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Liu J, Tu J, Xu L, Liu F, Lu Y, He F, Li A, Li Y, Liu S, Xiong J. MRI-based radiomics signatures for preoperative prediction of Ki-67 index in primary central nervous system lymphoma. Eur J Radiol 2024; 178:111603. [PMID: 38976966 DOI: 10.1016/j.ejrad.2024.111603] [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: 03/14/2024] [Revised: 04/30/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The aim of this study was to develop and validate radiomics signatures based on MRI for preoperative prediction of Ki-67 proliferative index (PI) expression in primary central nervous system lymphoma (PCNSL). METHODS A total of 341 patients with PCNSL were retrospectively analyzed, including 286 patients in one center as the training set and 55 patients in another two centers as the external validation set. Radiomics features were extracted and selected from preoperative contrast-enhanced T1-weighted images, fluid attenuation inversion recovery to build radiomics signatures according to the Ki-67 PI. The predictive performances of the radiomics model were evaluated using four classifiers including random forest, K-Nearest Neighbors, Neural Network and Decision Tree. A combined model was built by incorporating radiomics signature, clinical variables and MRI radiological characteristics using multivariate logistic regression analysis, and a nomogram was established to predict the expression of Ki-67 individually. The predictive performances of the models were evaluated using area under receiver operating characteristic curve (AUC) and decision curve analysis (DCA). RESULTS Radiomics signatures were independent predictors of the expression level of Ki-67 (OR: 2.523, P < 0.001). RF radiomics models had the highest accuracy (0.934 in the training set and 0.811 in the external validation set) and F1 Score (0.920 in the training set and 0.836 in the external validation set). The clinic-radiologic-radiomics nomogram showed better predictive performance with AUCs of 0.877(95 % CI: 0.837-0.918) in the training set and 0.866(95 % CI: 0.774-0.957) in the external validation set. The calibration curve and DCA demonstrated goodness-of-fit and improved benefits in clinical practice of the nomogram. CONCLUSIONS Nomograms integrating MRI-based radiomics and clinical-radiological characteristics could effectively predict Ki-67 PI in primary PCNSL.
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Affiliation(s)
- Jianpeng Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Tu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Linghui Xu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fangfei Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital, Shandong First Medical University, Tai'an, Shandong, China
| | - Yucheng Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fanru He
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Anning Li
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuyong Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital, Shandong First Medical University, Tai'an, Shandong, China.
| | - Ji Xiong
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China.
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Wang D, Wu Y, Ma J, Xu Z, Tao H, Guan Y, Wang J, Chen K, Chen B, Xie J, Jiang H, Guan M. Logistic regression modeling of cytokines for cerebrospinal fluid evaluation in primary central nervous system lymphoma. Clin Chim Acta 2024; 562:119879. [PMID: 39029646 DOI: 10.1016/j.cca.2024.119879] [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: 05/13/2024] [Revised: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The diagnostic utility of cerebrospinal fluid (CSF) cytology encounters impediments stemming from variability in cell collection techniques and pathologists' morphological acumen, resulting in wide-ranging CSF positivity rates for primary central nervous system lymphomas (PCNSL). Such disparity impacts patient evaluation, treatment stratagem, and prognostication. Thus, this study endeavors to explore liquid biomarkers complementary to CSF cytology or immunophenotype analysis in the diagnosis of CSF involvement. METHODS 398 newly diagnosed PCNSL patients were categorized into CSF involvement and non-involvement groups based on CSF cytology and immunophenotype analysis. Binary logistic regression analysis was performed on 338 patients to investigate factors predicting CSF involvement and to develop a joint prediction model. An additional cohort of 60 PCNSL patients was recruited for model validation. Statistical analyses included the Mann-Whitney U test for comparing various CSF parameters between two groups. ROC curve analyses were performed for each biomarker to identify PCNSL CSF involvement. RESULTS The cytokine IL-10 level in CSF has emerged as the most promising biomarker for CSF evaluation, boasting an ROC AUC of 0.922. C-TNFα and soluble C-IL2R demonstrate efficacy in quantifying tumor burden within the CSF. Logistic regression identified C-IL10lg (OR = 30.103, P < 0.001), C-TNC (OR = 1.126, P < 0.001), C-IL2Rlg (OR = 3.743, P = 0.029) as independent predictors for CSF involvement, contributing to a joint predictive model with an AUC of 0.935, sensitivity of 74.1 %, and specificity of 93.0 %. Validation of the model in an independent cohort confirmed its effectiveness, achieving an AUC of 0.9713. CONCLUSIONS The identification of these feasible biomarkers and the development of an accurate prediction model may facilitate the precise evaluation of CSF status in PCNSL, offering significant advancements in patient management.
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Affiliation(s)
- Di Wang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yejia Wu
- Department of Endoscopy and Interventional Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China; Department of Nursing, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Jingjing Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 201907, China
| | - Zhiyu Xu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Huicong Tao
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yongjie Guan
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jiaxin Wang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Kun Chen
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 201907, China
| | - Jun Xie
- Laboratory of Molecular Immunology, State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200433, China.
| | - Haoqin Jiang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
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von Roemeling C, Ferreri AJM, Soussain C, Tun HW, Grommes C. Targets and treatments in primary CNS lymphoma. Leuk Lymphoma 2024; 65:1055-1067. [PMID: 38659230 DOI: 10.1080/10428194.2024.2342560] [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: 02/29/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and highly aggressive lymphoma entirely localized in the central nervous system or vitreoretinal space. PCNSL generally initially responds to methotrexate-containing chemotherapy regimens, but progressive or relapsing disease is common, and the prognosis is poor for relapsed or refractory (R/R) patients. PCNSL is often characterized by activation of nuclear factor kappa B (NF-κB) due to mutations in the B-cell receptor (BCR) or toll-like receptor (TLR) pathways, as well as immune evasion. Targeted treatments that inhibit key PCNSL mechanisms and pathways are being evaluated; inhibition of Bruton's tyrosine kinase (BTK) downstream of BCR activation has demonstrated promising results in treating R/R disease. This review will summarize the evidence and potential for targeted therapeutic agents to improve treatment outcomes in PCNSL. This includes immunotherapeutic and immunomodulatory approaches and inhibitors of the key pathways driving PCNSL, such as aberrant BCR and TLR signaling.
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Affiliation(s)
- Christina von Roemeling
- Preston A. Wells Center for Brain Tumor Therapy, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Andrés J M Ferreri
- Department of Onco-Hematology, University Vita-Salute San Raffaele, Milano, Italy
- Department of Onco-Hematology, Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Carole Soussain
- Institut Curie, Service d'Hématologie, site de Saint-Cloud, France
- INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Han W Tun
- Department of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
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Goel A, Flintham R, Pohl U, Nagaraju S, Meade S, Sanghera P, Benghiat H, Ughratdar I, Wykes V, Sawlani V. The Utility of Multiparametric Magnetic Resonance Imaging in Reducing Diagnostic Uncertainty for Primary Central Nervous System Lymphoma. World Neurosurg 2024; 188:e71-e80. [PMID: 38740086 DOI: 10.1016/j.wneu.2024.05.037] [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: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND A key limitation in treatment initiation in primary central nervous system lymphoma (PCNSL) is the diagnostic delay caused by lack of recognition of a lesion as a possible lymphoma, steroid initiation, and lesion involution, often resulting in an inconclusive biopsy result. We highlight the importance of multiparametric magnetic resonance imaging (MRI), which incorporates diffusion-weighted imaging, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and proton magnetic resonance spectroscopy in addition to standard MRI sequences in resolving diagnostic uncertainty for PCNSL. METHODS At our center, a consecutive series of 10 patients with histology-proven PCNSL (specifically, diffuse large B-cell lymphoma of the central nervous system) underwent multiparametric MRI. We retrospectively analyzed qualitative and semiquantitative parameters and assessed their radiological concordance for this diagnosis. RESULTS We noted overall low apparent diffusion coefficient on diffusion-weighted imaging (mean minimum apparent diffusion coefficient of 0.74), high percentage signal recovery on perfusion-weighted imaging (mean 170%), a high choline-to-creatine ratio, and a high-grade lipid peak on proton magnetic resonance spectroscopy giving an appearance of twin towers. Of 10 patients, 9 had MRI findings concordant for PCNSL, defined as at least 3 of 4 parameters being consistent for PCNSL. CONCLUSIONS Concordance between these imaging multiparametric modalities could be used as a radiological predictor of PCNSL, reducing diagnostic delays, providing a more accurate biopsy target, and resulting in quicker treatment initiation.
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Affiliation(s)
- Aimee Goel
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Robert Flintham
- Department of Imaging, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ute Pohl
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Santhosh Nagaraju
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sara Meade
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Paul Sanghera
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Benghiat
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ismail Ughratdar
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Victoria Wykes
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, United Kingdom
| | - Vijay Sawlani
- Department of Imaging, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Psychology, University of Birmingham, United Kingdom.
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Schulz N, Nichelli L, Schenone L, Ursu R, Abraham J, Le Cann M, Morel V, Boussen I, Herran D, Leclercq D, Blonski M, Mathon B, Hoang-Xuan K, Soussain C, Choquet S, Houillier C. Primary central nervous system lymphomas in immunocompromised patients require specific response criteria. J Neurooncol 2024; 169:51-60. [PMID: 38865013 DOI: 10.1007/s11060-024-04694-3] [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: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Immunosuppression is a well-established risk factor for primary central nervous system lymphomas (PCNSLs), which present in this context distinct radiological characteristics. Our aim was to describe the radiological evolution of treated PCNSL in immunocompromised patients and suggest adapted MRI response criteria. METHODS We conducted a multicenter retrospective study of patients from the French LOC, K-Virogref and CANCERVIH network databases and enrolled adult immunocompromised patients with newly diagnosed PCNSL. RESULTS We evaluated the baseline, intermediate, end-of-treatment and follow-up MRI data of 31 patients (9 living with HIV, 16 with solid organ transplantation and 6 with an autoimmune disease under chronic immunosuppressive therapy). At baseline, 23/30 (77%) patients had necrotic lesions with ring enhancement and 28% of the lesions were hemorrhagic. At the end of the first-line treatment, 12/28 (43%) patients could not be classified according to the IPCG criteria. Thirteen of 28 (46%) patients still harbored contrast enhancement, and 11/28 (39%) patients had persistent large necrotic lesions with a median diameter of 15 mm. These aspects were not associated with a pejorative outcome and progressively diminished during follow-up. Six patients relapsed; however, we failed to identify any neuroimaging risk factors on the end-of-treatment MRI. CONCLUSION In immunocompromised patients, PCNSLs often harbor alarming features on end-of-treatment MRI, with persistent contrast-enhanced lesions frequently observed. However, these aspects seemed to be related to the necrotic and hemorrhagic nature of the lesions and were not predictive of a pejorative outcome. Specific response criteria for this population are thereby proposed.
