI: 10.3390/ijms22189992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
Primary Central Nervous System Lymphoma (PCNSL) is a lymphoid malignancy of the brain that occurs in ~1500 patients per year in the US. PCNSL can spread to the vitreous and retina, where it is known as vitreoretinal lymphoma (VRL). While confirmatory testing for diagnosis is dependent on invasive brain tissue or cerebrospinal fluid sampling, the ability to access the vitreous as a proximal biofluid for liquid biopsy to diagnose PCNSL is an attractive prospect given ease of access and minimization of risks and complications from other biopsy strategies. However, the extent to which VRL, previously considered genetically identical to PCNSL, resembles PCNSL in the same individual with respect to genetic alterations, diagnostic strategies, and precision-medicine based approaches has hitherto not been explored. Furthermore, the degree of intra-patient tumor genomic heterogeneity between the brain and vitreous sites has not been studied. In this work, we report on targeted DNA next-generation sequencing (NGS) of matched brain and vitreous samples in two patients who each harbored VRL and PCSNL. Our strategy showed enhanced sensitivity for molecular diagnosis confirmation over current clinically used vitreous liquid biopsy methods. We observed a clonal relationship between the eye and brain samples in both patients, which carried clonal CDKN2A deep deletions, a highly recurrent alteration in VRL patients, as well as MYD88 p.L265P activating mutation in one patient. Several subclonal alterations, however, in the genes SETD2, BRCA2, TERT, and broad chromosomal regions showed heterogeneity between the brain and the eyes, between the two eyes, and among different regions of the PCNSL brain lesion. Taken together, our data show that NGS of vitreous liquid biopsies in PCNSL patients with VRL highlights shared and distinct genetic alterations that suggest a common origin for these lymphomas, but with additional site-specific alterations. Liquid biopsy of VRL accurately replicates the findings for PCNSL truncal (tumor-initiating) genomic alterations; it can also nominate precision medicine interventions and shows intra-patient heterogeneity in subclonal alterations. To the best of our knowledge, this study represents the first interrogation of genetic underpinnings of PCNSL with matched VRL samples. Our findings support continued investigation into the utility of vitreous liquid biopsy in precision diagnosis and treatment of PCNSL/VRL.
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Affiliation(s)
- Daniel A. Balikov
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, MI 48109, USA; (D.A.B.); (L.V.D.)
| | - Kevin Hu
- Center of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Chia-Jen Liu
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (C.-J.L.); (B.L.B.); (A.M.C.); (S.V.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bryan L. Betz
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (C.-J.L.); (B.L.B.); (A.M.C.); (S.V.); (S.A.T.)
| | - Arul M. Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (C.-J.L.); (B.L.B.); (A.M.C.); (S.V.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Laxmi V. Devisetty
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, MI 48109, USA; (D.A.B.); (L.V.D.)
| | - Sriram Venneti
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (C.-J.L.); (B.L.B.); (A.M.C.); (S.V.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Scott A. Tomlins
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (C.-J.L.); (B.L.B.); (A.M.C.); (S.V.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andi K. Cani
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Hematology/Oncology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rajesh C. Rao
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, MI 48109, USA; (D.A.B.); (L.V.D.)
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (C.-J.L.); (B.L.B.); (A.M.C.); (S.V.); (S.A.T.)
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Center for RNA Biomedicine, University of Michigan, Ann Arbor, MI 48109, USA
- Division of Ophthalmology, Surgical Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48109, USA
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MI 48109, USA
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30
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Leone R, Sferruzza G, Calimeri T, Steffanoni S, Conte GM, De Cobelli F, Falini A, Ferreri AJM, Anzalone N. Quantitative muscle mass biomarkers are independent prognosis factors in primary central nervous system lymphoma: The role of L3-skeletal muscle index and temporal muscle thickness. Eur J Radiol 2021; 143:109945. [PMID: 34492625 DOI: 10.1016/j.ejrad.2021.109945] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/03/2021] [Accepted: 08/29/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the role of quantitative muscle biomarkers assessed with skeletal muscle index at the third lumbar vertebra (L3-SMI) and temporal muscle thickness (TMT) in predicting progression-free and overall survival in patients with primary central nervous system lymphoma (PCNSL) undergoing first-line high-dose methotrexate-based chemotherapy. METHODS L3-SMI and TMT were calculated on abdominal CT and brain high-resolution 3D-T1-weighted MR images, respectively, using predefined validated methods. Standardized sex-specific cut-off values were used to divide patients in different risk categories. Kaplan-Meier plots were calculated, and survival analysis was performed using log-rank tests, univariate, and multivariable Cox-regression models, calculating hazard ratios (HR) and 95% confidence intervals (CI), also adjusting for potential confounders (age, sex, and performance status). RESULTS Forty-three patients were included in this study. Median follow-up was 23 months (interquartile range 12-40); at median follow-up, rates of progression-free and overall survival for the cohort were 46% and 57%, respectively. Thirteen (30%) and 11 (26%) patients showed L3-SMI or TMT values below the predefined cut-offs. In Cox-regression multivariable analysis patients with low L3-SMI or TMT showed significantly worse progression-free (HR 4.40, 95% CI 1.66-11.61, p = 0.003; HR 4.40, 95% CI 1.68-11.49, p = 0.003, respectively) and overall survival (HR 3.16, 95% CI 1.09-9.11, p = 0.034; HR 4.93, 95% CI 1.78-13.65, p = 0.002, respectively) compared to patients with high L3-SMI or TMT. CONCLUSIONS Quantitative muscle mass evaluation assessed by both L3-SMI and TMT is a promising tool to identify PCNSL patients at high risk of negative outcome. Confirmatory studies on larger independent series are warranted.