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Affiliation(s)
- Nina Schulz
- Department of Neurooncology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France.
| | - Lucia Nichelli
- Department of Neuroradiology, APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Laurence Schenone
- Department of Neurooncology, CHRU de Nancy, Hôpital Central, Nancy, France
- Department of Hematology, CHRU de Nancy, Hôpitaux de Brabois, Nancy, France
| | - Renata Ursu
- Department of Neurology, AP-HP Nord, Université de Paris Cité, Saint-Louis Hospital, AP-HP, Paris, France
| | - Julie Abraham
- Department of Hematology, CHU de Limoges, Limoges, France
| | - Marie Le Cann
- Department of Hematology, Université Paris-SaclayHopital Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Véronique Morel
- Department of Clinical Hematology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Inès Boussen
- Department of Clinical Hematology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Dario Herran
- Department of Neuroradiology, APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Delphine Leclercq
- Department of Neuroradiology, APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Blonski
- Department of Neurooncology, CHRU de Nancy, Hôpital Central, Nancy, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurooncology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Carole Soussain
- Department of Clinical Hematology, Institut Curie, Saint Cloud, Paris, France
| | - Sylvain Choquet
- Department of Clinical Hematology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Caroline Houillier
- Department of Neurooncology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France
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Pons-Escoda A, Garcia-Ruiz A, Naval-Baudin P, Martinez-Zalacain I, Castell J, Camins A, Vidal N, Bruna J, Cos M, Perez-Lopez R, Oleaga L, Warnert E, Smits M, Majos C. Differentiating IDH-mutant astrocytomas and 1p19q-codeleted oligodendrogliomas using DSC-PWI: high performance through cerebral blood volume and percentage of signal recovery percentiles. Eur Radiol 2024; 34:5320-5330. [PMID: 38282078 PMCID: PMC11255054 DOI: 10.1007/s00330-024-10611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Presurgical differentiation between astrocytomas and oligodendrogliomas remains an unresolved challenge in neuro-oncology. This research aims to provide a comprehensive understanding of each tumor's DSC-PWI signatures, evaluate the discriminative capacity of cerebral blood volume (CBV) and percentage of signal recovery (PSR) percentile values, and explore the synergy of CBV and PSR combination for pre-surgical differentiation. METHODS Patients diagnosed with grade 2 and 3 IDH-mutant astrocytomas and IDH-mutant 1p19q-codeleted oligodendrogliomas were retrospectively retrieved (2010-2022). 3D segmentations of each tumor were conducted, and voxel-level CBV and PSR were extracted to compute mean, minimum, maximum, and percentile values. Statistical comparisons were performed using the Mann-Whitney U test and the area under the receiver operating characteristic curve (AUC-ROC). Lastly, the five most discriminative variables were combined for classification with internal cross-validation. RESULTS The study enrolled 52 patients (mean age 45-year-old, 28 men): 28 astrocytomas and 24 oligodendrogliomas. Oligodendrogliomas exhibited higher CBV and lower PSR than astrocytomas across all metrics (e.g., mean CBV = 2.05 and 1.55, PSR = 0.68 and 0.81 respectively). The highest AUC-ROCs and the smallest p values originated from CBV and PSR percentiles (e.g., PSRp70 AUC-ROC = 0.84 and p value = 0.0005, CBVp75 AUC-ROC = 0.8 and p value = 0.0006). The mean, minimum, and maximum values yielded lower results. Combining the best five variables (PSRp65, CBVp70, PSRp60, CBVp75, and PSRp40) achieved a mean AUC-ROC of 0.87 for differentiation. CONCLUSIONS Oligodendrogliomas exhibit higher CBV and lower PSR than astrocytomas, traits that are emphasized when considering percentiles rather than mean or extreme values. The combination of CBV and PSR percentiles results in promising classification outcomes. CLINICAL RELEVANCE STATEMENT The combination of histogram-derived percentile values of cerebral blood volume and percentage of signal recovery from DSC-PWI enhances the presurgical differentiation between astrocytomas and oligodendrogliomas, suggesting that incorporating these metrics into clinical practice could be beneficial. KEY POINTS • The unsupervised selection of percentile values for cerebral blood volume and percentage of signal recovery enhances presurgical differentiation of astrocytomas and oligodendrogliomas. • Oligodendrogliomas exhibit higher cerebral blood volume and lower percentage of signal recovery than astrocytomas. • Cerebral blood volume and percentage of signal recovery combined provide a broader perspective on tumor vasculature and yield promising results for this preoperative classification.
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Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain.
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain.
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036, Barcelona, Spain.
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain.
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institut d'Oncologia- VHIO, Carrer de Natzaret, 115-117, 08035, Barcelona, Spain
| | - Pablo Naval-Baudin
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Ignacio Martinez-Zalacain
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Josep Castell
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Angels Camins
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Noemi Vidal
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain
- Pathology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Jordi Bruna
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain
| | - Monica Cos
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institut d'Oncologia- VHIO, Carrer de Natzaret, 115-117, 08035, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esther Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Carles Majos
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain
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Pons-Escoda A, Naval-Baudin P, Viveros M, Flores-Casaperalta S, Martinez-Zalacaín I, Plans G, Vidal N, Cos M, Majos C. DSC-PWI presurgical differentiation of grade 4 astrocytoma and glioblastoma in young adults: rCBV percentile analysis across enhancing and non-enhancing regions. Neuroradiology 2024; 66:1267-1277. [PMID: 38834877 PMCID: PMC11246293 DOI: 10.1007/s00234-024-03385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE The presurgical discrimination of IDH-mutant astrocytoma grade 4 from IDH-wildtype glioblastoma is crucial for patient management, especially in younger adults, aiding in prognostic assessment, guiding molecular diagnostics and surgical planning, and identifying candidates for IDH-targeted trials. Despite its potential, the full capabilities of DSC-PWI remain underexplored. This research evaluates the differentiation ability of relative-cerebral-blood-volume (rCBV) percentile values for the enhancing and non-enhancing tumor regions compared to the more commonly used mean or maximum preselected rCBV values. METHODS This retrospective study, spanning 2016-2023, included patients under 55 years (age threshold based on World Health Organization recommendations) with grade 4 astrocytic tumors and known IDH status, who underwent presurgical MR with DSC-PWI. Enhancing and non-enhancing regions were 3D-segmented to calculate voxel-level rCBV, deriving mean, maximum, and percentile values. Statistical analyses were conducted using the Mann-Whitney U test and AUC-ROC. RESULTS The cohort consisted of 59 patients (mean age 46; 34 male): 11 astrocytoma-4 and 48 glioblastoma. While glioblastoma showed higher rCBV in enhancing regions, the differences were not significant. However, non-enhancing astrocytoma-4 regions displayed notably higher rCBV, particularly in lower percentiles. The 30th rCBV percentile for non-enhancing regions was 0.705 in astrocytoma-4, compared to 0.458 in glioblastoma (p = 0.001, AUC-ROC = 0.811), outperforming standard mean and maximum values. CONCLUSION Employing an automated percentile-based approach for rCBV selection enhances differentiation capabilities, with non-enhancing regions providing more insightful data. Elevated rCBV in lower percentiles of non-enhancing astrocytoma-4 is the most distinguishable characteristic and may indicate lowly vascularized infiltrated edema, contrasting with glioblastoma's pure edema.
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Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain.
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), Barcelona, Spain.
| | - Pablo Naval-Baudin
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
| | - Mildred Viveros
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Ignacio Martinez-Zalacaín
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
| | - Gerard Plans
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Noemi Vidal
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Monica Cos
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carles Majos
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
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Li Y, Mo Y, Chen M, Zhang W, Li S, Zhang X. The Prognostic Significance of Pontine-White Matter Score in Primary Central Nervous System Lymphoma Patients. Cancers (Basel) 2024; 16:2708. [PMID: 39123436 PMCID: PMC11311936 DOI: 10.3390/cancers16152708] [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: 05/20/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Limited data exist on the significance of PET imaging and quantitative PET parameters in primary central nervous system (CNS) lymphoma due to its relative rarity. This study was conducted to investigate the prognostic value of a novel internal standardization indicator, the pontine-white matter (PW) score, in primary CNS lymphoma patients undergoing post-treatment 18F-FDG PET/CT and PET/MR imaging. METHODS From January 2014 to December 2022, eligible patients with primary CNS lymphoma who underwent post-treatment PET imaging were enrolled. Using the FDG uptake of the pons and white matter as an internal reference, the PW score was graded based on the metabolism of the post-therapeutic lesion for each patient, and its associations with patients' prognosis were investigated. RESULTS In total, 41 patients with post-treatment PET/CT and 49 patients with post-treatment PET/MR imaging were enrolled. ROC curve analysis indicated that the PW score possessed robust discriminative ability in distinguishing patients with worse outcomes. Furthermore, a higher PW score was significantly correlated with and identified as an independent prognostic indicator for, worse prognosis in both the PET/CT and PET/MR cohorts. CONCLUSION The study demonstrated that the PW score was an effective prognostic indicator for identifying post-treatment primary CNS lymphoma patients with worse outcomes.
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Affiliation(s)
- Yongjiang Li
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yiwen Mo
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Mingshi Chen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Wenbiao Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Shuangjiang Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xu Zhang
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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9
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Jin S, Cho HJ. Cerebral hemodynamics as biomarkers for neuropathic pain in rats: a longitudinal study using a spinal nerve ligation model. Pain 2024:00006396-990000000-00655. [PMID: 38985168 DOI: 10.1097/j.pain.0000000000003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Neuropathic pain is one of the most challenging types of pain to diagnose and treat, a problem exacerbated by the lack of a quantitative biomarker. Recently, several clinical and preclinical studies have shown that neuropathic pain induces cerebral hemodynamic changes as a result of neuroplasticity in the brain. Our hypothesis in this study is that neuropathic pain leads to cerebral hemodynamic changes over postoperative time in a spinal nerve ligation (SNL) rat model, which has not been longitudinally explored previously. Furthermore, by identifying multiple regional hemodynamic features that are the most distinct between SNL and sham groups, where the sham group underwent only an incision without SNL, it may be possible to classify the SNL group regardless of when the onset of pain occurs. We investigate cerebral hemodynamic changes using dynamic susceptibility contrast magnetic resonance imaging in a rat model up to 28 days after ligating L5/L6 spinal nerves. We trained a linear support vector machine with relative cerebral blood volume data from different brain regions and found that the prediction model trained on the nucleus accumbens, motor cortex, pretectal area, and thalamus classified the SNL group and sham group at a 79.27% balanced accuracy, regardless of when the onset of pain occurred (SNL/sham: 60/45 data points). From the use of the SNL model without prior knowledge of the onset time of pain, the current findings highlight the potential of relative cerebral blood volume in the 4 highlighted brain regions as a biomarker for neuropathic pain.