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Affiliation(s)
- R Leone
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - G Sferruzza
- Department of Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan and Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - T Calimeri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - S Steffanoni
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - G M Conte
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - F De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - A Falini
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - A J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - N Anzalone
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
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Amano R, Tsukada S, Kosuge S, Yano S, Ono K, Yoneda M, Taki K. Case Report: Paraneoplastic Hashimoto's Encephalopathy Associated With Lymphomatosis Cerebri With Periodic Synchronous Discharges Resembling Creutzfeldt-Jakob Disease. Front Neurol 2021; 12:701178. [PMID: 34447347 PMCID: PMC8384121 DOI: 10.3389/fneur.2021.701178] [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: 04/27/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Hashimoto's encephalopathy (HE) is an autoimmune encephalopathy that presents with various clinical symptoms, including cognitive deterioration, convulsive seizures, and personality changes. HE is associated with thyroid autoimmunity; however, few cases have been reported to develop as paraneoplastic syndrome. Herein, we report the case of a 73-year-old woman with onset of rapidly progressive dementia. Brain magnetic resonance imaging showed diffuse T2 hyperintensity areas involving the bilateral cerebral white matter, right midbrain tegmental area, left cerebral peduncle, and right middle cerebellar peduncle without clear diffusion hyperintensities and gadolinium enhancement. Her neurological symptoms worsened rapidly, and she presented with the apallic syndrome. Electroencephalogram showed periodic synchronous discharge, suggestive of Creutzfeldt–Jakob disease. However, a brain biopsy revealed infiltration of atypical lymphoid cells expressing CD20, and the anti-NH2 terminal of the α-enolase antibody was detected, diagnosing the complication with lymphomatosis cerebri and HE. High-dose intravenous methylprednisolone therapy and oral prednisolone with whole cranial irradiation enabled her to have simple conversations and consume food orally; however, severe cognitive impairment persisted. Although HE is a rare complication of malignant lymphoma, clinicians should be aware that it could be strongly suspected if the clinical symptoms worsen in the absence of imaging changes.
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Affiliation(s)
- Ryota Amano
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
| | - Setsuro Tsukada
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
| | - Shota Kosuge
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
| | - Satoshi Yano
- Division of Neurology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kenjiro Ono
- Division of Neurology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Makoto Yoneda
- Faculty of Nursing and Social Welfare Science, Fukui Prefectural University, Fukui, Japan
| | - Katsumi Taki
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
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Paglia F, di Norcia V, D'Angelo L, Berra LV, Santoro A. A rare case of Meckel's cave primary lymphoma: a case report and elaboration of the diagnostic algorithm. Acta Neurol Belg 2021; 121:907-914. [PMID: 31983037 DOI: 10.1007/s13760-020-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/11/2020] [Indexed: 11/26/2022]
Abstract
Management of lesions involving Meckel's cave can represent a challenge for neurosurgeons, because of the deep-seated location and the surrounding complex neurovascular structures. Very small lesions arising from MC are generally asymptomatic and radiological follow-up with head MRI and PET-CT is sufficient to control these lesions. In rare cases, the rapid increase in the size of lesions and the alteration of the neurologic status make early histological characterization mandatory in the plethora of lesions arising from Meckel's cave; a very small percentage is represented by central nervous system lymphomas. Primary diffuse large B-cell lymphoma is the most commonly found. Aggressive surgery, in case of suspicious Meckel's cave lesions, is strongly discouraged, because this procedure may increase the risk of postoperative deficit and provides no survival benefit compared with biopsy alone. The aim of the present paper is to report a very rare case of primary Meckel's cave diffuse large B-cell lymphoma (only seven cases were described in literature) and standardize an operative algorithm to avoid the risks of an incorrect surgical conduct.
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Affiliation(s)
- Francesco Paglia
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
| | - Valerio di Norcia
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luca D'Angelo
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luigi Valentino Berra
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
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Suzuki T, Kaburaki T, Tanaka R, Shirahama S, Komae K, Nakahara H, Takamoto M, Kawashima H, Aihara M. Incidence and changing patterns of uveitis in Central Tokyo. Int Ophthalmol 2021; 41:2377-2388. [PMID: 34047908 DOI: 10.1007/s10792-021-01791-4] [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: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE The patterns of uveitis in Tokyo have recently changed due to advances in examination tools. We aimed to investigate the changes in the patterns of uveitis between 2004-2015 and 2016-2018. METHODS We retrospectively reviewed the data of 732 patients who visited the Uveitis Clinic at the University of Tokyo Hospital between January 2016 and December 2018. Background characteristics, laboratory results, and imaging findings were analysed. We compared the incidences of uveitis in 2016-2018 and 2004-2015 to identify changes in the patterns. RESULTS The most frequent diagnoses were sarcoidosis (8.9%), herpetic iridocyclitis (6.7%), intraocular lymphoma (5.5%), Vogt-Koyanagi-Harada disease (4.8%), unclassified acute anterior uveitis (4.6%), Behçet's disease (4.5%), bacterial endophthalmitis (2.9%), and Posner-Schlossman syndrome (2.6%). Suspected sarcoidosis (20.9%) was the most common cause of unclassified uveitis. The incidence of intraocular lymphoma was significantly higher in 2016-2018 than in 2004-2015. Between 2004 and 2018, herpetic iridocyclitis, bacterial endophthalmitis, and juvenile chronic iridocyclitis exhibited an increasing trend, and the incidences of Posner-Schlossman syndrome, unclassified acute anterior uveitis, Behçet's disease, and Vogt-Koyanagi-Harada disease exhibited a decreasing trend. CONCLUSION The changing patterns of uveitis were characterised by increases in the incidence of intraocular lymphoma. This may be attributed to recent advances in examination tools, the changes in the referred patient population, and the aging Japanese population.