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Affiliation(s)
- Seokha Jin
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
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10
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Rozenblum L, Houillier C, Baptiste A, Soussain C, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Galanaud D, Belin L, Hoang-Xuan K, Kas A. Interim FDG-PET improves treatment failure prediction in primary central nervous system lymphoma: An LOC network prospective multicentric study. Neuro Oncol 2024; 26:1292-1301. [PMID: 38366824 PMCID: PMC11226866 DOI: 10.1093/neuonc/noae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The purpose of our study was to assess the predictive and prognostic role of 2-18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/MRI during high-dose methotrexate-based chemotherapy (HD-MBC) in de novo primary central nervous system lymphoma (PCNSL) patients aged 60 and above. METHODS This prospective multicentric ancillary study included 65 immunocompetent patients who received induction HD-MBC as part of the BLOCAGE01 phase III trial. FDG-PET/MRI were acquired at baseline, post 2 cycles (PET/MRI2), and posttreatment (PET/MRI3). FDG-PET response was dichotomized with "positive" indicating persistent tumor uptake higher than the contralateral mirroring brain region. Performances of FDG-PET and International PCNSL Collaborative Group criteria in predicting induction response, progression-free survival (PFS), and overall survival (OS) were compared. RESULTS Of the 48 PET2 scans performed, 9 were positive and aligned with a partial response (PR) on MRI2. Among these, 8 (89%) progressed by the end of the induction phase. In contrast, 35/39 (90%) of PET2-negative patients achieved complete response (CR). Among the 18 discordant responses at interim (PETCR/MRIPR), 83% ultimately achieved CR. Eighty-seven percent of the PET2-negative patients were disease free at 6 months versus 11% of the PET2-positive patients (P < .001). The MRI2 response did not significantly differentiate patients based on their PFS, regardless of whether they were in CR or PR. Both PET2 and MRI2 independently predicted OS in multivariate analysis, with PET2 showing a stronger association. CONCLUSIONS Our study highlights the potential of interim FDG-PET for early management of PCNSL patients. Response-driven treatment based on PET2 may guide future clinical trials. TRIAL LOCALYZE, NCT03582254, ancillary of phase III clinical trial BLOCAGE01, NCT02313389 (Registered July 10, 2018-retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT03582254?term=LOCALYZE&draw=2&rank=1.
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Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- INSERM, CNRS, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Caroline Houillier
- Department of Neurology 2 Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France
| | - Amandine Baptiste
- Department of Public Health, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière—Charles Foix, Sorbonne Université, Paris, France
| | - Carole Soussain
- Department of Haematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Haematology, Cochin Hospital, AP-HP, Paris
| | - Sylvain Choquet
- Department of Haematology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Department of Neurology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Damien Galanaud
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Lisa Belin
- Department of Public Health, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière—Charles Foix, Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology 2 Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- INSERM, CNRS, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, Paris, France
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11
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Calimeri T, Anzalone N, Cangi MG, Fiore P, Gagliardi F, Miserocchi E, Ponzoni M, Ferreri AJM. Molecular diagnosis of primary CNS lymphoma in 2024 using MYD88 Leu265Pro and IL-10. Lancet Haematol 2024; 11:e540-e549. [PMID: 38937027 DOI: 10.1016/s2352-3026(24)00104-2] [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: 01/21/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 06/29/2024]
Abstract
Early diagnosis is crucial for the successful treatment of primary CNS lymphoma (PCNSL), a rapidly progressing tumour. Suspicion raised on brain MRI must be confirmed by a histopathological diagnosis of a tumour specimen collected by stereotactic biopsy. In rare cases, cerebrospinal fluid (CSF) or vitreous humour might aid in providing a cytological diagnosis. Several disease-related, patient-related, and treatment-related factors affect the timing and accuracy of diagnosis and patient outcome. Some molecules detected in CSF, aqueous and vitreous humour, and peripheral blood were proposed as diagnostic biomarkers for PCNSL; however, detection methods for most of these molecules are not yet standardised, have a long turnaround time, are expensive, and have little reproducibility among labs. By contrast, the MYD88Leu265Pro somatic hotspot mutation, revealed by PCR-based assay, is currently and reliably used during the diagnosis of some lymphomas, and IL-10, measured by enzyme-linked immunosorbent assay, is routinely used to diagnose and monitor different common metabolic and immunological diseases. Several independent studies have shown that MYD88Leu265Pro and IL-10 can be easily assessed in peripheral blood, plasma, aqueous and vitreous humour, and CSF of patients with PCNSL with substantial sensitivity and specificity, especially when evaluated in combination. In this Viewpoint, evidence supporting the routine use of MYD88Leu265Pro and IL-10 in diagnosing PCNSL is considered, and some examples of the frequent difficulties found in the diagnosis of PCNSL are provided, highlighting the role and indications of these two biomarkers to improve the timely recognition of this aggressive tumour.
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Affiliation(s)
| | - Nicoletta Anzalone
- Neuroradiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | | | - Paolo Fiore
- Lymphoma Unit, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Ophthalmological Unit, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrés J M Ferreri
- Lymphoma Unit, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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12
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Qi H, Zheng Y, Li J, Chen K, Zhou L, Luo D, Huang S, Zhang J, Lv Y, Tian Z. Correlation of functional magnetic resonance imaging features of primary central nervous system lymphoma with vasculogenic mimicry and reticular fibers. Heliyon 2024; 10:e32111. [PMID: 38947483 PMCID: PMC11214443 DOI: 10.1016/j.heliyon.2024.e32111] [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: 10/02/2023] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Objective To deepen the imaging-pathological mechanism of primary central nervous system lymphoma (PCNSL) and provide a theoretical basis for clinical diagnosis and treatment, the functional magnetic resonance imaging (fMRI) characteristics of PCNSL were analyzed, and the relationship between the fMRI characteristics and vasculogenic mimicry (VM) and reticular fiber in PCNSL was discussed. Methods Ninety-six patients with PCNSL treated in our hospital were divided into three groups according to the pathological examination results, including strong positive group of VM (n = 40), weak positive group of VM (n = 56), strong positive group of reticular fiber (n = 45) and weak positive group of reticular fiber (n = 51). The levels of augmentation index and apparent diffusion coefficient (ADC) were compared among the groups. receiver operator characteristic (ROC) curve analysis was used to analyze the clinical value of ADC value in differential diagnosis of PCNSL. Results The levels of augmentation index in the strong positive group of VM were significantly higher than that in the weak positive group of VM, and the ADC value in the strong positive group of VM was significantly lower than that in the weak positive group of VM (P < 0.001). The levels of augmentation index in the strong positive group of reticular fiber were significantly higher than that in the weak positive group of reticular fiber, and ADC value in the strong positive group of reticular fiber was significantly lower than that in reticular fiber weak positive group (P < 0.001). Pearson correlation analysis showed that the levels of augmentation index were positively correlated with VM and reticular fiber (r = 0.529, 0.548, P < 0.001) and the ADC value was negatively correlated with VM and reticular fiber (r = -0.485, -0.513, P < 0.001). There was a significant negative correlation between necrotic lesions and VM (r = -0.185, P < 0.05). The area under the curve (AUC) values of average ADC value, minimum ADC value, and maximum ADC value for individual differential diagnosis of PCNSL were 0.920, 0.901, and 0.702, while the AUC of the combined differential diagnosis was 0.985, with a sensitivity of 95.00 % and a specificity of 92.70 %. Conclusion The levels of augmentation index and the ADC value of PCNSL focus are significantly correlated with VM and reticular fiber, and there is a strong negative correlation between necrotic lesions and VM. MRI imaging technology is of great significance in revealing the biological behavior of PCNSL, which can effectively reveal the relationship between VM and reticular fibers and the MRI characteristics in PCNSL, thereby providing a new imaging basis for the clinical diagnosis and treatment of PCNSL.
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Affiliation(s)
- Huaiju Qi
- Department of Emergency, Shapingba Hospital, Chongqing University. people’s hospital of Shapingba district, 400033, Chongqing, China
| | - Yu Zheng
- Department of Oncology, Chongqing Hospital of Traditional Chinese Medicine, 400000, Chongqing, China
| | - Jiansheng Li
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Kaixuan Chen
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Li Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Dilin Luo
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Shan Huang
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Jiahui Zhang
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Yongge Lv
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Zhu Tian
- Department of Emergency, Shapingba Hospital, Chongqing University. people’s hospital of Shapingba district, 400033, Chongqing, China
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13
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Wu J, Zhou D, Zhu X, Zhang Y, Xiao Y. Updates of primary central nervous system lymphoma. Ther Adv Hematol 2024; 15:20406207241259010. [PMID: 38883164 PMCID: PMC11177745 DOI: 10.1177/20406207241259010] [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: 12/17/2023] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Lymphoma occurring in the central nervous system is considered primary central nervous system lymphoma (PCNSL), usually without systematic lesions. Over the last few decades, a deep understanding of PCNSL has been lacking due to the low incidence rate, and the overall survival and progression-free survival of patients with PCNSL are lower than those with other types of non-Hodgkin lymphoma. Recently, there have been several advancements in research on PCNSL. Advances in diagnosis of the disease are primarily reflected in the promising diagnostic efficiency of novel biomarkers. Pathogenesis mainly involves abnormal activation of nuclear factor kappa-B signaling pathways, copy number variations, and DNA methylation. Novel therapies such as Bruton's tyrosine kinase inhibitors, immunomodulatory drugs, immune checkpoint inhibitors, and phosphoinositide 3-kinase/mammalian target of rapamycin inhibitors are being evaluated as possible treatment options for PCNSL, especially for relapsed/refractory (R/R) cases. Several clinical trials also indicated the promising feasibility and efficacy of chimeric antigen receptor T-cell therapy for selected R/R PCNSL patients. This review focuses on discussing recent updates, including the diagnosis, pathogenesis, and novel therapy of PCNSL.
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Affiliation(s)
- Jiaying Wu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Delian Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. No. 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei 430030, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. No. 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei 430030, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. No. 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei 430030, China
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14
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Ferreri AJM, Illerhaus G, Doorduijn JK, Auer DP, Bromberg JEC, Calimeri T, Cwynarski K, Fox CP, Hoang‐Xuan K, Malaise D, Ponzoni M, Schorb E, Soussain C, Specht L, Zucca E, Buske C, Jerkeman M, Dreyling M. Primary central nervous system lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Hemasphere 2024; 8:e89. [PMID: 38836097 PMCID: PMC11148853 DOI: 10.1002/hem3.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
This EHA-ESMO Clinical Practice Guideline provides key recommendations for managing primary DLBCL of the CNS.The guideline covers clinical, imaging and pathological diagnosis, staging and risk assessment, treatment and follow-up.Algorithms for first-line and salvage treatments are provided.The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe.Recommendations are based on available scientific data and the authors' collective expert opinion.
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Affiliation(s)
- Andreas J. M. Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific InstituteMilanItaly
- Università Vita e Salute San RaffaeleMilanItaly
| | - Gerald Illerhaus
- Department of HematologyOncology, Stem‐Cell Transplantation and Palliative Care, Klinikum StuttgartStuttgartGermany
| | - Jeanette K. Doorduijn
- Department of Haematology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Dorothee P. Auer
- Mental Health & Clinical Neurosciences Unit, School of MedicineUniversity of NottinghamNottinghamUK
- NIHR Nottingham Biomedical Research CentreUniversity of NottinghamNottinghamUK
| | - Jacoline E. C. Bromberg
- Department of Neuro‐Oncology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Kate Cwynarski
- Department of HaematologyUniversity College HospitalLondonUK
| | | | - Khê Hoang‐Xuan
- Department of Neurology 2 MazarinAPHP, Groupe Hospitalier Pitié‐Salpêtrière, Sorbonne Université, ICMParisFrance
| | - Denis Malaise
- Department of OphthalmologyInstitut CurieParisFrance
- LITO, INSERM U1288, Institut CuriePSL UniversityOrsayFrance
| | - Maurilio Ponzoni
- Lymphoma Unit, IRCCS San Raffaele Scientific InstituteMilanItaly
- Università Vita e Salute San RaffaeleMilanItaly
- Pathology Unit, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Elisabeth Schorb
- Department of Medicine I, Medical Center, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Carole Soussain
- Clinical Hematology Unit, Institut CurieSt CloudFrance
- INSERM U932, Institut CuriePSL Research UniversityParisFrance
| | - Lena Specht
- Department of Oncology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Emanuele Zucca
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero CantonaleBellinzonaSwitzerland
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera ItalianaBellinzonaSwitzerland
- Department of Medical OncologyBern University Hospital and University of BernBernSwitzerland
| | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center UlmUniversity Hospital of UlmUlmGermany
| | - Mats Jerkeman
- Department of OncologySkåne University Hospital and Lund UniversityLundSweden
| | - Martin Dreyling
- Department of Medicine IIILMU University Hospital MunichMunichGermany
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15
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Bai SJ, He JX, Zheng YJ, Geng Y, Gao YN, Zhang CX, Wang YR, Qin LY, Wang WJ, Yang LH. Clinical characteristics and prognosis of patients with newly diagnosed primary central nervous system lymphoma: a multicentre retrospective analysis. Ann Hematol 2024:10.1007/s00277-024-05797-7. [PMID: 38761184 DOI: 10.1007/s00277-024-05797-7] [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: 12/26/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Bruton's tyrosine kinase inhibitors (BTKi) exhibit superior efficacy in relapsed/refractory primary central nervous system lymphoma (PCNSL), but few studies have evaluated patients with newly diagnosed PCNSL, and even fewer studies have evaluated differences in efficacy between treatment with BTKi and traditional chemotherapy. This study retrospectively analyzed the clinical characteristics of 86 patients with PCNSL and identified predictors of poor prognosis for overall survival (OS). After excluding patients who only received palliative care, 82 patients were evaluated for efficacy and survival. According to the induction regimen, patients were divided into the traditional chemotherapy, BTKi combination therapy, and radiotherapy groups; the objective response rates (ORR) of the three groups were 71.4%, 96.2%, and 71.4% (P = 0.037), respectively. Both median progression-free survival and median duration of remission showed statistically significant differences (P = 0.019 and P = 0.030, respectively). The median OS of the BTKi-containing therapy group was also longer than that of the traditional chemotherapy group (not reached versus 47.8 (32.5-63.1) months, P = 0.038).Seventy-one patients who achieved an ORR were further analyzed, and achieved an ORR after four cycles of treatment and maintenance therapy had prolonged OS (P = 0.003 and P = 0.043, respectively). In conclusion, survival, and prognosis of patients with newly diagnosed PCNSL are influenced by the treatment regimen, with the BTKi-containing regimen showing great potential.
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Affiliation(s)
- Si-Jun Bai
- Department of Hematology, Second Hospital of Shanxi Medical University, No.382 Wuyi Road, Xinghualing District, Taiyuan, Shanxi, 030000, China
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Jian-Xia He
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Yuan-Jun Zheng
- Department of Hematology, First Hospital of Shanxi Medical University, Taiyuan, 030000, China
| | - Ye Geng
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Yi-Nan Gao
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Cai-Xia Zhang
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Ya-Ru Wang
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Li-Yuan Qin
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Wen-Jun Wang
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China
| | - Lin-Hua Yang
- Department of Hematology, Second Hospital of Shanxi Medical University, No.382 Wuyi Road, Xinghualing District, Taiyuan, Shanxi, 030000, China.
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16
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Ferreri AJM, Illerhaus G, Doorduijn JK, Auer DP, Bromberg JEC, Calimeri T, Cwynarski K, Fox CP, Hoang-Xuan K, Malaise D, Ponzoni M, Schorb E, Soussain C, Specht L, Zucca E, Buske C, Jerkeman M, Dreyling M. Primary central nervous system lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:S0923-7534(23)05074-3. [PMID: 38839484 DOI: 10.1016/j.annonc.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 06/07/2024] Open
Affiliation(s)
- A J M Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan; Università Vita e Salute San Raffaele, Milan, Italy
| | - G Illerhaus
- Department of Hematology, Oncology, Stem-Cell Transplantation and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - J K Doorduijn
- Department of Haematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D P Auer
- Mental Health & Clinical Neurosciences Unit, School of Medicine, University of Nottingham, Nottingham; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - J E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan
| | - K Cwynarski
- Department of Haematology, University College Hospital, London
| | - C P Fox
- School of Medicine, University of Nottingham, Nottingham, UK
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, ICM, Paris
| | - D Malaise
- Department of Ophthalmology, Institut Curie, Paris; LITO, INSERM U1288, Institut Curie, PSL University, Orsay, France
| | - M Ponzoni
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan; Università Vita e Salute San Raffaele, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Schorb
- Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Soussain
- Clinical Hematology Unit, Institut Curie, St Cloud; INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - L Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E Zucca
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona; Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona; Department of Medical Oncology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - C Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - M Dreyling
- Department of Medicine III, LMU University Hospital Munich, Munich, Germany
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17
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de Koning ME, Hof JJ, Jansen C, Doorduijn JK, Bromberg JEC, van der Meulen M. Primary central nervous system lymphoma. J Neurol 2024; 271:2906-2913. [PMID: 38112784 DOI: 10.1007/s00415-023-12143-w] [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: 11/05/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma (NHL) manifesting in the brain, spinal cord, cerebrospinal fluid and/or eyes, in the absence of systemic manifestations. With an increasing incidence and a 30% 5-year overall survival if promptly treated, timely diagnosis and subsequent treatment is paramount. The typical MRI appearance for PCNSL is a solitary or multiple T2-hypointense, homogeneous gadolinium-enhancing lesion with restricted diffusion. Dexamethasone treatment might compromise and delay the diagnosis. Hallmark of treatment is induction with intravenous high-dose methotrexate consisting polychemotherapy followed by consolidation treatment. Consolidation treatment consists of either whole brain radiotherapy (WBRT) or autologous stem cell transplantation (ASCT). Given the (cognitive) side effects of WBRT, ASCT is increasingly being used as the first choice of treatment.
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Affiliation(s)
- Myrthe E de Koning
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Jurrit J Hof
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Casper Jansen
- Laboratory of Pathology Eastern Netherlands, Hengelo, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Yang X, Deng X, Wu M, Chen SW, Jiang M, Long L, Chen BT. Neuroimaging features of primary central nervous system post-transplantation lymphoproliferative disorder following hematopoietic stem cell transplant in patients with β-thalassemia: a case series and review of literature. Insights Imaging 2024; 15:40. [PMID: 38353902 PMCID: PMC10866827 DOI: 10.1186/s13244-024-01605-y] [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: 11/26/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Primary central nervous system post-transplantation lymphoproliferative disorder (PCNS-PTLD) is a rare but serious complication of hematopoietic stem cell transplantation (HSCT) in patients with severe β-thalassemia. This study aimed to assess the clinical presentation, pathological characteristics, neuroimaging findings, and treatment strategies in patients with β-thalassemia who developed PCNS-PTLD and to compare a case series from our transplant center to reported cases from literature. METHODS We retrospectively reviewed our hospital database and identified four cases of pathologically confirmed PCNS-PTLD without a history of systemic PTLD in patients with severe β-thalassemia after HSCT. We also performed a relevant literature review on PCNS-PTLD. RESULTS The median time from transplantation to diagnosis of PCNS-PTLD was 5.5 months. Intracerebral lesions were usually multiple involving both supratentorial and infratentorial regions with homogeneous or rim enhancement. All patients had pathologically confirmed PCNS-PTLD with three patients having diffuse large B-cell lymphoma and the fourth patient having plasmacytic hyperplasia. There was low response to treatment with a median survival of 83 days. CONCLUSION PCNS-PTLD should be considered in the differential diagnosis of patients with β-thalassemia who had an intracranial lesion on neuroimaging after HSCT. CRITICAL RELEVANCE STATEMENT This case series with a comprehensive review of neuroimaging and clinical characteristics of children with primary central nervous system post-transplantation lymphoproliferative disorder should advance our understanding and improve management of this rare yet severe complication following transplant for β-thalassemia. KEY POINTS • We assessed clinical presentation, treatment strategies, and neuroimaging characteristics of PCNS-PTLD in patients with β-thalassemia after transplantation. • Patients with β-thalassemia may have post-transplantation lymphoproliferative disorder presenting as brain lesions on neuroimaging. • Neuroimaging findings of the brain lesions are helpful for prompt diagnosis and proper management.
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Affiliation(s)
- Xueqing Yang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Xi Deng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Meiqing Wu
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Sean W Chen
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, 1500 E, Duarte, CA, 91010, USA
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope Comprehensive Cancer Center, 1500 E, Duarte, CA, 91010, USA
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19
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Heger JM, Mattlener J, Schneider J, Gödel P, Sieg N, Ullrich F, Lewis R, Bucaciuc-Mracica T, Schwarz RF, Rueß D, Ruge MI, Montesinos-Rongen M, Deckert M, Blau T, Kutsch N, Balke-Want H, Weiss J, Becker K, Reinhardt HC, Hallek M, Borchmann P, von Tresckow B, Borchmann S. Entirely noninvasive outcome prediction in central nervous system lymphomas using circulating tumor DNA. Blood 2024; 143:522-534. [PMID: 37946299 DOI: 10.1182/blood.2023022020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
ABSTRACT State-of-the-art response assessment of central nervous system lymphoma (CNSL) by magnetic resonance imaging is challenging and an insufficient predictor of treatment outcomes. Accordingly, the development of novel risk stratification strategies in CNSL is a high unmet medical need. We applied ultrasensitive circulating tumor DNA (ctDNA) sequencing to 146 plasma and cerebrospinal fluid (CSF) samples from 67 patients, aiming to develop an entirely noninvasive dynamic risk model considering clinical and molecular features of CNSL. Our ultrasensitive method allowed for the detection of CNSL-derived mutations in plasma ctDNA with high concordance to CSF and tumor tissue. Undetectable plasma ctDNA at baseline was associated with favorable outcomes. We tracked tumor-specific mutations in plasma-derived ctDNA over time and developed a novel CNSL biomarker based on this information: peripheral residual disease (PRD). Persistence of PRD after treatment was highly predictive of relapse. Integrating established baseline clinical risk factors with assessment of radiographic response and PRD during treatment resulted in the development and independent validation of a novel tool for risk stratification: molecular prognostic index for CNSL (MOP-C). MOP-C proved to be highly predictive of outcomes in patients with CNSL (failure-free survival hazard ratio per risk group of 6.60; 95% confidence interval, 3.12-13.97; P < .0001) and is publicly available at www.mop-c.com. Our results highlight the role of ctDNA sequencing in CNSL. MOP-C has the potential to improve the current standard of clinical risk stratification and radiographic response assessment in patients with CNSL, ultimately paving the way toward individualized treatment.