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Affiliation(s)
- Takafumi Suzuki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Ophthalmology, Shinseikai Toyama Hospital, Toyama, 939-0243, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Ophthalmology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Ohmiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Martins ES, Duque C, Rebelo O, Batista S. Primary intramedullary spinal-cord lymphoma (PISCL): a rare entity with a challenging diagnosis. BMJ Case Rep 2021; 14:14/5/e242548. [PMID: 34011646 DOI: 10.1136/bcr-2021-242548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary intramedullary spinal-cord lymphoma (PISCL) is a rare cause of myelopathy and constitutes only 1% of central nervous system lymphomas. Delay to diagnosis is common due to its rarity, its similarity to other causes of myelopathy and the difficulties in obtaining pathological diagnosis. We report a case of PISCL and discuss the challenges faced on diagnosis, namely the impact of corticosteroids on histological findings, the usefulness of MRI, positron-emission tomography/CT (PET/CT) and repeated lumbar punctures.
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Affiliation(s)
| | - Cristina Duque
- Neurology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Olinda Rebelo
- Neurology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Neurology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
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Luo Q, Yang C, Fu C, Wu W, Wei Y, Zou L. Prognostic Role of Blood Markers in Primary Central Nervous System Lymphoma Patients Treated With High-Dose Methotrexate-Based Therapy. Front Oncol 2021; 11:639644. [PMID: 33996552 PMCID: PMC8117413 DOI: 10.3389/fonc.2021.639644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: Primary central nervous system lymphoma (PCNSL) is a rare type of extra-nodal non-Hodgkin lymphoma, but the prognostic value of blood parameters indicating systemic inflammation and nutritional status remains unknown. We aim to explore the prognostic role of blood parameters in PCNSL. Methods: All PCNSL patients diagnosed at West China Hospital between February 2011 and February 2020 were retrospectively screened. For patients who were initially treated with high-dose methotrexate (HD-MTX)-based therapy, clinical data were collected. Survival analyses were performed using the Kaplan–Meier method and multivariable Cox proportional regression. The accuracies of different multivariate models were assessed by Harrell's C statistical analysis (C-index). Results: Sixty patients were included. Median overall survival (OS) was 4.8 ± 3.7 years, and median progression-free survival (PFS) was 1.9 ± 1.3 years. In the multivariate analysis, hemoglobin (Hb) (HR 3.940, p = 0.013), neutrophil–lymphocyte ratio (NLR) (HR 10.548, p = 0.034), and total bilirubin (TBIL) (HR 3.429, p = 0.004) had independent prognostic values for PFS, while lymphocyte–monocyte ratio (LMR) (HR 6.195, p = 0.039), systemic immune-inflammation index (SII) (HR 5.144, p = 0.012), and TBIL (HR 3.892, p = 0.009) were independently related to OS. The C-index of the Memorial Sloan-Kettering Cancer Center (MSKCC) score increased from 0.57 to 0.72 when SII and TBIL were combined. Conclusions: Our study indicated that pretreatment Hb, NLR, SII, LMR, and TBIL were convenient prognostic factors in PCNSL. Adding SII and TBIL to the MSKCC score can better predict the survival of PCNSL based on HD-MTX regimens.
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Affiliation(s)
- Qian Luo
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunli Yang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunxi Fu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wanchun Wu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Department of Central Medical Transportation, West China Hospital, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Liu Q, Chen X, Li G, Ye Y, Liu W, Zhao S, Zhang W. Primary central nervous system ALK-positive anaplastic large cell lymphoma with CD56 abnormally expression in a Chinese child: Challenge in diagnostic practice. Int J Immunopathol Pharmacol 2021; 34:2058738420941756. [PMID: 32664812 PMCID: PMC7364798 DOI: 10.1177/2058738420941756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALK + ALCL) is most frequent in youth and possesses a broad morphologic spectrum. However, involvement in central nervous system (CNS) is definitely rare. The case we presented was a 12-year-old Chinese male who presented with headache and emesis for a couple of days. The neoplastic component was smaller cells resembling starry-sky growth pattern and immunohistochemical stained positively for CD30, ALK1, and CD56. Monoclonal T-cell receptor (TCRγ) gene rearrangement and gene translocation involving ALK identified by fluorescence in situ hybridization (FISH) using ALK break apart probe supported the diagnosis of ALK + ALCL. This case showed ALK + ALCL occur in a rare site with an abnormal CD56 expression. Awareness of this entity is important to distinguish it from other intracranial lymphoma.