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Affiliation(s)
- Jan-Michel Heger
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
| | - Julia Mattlener
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- German Hodgkin Study Group, Cologne, Germany
| | - Jessica Schneider
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
| | - Philipp Gödel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
| | - Noëlle Sieg
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
| | - Fabian Ullrich
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- CCCE, Essen, Germany
| | - Richard Lewis
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
| | - Teodora Bucaciuc-Mracica
- Institute for Computational Cancer Biology, Center for Integrated Oncology, Cancer Research Center Cologne Essen, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roland F Schwarz
- Institute for Computational Cancer Biology, Center for Integrated Oncology, Cancer Research Center Cologne Essen, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
| | - Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Maximilian I Ruge
- Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Manuel Montesinos-Rongen
- Institute of Neuropathology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Martina Deckert
- Institute of Neuropathology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Tobias Blau
- Institute of Neuropathology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
| | - Hyatt Balke-Want
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA
| | - Jonathan Weiss
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Kerstin Becker
- West German Genome Center, University of Cologne, Cologne, Germany
| | - H Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- CCCE, Essen, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- German Hodgkin Study Group, Cologne, Germany
| | | | - Sven Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
- Cancer Center Cologne Essen (CCCE), Cologne, Germany
- Cologne Lymphoma Working Group, Cologne, Germany
- German Hodgkin Study Group, Cologne, Germany
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20
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Lauer EM, Riegler E, Mutter JA, Alig SK, Bleul S, Kuehn J, Ranganathan L, Klingler C, Demerath T, Würtemberger U, Rau A, Weiß J, Eisenblaetter M, Bamberg F, Prinz M, Finke J, Duyster J, Illerhaus G, Diehn M, Alizadeh AA, Schorb E, Reinacher PC, Scherer F. Improved early outcome prediction by MRI-based 3D tumor volume assessment in patients with CNS lymphomas. Neuro Oncol 2024; 26:374-386. [PMID: 37713267 PMCID: PMC10836777 DOI: 10.1093/neuonc/noad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Central nervous system lymphomas (CNSL) display remarkable clinical heterogeneity, yet accurate prediction of outcomes remains challenging. The IPCG criteria are widely used in routine practice for the assessment of treatment response. However, the value of the IPCG criteria for ultimate outcome prediction is largely unclear, mainly due to the uncertainty in delineating complete from partial responses during and after treatment. METHODS We explored various MRI features including semi-automated 3D tumor volume measurements at different disease milestones and their association with survival in 93 CNSL patients undergoing curative-intent treatment. RESULTS At diagnosis, patients with more than 3 lymphoma lesions, periventricular involvement, and high 3D tumor volumes showed significantly unfavorable PFS and OS. At first interim MRI during treatment, the IPCG criteria failed to discriminate outcomes in responding patients. Therefore, we randomized these patients into training and validation cohorts to investigate whether 3D tumor volumetry could improve outcome prediction. We identified a 3D tumor volume reduction of ≥97% as the optimal threshold for risk stratification (=3D early response, 3D_ER). Applied to the validation cohort, patients achieving 3D_ER had significantly superior outcomes. In multivariate analyses, 3D_ER was independently prognostic of PFS and OS. Finally, we leveraged prognostic information from 3D MRI features and circulating biomarkers to build a composite metric that further improved outcome prediction in CNSL. CONCLUSIONS We developed semi-automated 3D tumor volume measurements as strong and independent early predictors of clinical outcomes in CNSL patients. These radiologic features could help improve risk stratification and help guide future treatment approaches.
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Affiliation(s)
- Eliza M Lauer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ella Riegler
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jurik A Mutter
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Sabine Bleul
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Kuehn
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lavanya Ranganathan
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Klingler
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Urs Würtemberger
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Weiß
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerald Illerhaus
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford School of Medicine, Stanford, CA, USA
| | - Ash A Alizadeh
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Elisabeth Schorb
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Cite Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
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21
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D'Angelo CR. Diagnostic, Pathologic, and Therapeutic Considerations for Primary CNS Lymphoma. JCO Oncol Pract 2024; 20:195-202. [PMID: 37967301 DOI: 10.1200/op.23.00294] [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: 05/12/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
Primary CNS lymphoma (PCNSL) is a rare lymphoma representing 3% of CNS malignancies. The diagnosis is complicated by the unique risks associated with brain biopsy, and the treatment is similarly complicated by the restriction of effective therapeutics able to cross the blood-brain barrier. Currently, the majority of individuals diagnosed with this disease are immunocompetent although immune deficiency related to HIV or immunosuppressive therapy remains an important risk factor. Improvements in both frontline therapy and consolidation options, including the use of hematopoietic stem-cell transplantation, have translated to improved survival. Unfortunately, patients experiencing relapsed or refractory disease often fare poorly. Here, we review key clinical, pathologic, and therapeutic aspects of PCNSL and highlight challenging clinical scenarios that may be encountered by the treating oncologist.
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22
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Fahmy DM. Might sarcopenia be patient-oriented evidence that matters in CNS lymphomas? A glance out of the neuraxis. Eur Radiol 2024; 34:788-789. [PMID: 38123692 DOI: 10.1007/s00330-023-10512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/25/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
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23
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Husby T, Johannessen K, Berntsen EM, Johansen H, Giskeødegård GF, Karlberg A, Fagerli UM, Eikenes L. 18F-FACBC and 18F-FDG PET/MRI in the evaluation of 3 patients with primary central nervous system lymphoma: a pilot study. EJNMMI REPORTS 2024; 8:2. [PMID: 38748286 PMCID: PMC10962628 DOI: 10.1186/s41824-024-00189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/06/2023] [Indexed: 05/19/2024]
Abstract
BACKGROUND This PET/MRI study compared contrast-enhanced MRI, 18F-FACBC-, and 18F-FDG-PET in the detection of primary central nervous system lymphomas (PCNSL) in patients before and after high-dose methotrexate chemotherapy. Three immunocompetent PCNSL patients with diffuse large B-cell lymphoma received dynamic 18F-FACBC- and 18F-FDG-PET/MRI at baseline and response assessment. Lesion detection was defined by clinical evaluation of contrast enhanced T1 MRI (ce-MRI) and visual PET tracer uptake. SUVs and tumor-to-background ratios (TBRs) (for 18F-FACBC and 18F-FDG) and time-activity curves (for 18F-FACBC) were assessed. RESULTS At baseline, seven ce-MRI detected lesions were also detected with 18F-FACBC with high SUVs and TBRs (SUVmax:mean, 4.73, TBRmax: mean, 9.32, SUVpeak: mean, 3.21, TBRpeak:mean: 6.30). High TBR values of 18F-FACBC detected lesions were attributed to low SUVbackground. Baseline 18F-FDG detected six lesions with high SUVs (SUVmax: mean, 13.88). In response scans, two lesions were detected with ce-MRI, while only one was detected with 18F-FACBC. The lesion not detected with 18F-FACBC was a small atypical MRI detected lesion, which may indicate no residual disease, as this patient was still in complete remission 12 months after initial diagnosis. No lesions were detected with 18F-FDG in the response scans. CONCLUSIONS 18F-FACBC provided high tumor contrast, outperforming 18F-FDG in lesion detection at both baseline and in response assessment. 18F-FACBC may be a useful supplement to ce-MRI in PCNSL detection and response assessment, but further studies are required to validate these findings. Trial registration ClinicalTrials.gov. Registered 15th of June 2017 (Identifier: NCT03188354, https://clinicaltrials.gov/study/NCT03188354 ).
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Affiliation(s)
- Trine Husby
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Knut Johannessen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway
| | - Erik Magnus Berntsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon Johansen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Guro Fanneløb Giskeødegård
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Karlberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Unn-Merete Fagerli
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway.
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24
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Liu G, Zhang X, Zhang N, Xiao H, Chen X, Ma L. Detecting Double Expression Status in Primary Central Nervous System Lymphoma Using Multiparametric MRI Based Machine Learning. J Magn Reson Imaging 2024; 59:231-239. [PMID: 37199225 DOI: 10.1002/jmri.28782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Double expression lymphoma (DEL) is a subtype of primary central nervous system lymphoma (PCNSL) that often has a poor prognosis. Currently, there are limited noninvasive ways to detect protein expression. PURPOSE To detect DEL in PCNSL using multiparametric MRI-based machine learning. STUDY TYPE Retrospective. POPULATION Forty PCNSL patients were enrolled in the study among whom 17 were DEL (9 males and 8 females, 61.29 ± 14.14 years) and 23 were non-DEL (14 males and 9 females, 55.57 ± 14.16 years) with 59 lesions (28 DEL and 31 non-DEL). FIELD STRENGTH/SEQUENCE ADC map derived from DWI (b = 0/1000 s/mm2 ), fast spin echo T2WI, T2FLAIR, and contrast-enhanced T1 weighted imaging (T1CE) were collected at 3.0 T. ASSESSMENT Two raters manually segmented lesions by ITK-SNAP on ADC, T2WI, T2FLAIR and T1CE. A total of 2234 radiomics features from the tumor segmentation area were extracted. The t-test was conducted to filter the features, and elastic net regression algorithm combined with recursive feature elimination was used to calculate the essential features. Finally, 12 groups with combinations of different sequences were fitted to 6 classifiers, and the optimal models were selected. STATISTICAL TESTS Continuous variables were assessed by the t-test, while categorical variables were assessed by the non-parametric test. Interclass correlation coefficient tested variables' consistency. Sensitivity, specificity, accuracy F1-score, and area under the curve (AUC) were used to evaluate model performance. RESULTS DEL status could be identified to varying degrees with 72 models based on radiomics, and model performance could be improved by combining different sequences and classifiers. Both SVMlinear and logistic regression (LR) combined with four sequence group had similar largest AUCmean (0.92 ± 0.09 vs. 0.92 ± 0.05), and SVMlinear was considered as the optimal model in this study since the F1-score of SVMlinear (0.88) was higher than that of LR (0.83). DATA CONCLUSION Multiparametric MRI-based machine learning is promising in DEL detection. EVIDENCE LEVEL 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Guoli Liu
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xinyue Zhang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Nan Zhang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Huafeng Xiao
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xinjing Chen
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Lin Ma
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
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Sanvito F, Kaufmann TJ, Cloughesy TF, Wen PY, Ellingson BM. Standardized brain tumor imaging protocols for clinical trials: current recommendations and tips for integration. FRONTIERS IN RADIOLOGY 2023; 3:1267615. [PMID: 38152383 PMCID: PMC10751345 DOI: 10.3389/fradi.2023.1267615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023]
Abstract
Standardized MRI acquisition protocols are crucial for reducing the measurement and interpretation variability associated with response assessment in brain tumor clinical trials. The main challenge is that standardized protocols should ensure high image quality while maximizing the number of institutions meeting the acquisition requirements. In recent years, extensive effort has been made by consensus groups to propose different "ideal" and "minimum requirements" brain tumor imaging protocols (BTIPs) for gliomas, brain metastases (BM), and primary central nervous system lymphomas (PCSNL). In clinical practice, BTIPs for clinical trials can be easily integrated with additional MRI sequences that may be desired for clinical patient management at individual sites. In this review, we summarize the general concepts behind the choice and timing of sequences included in the current recommended BTIPs, we provide a comparative overview, and discuss tips and caveats to integrate additional clinical or research sequences while preserving the recommended BTIPs. Finally, we also reflect on potential future directions for brain tumor imaging in clinical trials.