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Affiliation(s)
- Qian Liu
- Department of Pathology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China.,Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Xian Chen
- Department of Pathology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Gandi Li
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Yunxia Ye
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Weiping Liu
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Sha Zhao
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Wenyan Zhang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
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Gomes Candido Reis D, Levy D, Lage LADPC, Culler HF, Rocha V, Bydlowski SP, Nogueira Zerbini MC, Pereira J. New genetic prognostic biomarkers in primary central nervous system lymphoma (PCNSL). Brain Behav 2021; 11:e02061. [PMID: 33591648 PMCID: PMC8035458 DOI: 10.1002/brb3.2061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/16/2020] [Accepted: 01/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND PCNSL is a rare extranodal NHL with poor prognosis. Tumorigenesis has been associated with hyperactivation of BCR downstream and NFkB pathways. We studied the prognosis of the relative expression profile of target genes of NFkB pathway (MYC, BCL2), the essential transcriptional regulator in hematopoiesis LMO2, the checkpoint regulation pathway MGMT, the transcription factor POU2F1, the immune checkpoint gene PDCD1, and the proto-oncogene and transcriptional repressor gene BCL6 and its proteins in PCNSL. METHODS This study is a retrospective cohort study; 35 immunocompetent PCNSL-DLBCL patients had their gene expression (RT-qPCR) normalized to internal control gene GUSB. RESULTS Median patient age was 62 years, median OS was 42.6 months (95% CI: 26.6-58.6), PFS was 41 months (95% CI: 19.7-62.4), and DFS was 59.2 months (95% CI 31.9-86.6). A moderate correlation was found between the gene/protein expressions of MYC (kappa = 0.596, p = .022) and of BCL2 (kappa = 0.426, p = .042). Relative gene expression of MYC ≥ 0.201 (HR 6.117; p = .003) was associated with worse 5-year OS. Relative gene expression of MYC ≥ 0.201 (HR 3.96; p = .016) and MGMT ≥ 0.335 (HR 3.749; p = .056) was associated with worse PFS. Age > 60 years and IELSG score moderate/high were also associated with worse prognosis. CONCLUSIONS Overexpression of MYC and overexpression of MGMT were prognostic markers associated with unfavorable clinical outcomes in PCNSL.
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Affiliation(s)
- Diego Gomes Candido Reis
- Department of Hematology, Hemotherapy and Cell Therapy, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Débora Levy
- Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy and Cell Therapy, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.,Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy and Cell Therapy, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy and Cell Therapy, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.,Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil.,Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Churchill Hospital, Oxford University, Oxford, UK
| | - Sérgio Paulo Bydlowski
- Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Juliana Pereira
- Department of Hematology, Hemotherapy and Cell Therapy, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.,Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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38
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Gazal S, Lebel E, Kalish Y, Makranz C, Gatt ME, Goldschmidt N, Nachmias B. Venous Thromboembolism Prophylaxis with Low-Molecular-Weight Heparin in Primary Central Nervous System Lymphoma. Oncol Res Treat 2020; 44:52-57. [PMID: 33296909 DOI: 10.1159/000512241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a frequent, potentially lethal complication in individuals with cancer. Patients with brain tumors are at particularly high risk for VTE. Primary central nervous system lymphoma (PCNSL) is a rare subtype of diffuse large B cell lymphoma, involving the craniospinal axis. The incidence of VTE in patients with PCNSL was reported as very high, occurring mostly in the early period of therapy. OBJECTIVES We aimed to evaluate the efficacy and safety of prophylactic low-molecular-weight heparin (LMWH) throughout the treatment of PCNSL. PATIENTS All patients >18 years of age diagnosed and treated for PCNSL at our institution in 2005-2017 were included. RESULTS There were 44 patients; mean age at diagnosis was 61.5 years. Three patients (6.8%) had a personal history of thrombosis, 11 (25%) had a history of diabetes or smoking, and 32 (72%) had an Eastern Cooperative Oncology Group performance status of 0-1 at diagnosis. During treatment with LMWH, no VTE events were recorded; 2 (4.5%) patients experienced a minor bleeding event and 1 (2.3%) a major bleeding event. CONCLUSIONS Among our 44 patients with PCNSL treated with prophylactic LMWH, no VTE events were recorded, and only 1 (asymptomatic) intracranial bleed was recorded. Within the limitations of a retrospective nonrandomized study, our findings suggest that VTE prophylaxis may be beneficial for individuals with PCNSL.
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Affiliation(s)
- Stav Gazal
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eyal Lebel
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Chen Makranz
- Leslie and Michael Gaffin Center for Neuro-Oncology, Departments of Oncology and Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Moshe E Gatt
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Boaz Nachmias
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel,
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Yamaura G, Ogasawara A, Ito T, Ohsugi S, Kanatsuka Y, Hayashi R, Iwashita H, Hayashi H, Koyano S, Yamaguchi S, Tanaka F. Pathologically Proven Gadolinium-enhanced MRI Lesions in the Bilateral Corticospinal Tracts in Lymphomatosis Cerebri. Intern Med 2020; 59:2931-2934. [PMID: 32713909 PMCID: PMC7725641 DOI: 10.2169/internalmedicine.4382-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 78-year-old woman in complete remission of mass-forming primary central nervous system lymphoma (PCNSL) showed diffuse leukoencephalopathy as well as corticospinal tract lesions with intense gadolinium enhancement on magnetic resonance imaging (MRI). She died 3 months later. In line with the MRI findings, pathological examination revealed dense infiltration of atypical lymphoid cells, consistent with a diagnosis of lymphomatosis cerebri (LC)-type PCNSL. This is the first report of LC in which the corticospinal tracts demonstrated robust contrast enhancement directly corresponding to the neuropathological findings, and it is also a rare instance in which LC presented as a recurrence of typical PCNSL.
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Affiliation(s)
- Genpei Yamaura
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | - Akihiro Ogasawara
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | - Takeshi Ito
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | - Shizuka Ohsugi
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | - Yoichi Kanatsuka
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | - Ryuichiro Hayashi
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | | | - Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen's Hospital, Japan
| | - Shigeru Koyano
- Department of Neurology, Yokohama Minami Kyousai Hospital, Japan
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Japan
| | - Shigeki Yamaguchi
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Japan
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El Dirani A, Hachem Z, Mohanna A, Zaylaa AJ. Traditional and Advanced Neuroimaging Contributions to the Diagnosis and Differential Diagnosis of Central Nervous System Lymphoma Patients Visiting a Comprehensive Medical Center. Open Neuroimag J 2020. [DOI: 10.2174/1874440002013010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The diagnosis of Central Nervous System Lymphoma, especially the Primary Central Nervous System Lymphoma is carried out based on brain imaging, thus avoiding an unnecessary extend of surgery. But the traditional imaging techniques, such as Computed Tomography and Magnetic Resonance Imaging, were not satisfactory.
Aims:
This study was conducted to characterize the spectrum of advanced Neuroimaging, such as the advanced Magnetic Resonance Imaging features in the Central Nervous System Lymphoma patients in a comprehensive medical center in Lebanon, and compare them to what has been described in the literature review.
Methods:
It is a retrospective exploratory study of the clinical data and imaging features for patients admitted to the emergency and radiology departments with ages above 10 years, and who were diagnosed histopathologically with intracranial lymphoma. This study may be the first to make a Radiological evaluation of Central Nervous System Lymphoma on the local population of patients over 9 years .
Results:
Results showed that the study of the Computed Tomography and Magnetic Resonance Imaging data of 10 immunocompetent patients with Central Nervous System Lymphoma concurs with the previously described patient populations, except for the gender parameter. Tumors were mostly presented in the fifth or Sixth decade and they could be solitary or multi-focal. Lesions were typically located Preprint submitted to The Open Neuroimaging Journal May 14, 2020 in the supratentorial compartment. On the brain Computed Tomography, the lesions were hyperdense, and in pre-contrast Magnetic Resonance images, the lesions appeared hypointense on T1 and hyperintense on T2-Weighted images, but hypointense with respect to the grey matter. The lesions were also surrounded with a mild to moderate edema as compared to other intracranial neoplasms, such as glioblastomas. Evaluation results showed that on post-contrast Magnetic Resonance images, the majority of lesions exhibited a homogeneous enhancement of 50%. Majority of the lesions also showed a less common heterogeneous ring-like enhancement of 40%, and revealed the uncommon absence of enhancement of 10%. Calcifications, hemorrhage, and necrosis were rare findings and were present in only one patient.
Conclusion:
As a future prospect, studying whether the advanced imaging techniques may provide not only non-invasive and morphological characteristics but also non-invasive biological characteristics and thus accurate diagnosis could be considered.
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41
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Chen L. Editorial for: "Primary Central Nervous System Lymphoma: Clinical Evaluation of Automated Segmentation on Multiparametric MRI Using Deep Learning". J Magn Reson Imaging 2020; 53:269-270. [PMID: 32770563 DOI: 10.1002/jmri.27312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
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Shao J, Chen K, Li Q, Ma J, Ma Y, Lin Z, Kang H, Chen B. High Level of IL-10 in Cerebrospinal Fluid is Specific for Diagnosis of Primary Central Nervous System Lymphoma. Cancer Manag Res 2020; 12:6261-6268. [PMID: 32801871 PMCID: PMC7386815 DOI: 10.2147/cmar.s255482] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/19/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose The pathological diagnosis of primary central nervous system lymphoma (PCNSL) by stereotactic brain biopsy and craniotomy is not often applicable due to the high cost and associated complications. In recent years, some biomarkers in cerebrospinal fluid (CSF), including interleukin 10 (IL-10), microRNAs, CXC chemokine ligand 13 (CXCL13), have been reported to be associated with PCNSL. However, this conclusion was controversial. Therefore, this study was to test whether Th17 cell-related cytokines could be used to distinguish PCNSL from other brain tumors. Patients and Methods Th17 cell-related cytokines in CSF were measured in 108 patients with intracranial tumors, which included 66 PCNSL patients and 42 patients with other types of brain tumors. A receiver-operating characteristic (ROC) curve was utilized to analyze the diagnostic value of the cytokines based on the area under the curve (AUC). Results The CSF IL-10 level and IL-10/IL-6 ratios were significantly higher in PCNSL than in the other brain tumors (58.2 pg/mL VS 1.5 pg/mL, p=0.001; 24.3 VS 0.6, p=0.001). When the cutoff level of IL-10 was set at 8.3 pg/mL, its sensitivity and specificity for diagnosing PCNSL were 59.0% and 98%, respectively. The CSF IL-10 levels over 5pg/mL (+LR 12.3) were of significant value for the diagnosis of PCNSL. These parameters are highly valuable in PCNSL diagnosis, but their sensitivity is less valuable. The sensitivity of IL-4 and IL-17A, the ratio of mature lymphocytes and the monocytes/macrophages ratio in CSF were relatively high. In combination, the sensitivity increased by 15% and the specificity remained above 85%. The best combination was IL-10 and IL-17A, whose sensitivity was 70% and specificity was 96%. Conclusion The CSF level of IL-10 is a useful diagnostic biomarker in patients with PCNSL. The CSF levels of IL-4, IL-17A, mature lymphocytes and monocytes/macrophages can be used to increase the diagnostic value of CSF IL-10 level and IL-10/IL-6 ratio.