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Affiliation(s)
- Francesco Sanvito
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Timothy F. Cloughesy
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, United States
| | - Benjamin M. Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Shah T, Venur VA. Central Nervous System Lymphoma. Semin Neurol 2023; 43:825-832. [PMID: 37995744 DOI: 10.1055/s-0043-1776783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Central nervous system lymphoma (CNSL) is a rare and aggressive malignancy that primarily affects the brain, spinal cord, and meninges. This article provides a comprehensive overview of the current understanding of CNSL encompassing its epidemiology, pathophysiology, clinical presentation, diagnosis, treatment modalities, and prognosis. Although the main focus is on primary CNS lymphoma (PCNSL), ocular lymphoma, primary leptomeningeal lymphoma, and secondary CNS lymphoma are also discussed. The pathobiology of CNSL involves the infiltration of malignant lymphocytes within the CNS parenchyma or leptomeninges. Various risk factors and immunological mechanisms contribute to its development, including immunodeficiency states, chronic inflammation, and genomic alterations. Accurate diagnosis is crucial for appropriate management, given the heterogeneous clinical presentation. The neuroimaging, systemic imaging, and other modalities for diagnosis and evaluation for extent of disease involvement will be discussed. Additionally, the importance of histopathological examination, cerebrospinal fluid (CSF) analysis, and molecular testing in confirming the diagnosis and guiding treatment decisions are highlighted. The treatment landscape for CNSL has evolved significantly. Therapeutic approaches encompass a multimodal strategy combining high-dose methotrexate-based chemotherapy, consolidation with whole-brain radiation therapy, and high-dose chemotherapy with stem cell rescue. Recent advancements in targeted therapies and immunomodulatory agents offer promising avenues for future treatment options. We review the clinical outcomes and prognostic factors influencing the survival of CNSL patients, including age, performance status, disease stage, and genetic abnormalities.
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Affiliation(s)
- Trusha Shah
- Department of Neurology, University of Washington, Seattle, Washington
| | - Vyshak A Venur
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
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Pons-Escoda A, Garcia-Ruiz A, Garcia-Hidalgo C, Gil-Solsona R, Naval-Baudin P, Martin-Noguerol T, Fernandez-Coello A, Flores-Casaperalta S, Fernandez-Viñas M, Gago-Ferrero P, Oleaga L, Perez-Lopez R, Majos C. MR dynamic-susceptibility-contrast perfusion metrics in the presurgical discrimination of adult solitary intra-axial cerebellar tumors. Eur Radiol 2023; 33:9120-9129. [PMID: 37439938 DOI: 10.1007/s00330-023-09892-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Adult solitary intra-axial cerebellar tumors are uncommon. Their presurgical differentiation based on neuroimaging is crucial, since management differs substantially. Comprehensive full assessment of MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) may reveal key differences between entities. This study aims to provide new insights on perfusion patterns of these tumors and to explore the potential of DSC-PWI in their presurgical discrimination. METHODS Adult patients with a solitary cerebellar tumor on presurgical MR and confirmed histological diagnosis of metastasis, medulloblastoma, hemangioblastoma, or pilocytic astrocytoma were retrospectively retrieved (2008-2023). Volumetric segmentation of tumors and normal-appearing white matter (for normalization) was semi-automatically performed on CE-T1WI and coregistered with DSC-PWI. Mean normalized values per patient tumor-mask of relative cerebral blood volume (rCBV), percentage of signal recovery (PSR), peak height (PH), and normalized time-intensity curves (nTIC) were extracted. Statistical comparisons were done. Then, the dataset was split into training (75%) and test (25%) cohorts and a classifier was created considering nTIC, rCBV, PSR, and PH in the model. RESULTS Sixty-eight patients (31 metastases, 13 medulloblastomas, 13 hemangioblastomas, and 11 pilocytic astrocytomas) were included. Relevant differences between tumor types' nTICs were demonstrated. Hemangioblastoma showed the highest rCBV and PH, pilocytic astrocytoma the highest PSR. All parameters showed significant differences on the Kruskal-Wallis tests (p < 0.001). The classifier yielded an accuracy of 98% (47/48) in the training and 85% (17/20) in the test sets. CONCLUSIONS Intra-axial cerebellar tumors in adults have singular and significantly different DSC-PWI signatures. The combination of perfusion metrics through data-analysis rendered excellent accuracies in discriminating these entities. CLINICAL RELEVANCE STATEMENT In this study, the authors constructed a classifier for the non-invasive imaging presurgical diagnosis of adult intra-axial cerebellar tumors. The resultant tool can be a support for decision-making in the clinical practice and enables optimal personalized patient management. KEY POINTS • Adult intra-axial cerebellar tumors exhibit specific, singular, and statistically significant different MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) signatures. • Data-analysis, applied to MR DSC-PWI, could provide added value in the presurgical diagnosis of solitary cerebellar metastasis, medulloblastoma, hemangioblastoma, and pilocytic astrocytoma. • A classifier based on DSC-PWI metrics yields excellent accuracy rates and could be used as a support tool for radiologic diagnosis with clinician-friendly displays.
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Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
- Neuro-Oncology Unit, Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain.
| | | | | | - Ruben Gil-Solsona
- Institut de Diagnostic Ambiental i Estudis de l'Aigua (IDAEA) - CSIC, Barcelona, Spain
| | - Pablo Naval-Baudin
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alejandro Fernandez-Coello
- Neuro-Oncology Unit, Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Biomedical Research Networking Centers of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Susanie Flores-Casaperalta
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Fernandez-Viñas
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Gago-Ferrero
- Institut de Diagnostic Ambiental i Estudis de l'Aigua (IDAEA) - CSIC, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Carles Majos
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- Neuro-Oncology Unit, Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain
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Fan M, Zhao L, Chen Q, Zhang M, Zhang X, Yang Z, Li S, Song Y. Clinical and imaging features of lymphomatosis cerebri: analysis of 8 cases and systematic review of the literature. Clin Exp Med 2023; 23:4673-4680. [PMID: 37979126 PMCID: PMC10725345 DOI: 10.1007/s10238-023-01224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
Lymphomatosis cerebri (LC) is a rare type of primary central nervous system lymphoma with diffuse, nonenhancing infiltrative lesions and is often misdiagnosed. Our study aimed to investigate the clinical characteristics and prognosis of LC through analyzing patients from the literature and our own center, so as to improve early diagnosis and treatment. PubMed, Web of Science and our hospital databases were reviewed, and information on demographic, clinical, pathological, cerebrospinal fluid (CSF), neuroimaging and treatment options was extracted. Univariate survival analysis was conducted by generating survival curves and comparing them using the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model to identify the prognostic predictors. A total of 81 patients (median age: 58 years; interquartile range, IQR: 50-66.5 years), 45 males and 36 females, were included. The most common symptoms were cognitive impairment (65.4%) and gait impairment (50.6%). Imaging studies indicated that all 81 patients had supratentorial structure involvement, and 93.8% (76/81) had bilateral hemisphere involvement. There were 53.3% (32/60) patients with CSF pleocytosis and 65% (39/60) patients with increased CSF protein levels. The median time of diagnosis was 4.8 months (IQR: 2.3-6.9 months). Compared with 4 (95% CI: 1.78-6.22) months for all 81 patients, the median OS was 20 (95% CI: 8.24-31.76) months for those who had chemotherapy plus radiotherapy. Multivariate Cox analysis revealed that chemoradiotherapy (HR: 0.12; 95% CI: 0.02-0.68) and higher CSF glucose level (HR: 0.01; 95% CI: 0.00-0.26) were inversely associated with death. The diagnosis of LC should be alerted when neuroimaging with bilateral hemispheric involvement and CSF abnormality with pleocytosis and increased protein. Once the diagnosis is confirmed, the combination of chemotherapy and radiotherapy can be considered if the patient's physical condition permits.Journal standard instruction requires an unstructured abstract. Kindly check and confirm.We have checked and confirmed that there is no problem.
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Affiliation(s)
- Mengke Fan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Νo. 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qingjiang Chen
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Νo. 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Νo. 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Νo. 1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.
| | - Zhihao Yang
- Department of Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Suxiao Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Νo. 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yunfei Song
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Νo. 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
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Pons-Escoda A, Smits M. Dynamic-susceptibility-contrast perfusion-weighted-imaging (DSC-PWI) in brain tumors: a brief up-to-date overview for clinical neuroradiologists. Eur Radiol 2023; 33:8026-8030. [PMID: 37178200 DOI: 10.1007/s00330-023-09729-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Albert Pons-Escoda
- Department of Radiology, Hospital Universitari de Bellvitge, Barcelona, Spain.
- Neurooncology Unit, Institut d'Investigacio Biomedica de Bellvitge - IDIBELL, Barcelona, Spain.
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
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Onishi S, Yamasaki F, Amatya VJ, Takayasu T, Yonezawa U, Taguchi A, Ozono I, Khairunnisa NI, Takeshima Y, Horie N. Residual diffusion-weighted imaging hyperintense signal in primary central nervous system lymphoma can predict early recurrence. J Neurooncol 2023; 165:171-179. [PMID: 37831389 DOI: 10.1007/s11060-023-04473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The treatment response of primary central nervous system lymphomas (PCNSLs) is mainly evaluated using postcontrast T1-weighted imaging (T1WI). Because poorly enhanced lesions may contain residual tumors, the combination of evaluation methods will potentially improve the accuracy of determining treatment effectiveness. In this study, we evaluated the usefulness of diffusion-weighted imaging (DWI) in predicting recurrence among patients with PCNSL who achieved complete response (CR)/unconfirmed CR (CRu). METHODS Fifty-four patients newly diagnosed with PCNSL who were treated at our institution and achieved CR/CRu at the end of treatment were included in this study. The patients were divided into two groups according to the presence or absence of residual DWI hyperintense signal at the tumor site at the end of treatment. Kaplan-Meier analysis was performed to analyze the median overall survival (OS) and progression-free survival (PFS). RESULTS The mean age of the 54 patients was 66.4 ± 13.3 years. The induction therapies were HD-MTX in 20 patients, R-MPV in 29 patients, and other chemotherapies in five patients. Radiotherapy was performed in 35 patients, high-dose cytarabine therapy in 14 patients, and autologous hematopoietic stem cell transplantation in one patient, and of the 54 patients, 10 had no consolidation therapy. The residual DWI hyperintense signal sign was observed in 18 patients. The R-MPV regimen was statistically associated with a lower rate of residual DWI hyperintense signal (p = 0.0453). The median PFS was statistically shorter in the residual DWI hyperintense signal group than in the non-residual DWI hyperintense signal group (14.0 months vs. 85.1 months) (p < 0.0001, log-rank test). CONCLUSION A residual DWI hyperintense signal at the end of treatment was statistically associated with shorter PFS. Among patients who achieved CR/CRu evaluated based on postcontrast T1WI, DWI could be a valuable additional sequence to predict the early recurrence of PCNSL.