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Affiliation(s)
- Jie Shao
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Kun Chen
- Department of Laboratory Medicine, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Qing Li
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Jingjing Ma
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Yan Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Zhiguang Lin
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Hui Kang
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
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Young PA, Gaut D, Kimaiyo DK, Grotts J, Romero T, Chute J, Schiller G, de Vos S, Eradat HA, Timmerman J. Durable Survival Outcomes in Primary and Secondary Central Nervous System Lymphoma After High-dose Chemotherapy and Autologous Stem Cell Transplantation Using a Thiotepa, Busulfan, and Cyclophosphamide Conditioning Regimen. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2020; 20:468-479. [PMID: 32229199 PMCID: PMC7138188 DOI: 10.1016/j.clml.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND High-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has been investigated in patients with primary central nervous system lymphoma (PCNSL) and non-Hodgkin lymphoma (NHL) with CNS involvement and has shown promising results. PATIENTS AND METHODS A retrospective analysis was performed of 48 consecutive patients who had undergone HDC/ASCT with TBC (thiotepa, busulfan, cyclophosphamide) conditioning for PCNSL (27 patients), secondary CNS lymphoma (SCNSL) (8 patients), or relapsed disease with CNS involvement (13 patients) from July 2006 to December 2017. Of the 27 patients with PCNSL, 21 had undergone ASCT at first complete remission (CR1). RESULTS The 2-year progression-free survival (PFS) rate was 80.5% (95% confidence interval [CI], 69.9-92.9) and the 2-year overall survival (OS) rate was 80.1% (95% CI, 69.2%-92.7%) among all patients. The 2-year PFS and OS rate for patients with PCNSL in CR1 was 95.2% (95% CI, 86.6%-100%) and 95.2% (95% CI, 86.6%-100%), respectively. On univariate analysis of the patients with PCNSL, ASCT in CR1 was the only variable statistically significant for outcome (P = .007 for PFS; P = .008 for OS). Among patients with SCNSL or CNS relapse, the 2-year PFS and OS rate were comparable at 75.9% (95% CI, 59.5%-96.8%) and 75.3% (95% CI, 58.6%-98.6%), respectively. The most common side effects were febrile neutropenia (89.6%; of which 66.7% had an infectious etiology identified), nausea/vomiting (85.4%), diarrhea (93.8%), mucositis (89.6%), and electrolyte abnormalities (89.6%). Four patients (8.3%) died of treatment-related overwhelming infection; of these patients, 3 had SCNSL. CONCLUSION HDC and ASCT using TBC conditioning for both PCNSL and secondary CNS NHL appears to have encouraging long-term efficacy with manageable side effects.
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Affiliation(s)
- Patricia A Young
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
| | - Daria Gaut
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Davis K Kimaiyo
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jonathan Grotts
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tahmineh Romero
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - John Chute
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Gary Schiller
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Sven de Vos
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Herbert A Eradat
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - John Timmerman
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Yang J, Liu Z, Yang Y, Chen H, Xu J. Lateral intraventricular primary central nervous system lymphoma (LIPCNSL): a review. QJM 2020; 113:457-464. [PMID: 31899520 DOI: 10.1093/qjmed/hcz330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lateral intraventricular primary central nervous system lymphoma (LIPCNSL) is an extremely rare intraventricular tumor with high malignancy and has never been systematically described. AIM To analyze the clinical characteristics and therapeutic strategy of LIPCNSL. DESIGN Single-center retrospective study. METHODS The clinical manifestation, imaging, treatment and outcomes of 13 patients with LIPCNSL who underwent craniotomy in West China Hospital between December 2008 and April 2018 were retrospectively analyzed. RESULTS Eleven male and two female patients were enrolled. The mean age was 49.7 years (14-65 years). The frequent manifestations include symptoms of raised intracranial pressure and limb weakness. The mean duration was 1.8 months (1 week to 1 year). The average maximal diameter of tumors was 4.1 cm (1.8-6.1 cm). Gross total resection was achieved in 84.6% of patients. Symptoms improved in 69.2% of patients but developed in 30.8% of patients after surgery. The median recurrence-free survival (RFS) and overall survival (OS) were 2.0 months (1-86 months) and 3.0 months (1-124 months). High-dose methotrexate or/and radiotherapy significantly prolonged the RFS and OS (P < 0.05). Eight patients (72.7%) experienced relapse and progression. Salvage treatment significantly prolonged survival after relapse (P < 0.05). CONCLUSIONS LIPCNSL should be considered as a differential diagnosis of intraventricular tumors. High-dose methotrexate-based chemotherapy with or without radiotherapy should be the first-line treatment, and surgery is only for biopsy and improving symptoms. Long-term intensive follow-up is necessary and active salvage treatment should be performed after relapse.