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Affiliation(s)
- Shumpei Onishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Iori Ozono
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Novita Ikbar Khairunnisa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Joudar I, Nasri S, Aichouni N, Kamaoui I, Skiker I. A cerebral lymphoma mimicking a meningioma: case report. Ann Med Surg (Lond) 2023; 85:5100-5104. [PMID: 37811052 PMCID: PMC10553179 DOI: 10.1097/ms9.0000000000001126] [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: 06/05/2023] [Accepted: 07/22/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Cerebral lymphoma is a rare and aggressive brain tumor. It accounts for 1% of all non-Hodgkin's lymphomas (NHL) and 2% of all brain tumors. Untreated brain lymphoma has a very poor prognosis, with an overall life expectancy of around 1.5 months. Case presentation The authors report the case of a 35-year-old patient, with no previous pathological history, who presented for 3 weeks with deafness and recently aggravated otalgia. In MRI, brain imaging revealed a formation initially suggestive of an aggressive meningioma, and the histological study of the operative specimen was in favor of a diffuse large-cell non-germ-center B NHL. Clinical discussion Primary central nervous system lymphoma is an extra-nodal NHL localized to the brain, meninges, spinal cord, and eyes. In 90% of cases, these are diffuse large B-cell lymphomas, the other types being poorly characterized low-grade lymphomas, T-cell lymphomas, and Burkitt's lymphomas. MRI with gadolinium contrast is the gold standard for diagnosis which enhancement is homogeneous and well-limited, frequently associated with perilesional vascular edema. In T2-weighted sequences, there is a weak signal with restricted diffusion on diffusion-weighted imaging. The management of brain lymphoma is currently based on chemotherapy with high-dose methotrexate combined with the other agents, mainly rituximab. Conclusion Cerebral lymphoma remains a non-negligible entity of central nervous system tumors, which can be confused with several other tumors, mainly glial and meningioma.
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Affiliation(s)
- Imane Joudar
- Faculty of Medicine and Pharmacy, Mohammed First University
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University
| | - Siham Nasri
- Faculty of Medicine and Pharmacy, Mohammed First University
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Narjisse Aichouni
- Faculty of Medicine and Pharmacy, Mohammed First University
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University
| | - Imane Kamaoui
- Faculty of Medicine and Pharmacy, Mohammed First University
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University
| | - Imane Skiker
- Faculty of Medicine and Pharmacy, Mohammed First University
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
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Rozenblum L, Galanaud D, Houillier C, Soussain C, Baptiste A, Belin L, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Hoang-Xuan K, Kas A. [18F]FDG PET-MRI provides survival biomarkers in primary central nervous system lymphoma in the elderly: an ancillary study from the BLOCAGE trial of the LOC network. Eur J Nucl Med Mol Imaging 2023; 50:3684-3696. [PMID: 37462774 DOI: 10.1007/s00259-023-06334-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) incidence is rising among elderly patients, presenting challenges due to poor prognosis and treatment-related toxicity risks. This study explores the potential of combining [18F]fluorodeoxyglucose ([18F]FDG) PET scans and multimodal MRI for improving management in elderly patients with de novo PCNSL. METHODS Immunocompetent patients over 60 years with de novo PCNSL were prospectively enrolled in a multicentric study between January 2016 and April 2021. Patients underwent brain [18F]FDG PET-MRI before receiving high-dose methotrexate-based chemotherapy. Relationships between extracted PET (metabolic tumor volume (MTV), sum of MTV for up to five lesions (sumMTV), metabolic imaging lymphoma aggressiveness score (MILAS)) and MRI parameters (tumor contrast-enhancement size, cerebral blood volume (CBV), cerebral blood flow (CBF), apparent diffusion coefficient (ADC)) and treatment response and outcomes were analyzed. RESULTS Of 54 newly diagnosed diffuse large B-cell PCNSL patients, 52 had positive PET and MRI with highly [18F]FDG-avid and contrast-enhanced disease (SUVmax: 27.7 [22.8-36]). High [18F]FDG uptake and metabolic volume were significantly associated with low ADCmean values and high CBF at baseline. Among patients, 69% achieved an objective response at the end of induction therapy, while 17 were progressive. Higher cerebellar SUVmean and lower sumMTV at diagnosis were significant predictors of complete response: 6.4 [5.7-7.7] vs 5.4 [4.5-6.6] (p = 0.04) and 5.5 [2.1-13.3] vs 15.9 [4.2-19.5] (p = 0.01), respectively. Two-year overall survival (OS) was 71%, with a median progression-free survival (PFS) of 29.6 months and a median follow-up of 37 months. Larger tumor volumes on PET or enhanced T1-weighted MRI were significant predictors of poorer OS, while a high MILAS score at diagnosis was associated with early death (< 1 year). CONCLUSION Baseline cerebellar metabolism and sumMTV may predict response to end of chemotherapy in PCNSL. Tumor volume and MILAS at baseline are strong prognostic factors.
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Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.
| | - Damien Galanaud
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Caroline Houillier
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, 75005, Paris, France
| | - Amandine Baptiste
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Lisa Belin
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Hematology, Cochin Hospital, APHP, Paris, France
| | - Sylvain Choquet
- Department of Hematology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Service de Neurologie, Paris, France
| | - Khê Hoang-Xuan
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
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Liu LH, Zhang HW, Zhang HB, Liu XL, Deng HZ, Lin F, Huang B. Distinctive magnetic resonance imaging features in primary central nervous system lymphoma: A case report. World J Radiol 2023; 15:274-280. [PMID: 37823021 PMCID: PMC10563853 DOI: 10.4329/wjr.v15.i9.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare malignant tumor originating from the lymphatic hematopoietic system. It exhibits unique imaging manifestations due to its biological characteristics. CASE SUMMARY Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy was performed. The imaging findings showed multiple space-occupying lesions with low signal on T1-weighted imaging, uniform high signal on T2-weighted imaging, and obvious enhancement on contrast-enhanced scans. DWI revealed diffusion restriction, PWI demonstrated hypoperfusion, and spectroscopy showed elevated choline peak and decreased N-acetylaspartic acid. The patient's condition significantly improved after hormone shock therapy. CONCLUSION This case highlights the distinctive imaging features of PCNSL and their importance in accurate diagnosis and management.
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Affiliation(s)
- Li-Hong Liu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518036, Guangdong Province, China
| | - Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518036, Guangdong Province, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Hong-Bo Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510282, Guangdong Province, China
- Department of Radiology, Sun Yat-Sen University, Shenzhen 518000, Guangdong Province, China
| | - Xiao-Lei Liu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518036, Guangdong Province, China
| | - Hua-Zhen Deng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518036, Guangdong Province, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518036, Guangdong Province, China
| | - Biao Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510282, Guangdong Province, China
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong Province, China
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34
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Hu LS, D'Angelo F, Weiskittel TM, Caruso FP, Fortin Ensign SP, Blomquist MR, Flick MJ, Wang L, Sereduk CP, Meng-Lin K, De Leon G, Nespodzany A, Urcuyo JC, Gonzales AC, Curtin L, Lewis EM, Singleton KW, Dondlinger T, Anil A, Semmineh NB, Noviello T, Patel RA, Wang P, Wang J, Eschbacher JM, Hawkins-Daarud A, Jackson PR, Grunfeld IS, Elrod C, Mazza GL, McGee SC, Paulson L, Clark-Swanson K, Lassiter-Morris Y, Smith KA, Nakaji P, Bendok BR, Zimmerman RS, Krishna C, Patra DP, Patel NP, Lyons M, Neal M, Donev K, Mrugala MM, Porter AB, Beeman SC, Jensen TR, Schmainda KM, Zhou Y, Baxter LC, Plaisier CL, Li J, Li H, Lasorella A, Quarles CC, Swanson KR, Ceccarelli M, Iavarone A, Tran NL. Integrated molecular and multiparametric MRI mapping of high-grade glioma identifies regional biologic signatures. Nat Commun 2023; 14:6066. [PMID: 37770427 PMCID: PMC10539500 DOI: 10.1038/s41467-023-41559-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
Sampling restrictions have hindered the comprehensive study of invasive non-enhancing (NE) high-grade glioma (HGG) cell populations driving tumor progression. Here, we present an integrated multi-omic analysis of spatially matched molecular and multi-parametric magnetic resonance imaging (MRI) profiling across 313 multi-regional tumor biopsies, including 111 from the NE, across 68 HGG patients. Whole exome and RNA sequencing uncover unique genomic alterations to unresectable invasive NE tumor, including subclonal events, which inform genomic models predictive of geographic evolution. Infiltrative NE tumor is alternatively enriched with tumor cells exhibiting neuronal or glycolytic/plurimetabolic cellular states, two principal transcriptomic pathway-based glioma subtypes, which respectively demonstrate abundant private mutations or enrichment in immune cell signatures. These NE phenotypes are non-invasively identified through normalized K2 imaging signatures, which discern cell size heterogeneity on dynamic susceptibility contrast (DSC)-MRI. NE tumor populations predicted to display increased cellular proliferation by mean diffusivity (MD) MRI metrics are uniquely associated with EGFR amplification and CDKN2A homozygous deletion. The biophysical mapping of infiltrative HGG potentially enables the clinical recognition of tumor subpopulations with aggressive molecular signatures driving tumor progression, thereby informing precision medicine targeting.
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Affiliation(s)
- Leland S Hu
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA.
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| | - Fulvio D'Angelo
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Taylor M Weiskittel
- Mayo Clinic Alix School of Medicine Minnesota, Rochester, MN, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Francesca P Caruso
- Department of Electrical Engineering and Information Technologies, University of Naples, "Federico II", I-80128, Naples, Italy
- BIOGEM Institute of Molecular Biology and Genetics, I-83031, Ariano Irpino, Italy
| | - Shannon P Fortin Ensign
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mylan R Blomquist
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Alix School of Medicine Arizona, Scottsdale, AZ, USA
| | - Matthew J Flick
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Mayo Clinic Alix School of Medicine Arizona, Scottsdale, AZ, USA
| | - Lujia Wang
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Christopher P Sereduk
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kevin Meng-Lin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Gustavo De Leon
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ashley Nespodzany
- Department of Neuroimaging Research, Barrow Neurological Institute, Dignity Health, Phoenix, AZ, USA
| | - Javier C Urcuyo
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ashlyn C Gonzales
- Department of Neuroimaging Research, Barrow Neurological Institute, Dignity Health, Phoenix, AZ, USA
| | - Lee Curtin
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Erika M Lewis
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Kyle W Singleton
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Aliya Anil
- Department of Neuroimaging Research, Barrow Neurological Institute, Dignity Health, Phoenix, AZ, USA
| | - Natenael B Semmineh
- Department of Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Teresa Noviello
- Department of Electrical Engineering and Information Technologies, University of Naples, "Federico II", I-80128, Naples, Italy
- BIOGEM Institute of Molecular Biology and Genetics, I-83031, Ariano Irpino, Italy
| | - Reyna A Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Panwen Wang
- Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Junwen Wang
- Division of Applied Oral Sciences & Community Dental Care, The University of Hong Kong, Hong Kong SAR, China
| | - Jennifer M Eschbacher
- Department of Neuropathology, Barrow Neurological Institute, Dignity Health, Phoenix, AZ, USA
| | | | - Pamela R Jackson
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Itamar S Grunfeld
- Department of Psychology, Hunter College, The City University of New York, New York, NY, USA
- Department of Psychology, The Graduate Center, The City University of New York, New York, NY, USA
| | | | - Gina L Mazza
- Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Sam C McGee
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA
| | - Lisa Paulson
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | | | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, Dignity Health, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Richard S Zimmerman
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Naresh P Patel
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Mark Lyons
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Matthew Neal
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kliment Donev
- Department of Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Alyx B Porter
- Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Scott C Beeman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | | | - Kathleen M Schmainda
- Departments of Biophysics and Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Leslie C Baxter
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
- Departments of Psychiatry and Psychology, Mayo Clinic, AZ, USA
| | - Christopher L Plaisier
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Jing Li
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hu Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Anna Lasorella
- Department of Biochemistry and Molecular Biology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C Chad Quarles
- Department of Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristin R Swanson
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Michele Ceccarelli
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Antonio Iavarone
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Nhan L Tran
- Department of Cancer Biology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
- Department of Neurological Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.