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Affiliation(s)
- J Yang
- Department of Neurosurgery, West China Hospital, Guoxue Street 37
| | - Z Liu
- Department of Neurosurgery, West China Hospital, Guoxue Street 37
| | - Y Yang
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Chengdu, Sichuan 610041, P. R. China
| | - H Chen
- Department of Neurosurgery, West China Hospital, Guoxue Street 37
| | - J Xu
- Department of Neurosurgery, West China Hospital, Guoxue Street 37
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The combination of methotrexate and cytosine arabinoside in newly diagnosed adult Langerhans cell histiocytosis: a prospective phase II interventional clinical trial. BMC Cancer 2020; 20:433. [PMID: 32423455 PMCID: PMC7236107 DOI: 10.1186/s12885-020-06872-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Langerhans Cell Histiocytosis (LCH) is a rare disease puzzling both children and adults, however outcome of adult patients is unfavorable. This prospective interventional trial aims to test the efficacy and safety of the combination of methotrexate and cytosine arabinoside in adult LCH patients. METHOD A total of 36 patients enrolled diagnosed with LCH and treated in our center from 1st Jan, 2014 to 30th Jun, 2016. RESULT Nineteen patients underwent the detection of BRAF mutation, with a positive rate of 21.1%. The overall response rate was 100%, only 16.7% achieved complete response. The overall regression rate of osseous lesions was 100%. Regression of central nervous system involvement was also favorable. After a median follow-up of 44 months, the estimated event-free survival was 48.9 months, the overall survival rate was 97.2%. The risk organ involvement showed strong prognostic value, EFS was 34.1 or 54.6 months (p = 0.001) in groups with/without risk organ involvement respectively. Neutropenia and thrombocytopenia were the most common adverse effects. CONCLUSION The regimen of methotrexate and cytosine arabinoside (MA) is effective and safe in treating adult LCH patients, and timely preventions may be considered for the high incidence of hematological adverse effects. TRIAL REGISTRATION Trial No. NCT02389400 on Clinicaltrials.gov, registered on 10th Mar. 2015.
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Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy. Support Care Cancer 2020; 28:5363-5369. [PMID: 32140974 DOI: 10.1007/s00520-020-05376-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a very rare type of malignancy with a poor prognosis. The role of whole brain radiotherapy (WBRT) in PCNSL has been questioned due to the significant neurotoxicity and lack of convincing data for survival benefit. Even its role in a palliative setting remains to be clearly elucidated. Our study aims to investigate the benefit of WBRT in patients who are ineligible for systemic therapy. METHODS A single-institution retrospective study was conducted on patients diagnosed with PCNSL between 2002 and 2017. Patients were excluded if they received systemic therapy or focal radiation only. Data on patient demographics and WBRT were collected and correlated with clinical outcomes. RESULTS A total of 48 patients were selected for analysis, among which 31 (64.6%) patients received WBRT and 17 (35.4%) patients received supportive care only. Patient baseline characteristics were similar between the two groups. Median overall survival (OS) was 4.3 months among the entire cohort. WBRT was associated with improved median OS (8.0 months, range 1.4-62.3 months) compared with supportive care only (3.3 months, range 0.7-18.3 months) (HR 0.39, 95% CI 0.20-0.75, p = 0.005). Among patients who received WBRT, higher radiation dose to the whole brain was not associated with survival (p = 0.10), but higher radiation dose to the gross tumor was associated with improved survival (p = 0.007). CONCLUSION Patients with PCNSL who are ineligible for systemic therapy may still benefit from WBRT with improvement in survival, compared with the best supportive care. Dose escalation through the addition of a gross tumor boost in these patients was associated with improved overall survival. Further studies in the prospective setting are necessary to confirm the findings from the study.
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Palmer JD, Bhamidipati D, Shukla G, Epperla N, Glass J, Kim L, Shi W. Outcomes after stereotactic radiosurgery for CNS lymphoma. J Neurooncol 2020; 147:465-476. [PMID: 32108296 DOI: 10.1007/s11060-020-03444-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The standard of care for CNS lymphoma typically includes high dose methotrexate followed by whole brain radiation therapy, but there is an increased risk of neurotoxicity with this regimen. In our institution, we offered stereotactic radiosurgery (SRS) for disease refractory to HD-MTX in a subset of patients. A search of the literature on this modality for CNS lymphoma was also conducted. METHODS Medical records of six patients who received partial brain radiation therapy for persistent CNS lymphoma were reviewed. SRS was given via 1-3 fractions to doses of 21 or 24 Gy. PubMed, SCOPUS, and Cochrane Library databases were systematically searched for articles reporting on outcomes for CNS lymphoma treated with SRS. RESULTS Six patients (eleven lesions) were treated with SRS for CNS lymphomas. Median follow up was 15.6 months (range 3.3-37.8). Median RT dose per lesion was 21 Gy and median time to progression was 12.7 months. Median overall survival was not reached. Four patients had distant intracranial failure with two developing local recurrence. The search strategy yielded 16 studies of which only one was prospective and included a control group. 183 out of 256 evaluated lesions (69%) responded completely to treatment and 13 of 204 patients (6%) recurred within the treatment area at last follow-up. Overall, the treatment was well tolerated. CONCLUSION SRS may provide favorable local control in patients with refractory CNS lymphomas. A prospective trial is warranted to validate the efficacy of such an approach.
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Affiliation(s)
- Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, 460 W 10th Avenue, Columbus, OH, 43210, USA.
| | - Deepak Bhamidipati
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Gaurav Shukla
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Narendranath Epperla
- Department of Internal Medicine, Division of Hematology, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, USA
| | - Jon Glass
- Department of Neurosurgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Lyndon Kim
- Department of Neurosurgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
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Watanabe J, Natsumeda M, Okada M, Kobayashi D, Kanemaru Y, Tsukamoto Y, Oishi M, Kakita A, Fujii Y. High Detection Rate of MYD88 Mutations in Cerebrospinal Fluid From Patients With CNS Lymphomas. JCO Precis Oncol 2019; 3:1-13. [DOI: 10.1200/po.18.00308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Biopsy is the gold standard for the diagnosis of primary CNS lymphoma (PCNSL). However, surgical biopsy has problems of morbidity related to hemorrhagic complications and false-negative findings, so safer and more reliable diagnostic methods are required. The aim of this study is to detect the MYD88 mutation, an important driver mutation, in the cerebrospinal fluid (CSF) of patients with CNS lymphoma. PATIENTS AND METHODS Twenty-six patients with CNS lymphoma (20 primary CNS lymphoma and six CNS relapse from systemic lymphoma) were studied. We extracted cell-free DNA (cfDNA) from CSF by lumbar puncture. cfDNA was extracted from 1 mL of CSF, and Sanger sequencing and droplet digital polymerase chain reaction (ddPCR) were performed. Furthermore, we performed DNA sequencing of MYD88 in 21 cases with available surgically obtained formalin-fixed paraffin-embedded (FFPE) tissue and compared the results. RESULTS The median cfDNA amount extracted from 1 mL CSF was 219 ng/mL (25th to 75th percentile, 129 to 333 ng/mL). MYD88 mutations were detected from CSF in 76.9% (20 of 26 cases), and L265P in exon 5 was the most frequent mutation in 19 out of 20 (95.0%) cases. S219C in exon 3 was detected in one case. In four patients, MYD88 mutation was confirmed by ddPCR but not by Sanger sequencing. In all 21 cases with sufficient FFPE tissue for DNA analysis, the detection of MYD88 mutation from cfDNA was consistent with those of tumor-derived DNA from FFPE tissue. CONCLUSION This pilot study provided evidence that the somatic driver mutation MYD88 can be reliably detected by combination of Sanger sequencing and ddPCR in the cfDNA taken from 1 mL of CSF in patients with CNS lymphomas.
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Guillen A, Finotello R, Wynne P, Harper A, Killick D, Amores-Fuster I, Blackwood L. Toxicity of cytarabine constant rate infusion in dogs with high-grade non-Hodgkin lymphoma with bone marrow or central nervous system involvement. Aust Vet J 2019; 98:69-78. [PMID: 31769013 DOI: 10.1111/avj.12895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cytarabine, a cell-cycle phase-specific antimetabolite, has been reported to improve outcomes in dogs with bone marrow (BM) or central nervous system (CNS) lymphoma involvement receiving combination chemotherapy. The objective of this study was to evaluate the incidence and severity of toxicity of cytarabine constant rate infusion (CRI) in dogs with high-grade non-Hodgkin lymphoma. METHODS Medical records of canine lymphoma patients with confirmed or suspected BM (group 1) or CNS (group 2) involvement, treated with a modified cyclophosphamide, epirubicin, vincristine and prednisolone protocol, including a single dose of cytarabine given as CRI, were reviewed and adverse events graded. RESULTS Twenty-six dogs were included. Gastrointestinal toxicity occurred in 17 dogs (65.3%), with 5 (19.2%) experiencing grade III or IV toxicity. Neutropenia occurred in nine dogs (34.6%), but was grade I or II in most cases. Three dogs (11.5%) had thrombocytopenia: one grade III and two grade IV. Four dogs (15.3%) experienced increases in alanine amino transferase: one each grade I and II and two grade III. Five dogs (19.2%) required hospitalisation to manage toxicity after completing cytarabine CRI, and haematological toxicity resulted in treatment delays in five dogs (median delay of 4 days, range: 3-7 days). CONCLUSION Our findings suggest that gastrointestinal toxicity should be expected in lymphoma patients undergoing cytarabine CRI.
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Affiliation(s)
- A Guillen
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - R Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - P Wynne
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - A Harper
- Southfields Veterinary Specialists, Southfields, Laindon Essex, SS15 6TP, UK
| | - D Killick
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - L Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
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Mondello P, Mian M, Bertoni F. Primary central nervous system lymphoma: Novel precision therapies. Crit Rev Oncol Hematol 2019; 141:139-145. [DOI: 10.1016/j.critrevonc.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023] Open
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