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Lebrun L, Allard-Demoustiez S, Salmon I. Pathology and new insights in central nervous system lymphomas. Curr Opin Oncol 2023; 35:347-356. [PMID: 37439536 PMCID: PMC10408733 DOI: 10.1097/cco.0000000000000978] [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] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW Primary central nervous system lymphoma (PCNSL) is a rare central nervous system (CNS) malignancy, which represents a heterogenous group of tumors. Among PCNSL, diffuse large B-cell lymphoma of the CNS (CNS-DLBCL) represents the most common tumor type. Multiomics studies have recently revealed the complex genomic landscape of these rare diseases. These findings lead to a potential new molecular and epigenetic classification. RECENT FINDINGS Our review is focused on CNS-DLBCL in immunocompetent patients. CNS-DLBCL are derived from self-reactive/polyreactive precursor cells. An early molecular event such as MYD88 mutation leads to escape elimination of precursor cells, which, by a dysregulated GC reaction, acquire auto-/polyreactivity of the B-cell tumoral cells for antigens physiologically expressed in the CNS. Most of CNS-DLBCL tumor cells harbor a non-GCB, ABC-like immunophenotype associated with a late GC (exit) B-cells genotype by gene expression profiling. Various mechanisms of genetic alterations are involved in the pathogenesis of PCNSL, including point mutations [nonsomatic hypermutation (SHM), aberrant SHM (aSHM)], SHM/aSHM, chromosome copy gains or losses, and DNA hypermethylation. Constitutive NFκB activation plays a key role in lymphoma cell proliferation and survival by dysregulation of toll-like receptor (mutations of CARD11 and MYD88 ), BCR ( CD79B ), JAK-STAT, and NFκB signaling pathways. SUMMARY Multiomics approaches have succeeded to substantially improve the understanding of the pathogenesis, as well as the molecular and epigenetic events in PCNSL. Challenges remain due to the obvious heterogeneity of CNS-DLBCL, and improvement is needed for their classification.
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Affiliation(s)
- Laetitia Lebrun
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Department of Pathology, Brussels
| | - Sacha Allard-Demoustiez
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Department of Pathology, Brussels
| | - Isabelle Salmon
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Department of Pathology, Brussels
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
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Huntoon K, Makary MS, Shah VS, Aquino A, Pandya V, Giglio P, Slone HW, Elder JB. Pretreatment findings on magnetic resonance imaging in primary central nervous system lymphoma may predict overall survival duration. Neuroradiol J 2023; 36:479-485. [PMID: 36715098 PMCID: PMC10588594 DOI: 10.1177/19714009231154681] [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] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND and purpose: Primary central nervous system lymphoma (PCNSL) lesions often show avid contrast enhancement on T1-weighted contrast-enhanced MRI sequences. However, several case reports and a clinical study have described PCNSL in patients with no contrast enhancement on MRI. We assessed whether overall survival (OS) time was related to any tumor characteristics (lesion location, volume, and number; contrast enhancement; necrosis; proximity to the subarachnoid space; and edema) on MRI in patients with PCNSL. MATERIALS AND METHODS We retrospectively reviewed records (MRI features, pathology, and survival data) of all patients at our institution with PCNSL who had been seen from, 2007 through 2017, and had undergone pretreatment MRI. RESULTS We identified 79 patients (42 men, 37 women) with a mean age at diagnosis of 61.7 ± 10.4 years. The mean OS duration was 44.6 ± 41.7 months. The most common pathological diagnosis (74 patients) was diffuse large B-cell lymphoma. No associations were found between OS time and lesion location, volume, and number; contrast enhancement; necrosis; proximity to the subarachnoid space; or edema. However, a sole patient with non-enhancing PCNSL on MRI was found to have low-grade disease, with prolonged survival (>83 months). Several other patients with leptomeningeal disease had a mean OS time of 80 months. Patients with hemorrhagic lesions had a mean OS of 25.5 months. CONCLUSIONS The survival time for patients with PCNSL may be longer than previously thought, especially for patients with leptomeningeal seeding and lesions with hemorrhagic components Also, non-enhancing tumors may be less aggressive than enhancing tumors.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mina S Makary
- Division of Neuroradiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Varun S Shah
- Department of Neurological Surgery, Case Western Reserve, Cleveland, Ohio, USA
| | - Anthony Aquino
- Division of Neuroradiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vijay Pandya
- Division of Neuroradiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pierre Giglio
- Division of Neuro-Oncology, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Wayne Slone
- Division of Neuroradiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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37
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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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Dong J, Wang F, Xu Y, Gao X, Zhao H, Zhang J, Wang N, Liu Z, Yan X, Jin J, Ji H, Cheng R, Wang L, Qiu Z, Hu S. Using mixed reality technique combines multimodal imaging signatures to adjuvant glioma photodynamic therapy. Front Med (Lausanne) 2023; 10:1171819. [PMID: 37534312 PMCID: PMC10392826 DOI: 10.3389/fmed.2023.1171819] [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: 02/22/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background Photodynamic therapy (PDT) promotes significant tumor regression and extends the lifetime of patients. The actual operation of PDT often relies on the subjective judgment of experienced neurosurgeons. Patients can benefit more from precisely targeting PDT's key operating zones. Methods We used magnetic resonance imaging scans and created 3D digital models of patient anatomy. Multiple images are aligned and merged in STL format. Neurosurgeons use HoloLens to import reconstructions and assist in PDT execution. Also, immunohistochemistry was used to explore the association of hyperperfusion sites in PDT of glioma with patient survival. Results We constructed satisfactory 3D visualization of glioma models and accurately localized the hyperperfused areas of the tumor. Tumor tissue taken in these areas was rich in CD31, VEGFA and EGFR that were associated with poor prognosis in glioma patients. We report the first study using MR technology combined with PDT in the treatment of glioma. Based on this model, neurosurgeons can focus PDT on the hyperperfused area of the glioma. A direct benefit was expected for the patients in this treatment. Conclusion Using the Mixed Reality technique combines multimodal imaging signatures to adjuvant glioma PDT can better exploit the vascular sealing effect of PDT on glioma.
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Affiliation(s)
- Jiawei Dong
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Fang Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuyun Xu
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xin Gao
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hongtao Zhao
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jiheng Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhihui Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiuwei Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jiaqi Jin
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hang Ji
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ruiqi Cheng
- Heilongjiang Tuomeng Technology Co., Ltd, Harbin, China
| | - Lihai Wang
- College of Engineering and Technology, Northeast Forestry University, Harbin, China
| | - Zhaowen Qiu
- College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Shaoshan Hu
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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39
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Foerster AK, Lauer EM, Scherer F. Clinical applications of circulating tumor DNA in central nervous system lymphoma. Semin Hematol 2023; 60:150-156. [PMID: 37442670 DOI: 10.1053/j.seminhematol.2023.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Detection and characterization of circulating tumor DNA (ctDNA) in body fluids have the potential to revolutionize management of patients with lymphoma. Minimal access to malignant DNA through a simple blood draw or lumbar puncture is particularly appealing for CNS lymphomas (CNSL), which cannot be easily or repeatedly sampled without invasive surgeries. Profiling of ctDNA provides a real-time snapshot of the genetic composition in patients with CNSL and enables ultrasensitive quantification of lymphoma burden at any given time point during the course of the disease. Here, we broadly review technical challenges of ctDNA identification in CNSL, recent advances of innovative liquid biopsy technologies, potential clinical applications of ctDNA and how it may improve CNSL risk stratification, outcome prediction, and monitoring of measurable residual disease. Finally, we discuss clinical trials and scenarios in which ctDNA could be implemented to guide risk-adapted and personalized treatment decisions.
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Affiliation(s)
- Anna Katharina Foerster
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eliza M Lauer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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40
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Ghione P, Lewis KL, Bobillo S, Nayak L, Schorb E, Nichelli L, Ng A, Savage KJ, McKay P, Nastoupil L, Soussain C, Cwynarski K. Central nervous system lymphomas-Assessment and treatment and prevention of central nervous system relapse. Hematol Oncol 2023. [PMID: 37381737 DOI: 10.1002/hon.3197] [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: 04/08/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
In this review focused on lymphoma and the central nervous system (CNS), we summarize recent developments in the management of primary (PCNSL) and secondary CNS lymphoma (SCNSL), treatment of CNS lymphoma in the older population, the neuroradiological assessment of CNS lymphoma and finally highlight the ongoing debate on optimal CNS prophylaxis. The section on PCNSL focuses on the different approaches available for frontline treatment in Europe and the United States and discusses consolidation strategies. We then highlight available strategies to treat PCNSL in the elderly population, an area of unmet need. New therapies aiming at minimizing toxicity and prioritizing quality of life are emerging for these patients. Secondary CNS lymphoma, especially in the relapsed/refractory setting is another area of unmet need, and the efficacy of CAR-T cell therapy is being explored. We provide an overview of the imaging challenges in the neuroradiological assessment of CNS lymphoma. Finally, the section on CNS prophylaxis summarizes recent findings from large retrospective studies challenging the efficacy of present approaches to prophylaxis in higher-risk patients with lymphoma.
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Affiliation(s)
- Paola Ghione
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katharine L Lewis
- Sir Charles Gairdner Hospital and Linear Clinical Research, Nedlands, Western Australia, Australia
| | | | - Laksmi Nayak
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elisabeth Schorb
- Department of Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lucia Nichelli
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Andrea Ng
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kerry J Savage
- Centre for Lymphoid Cancer, Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | | | - Loretta Nastoupil
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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41
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Ferreri AJM, Calimeri T, Cwynarski K, Dietrich J, Grommes C, Hoang-Xuan K, Hu LS, Illerhaus G, Nayak L, Ponzoni M, Batchelor TT. Primary central nervous system lymphoma. Nat Rev Dis Primers 2023; 9:29. [PMID: 37322012 PMCID: PMC10637780 DOI: 10.1038/s41572-023-00439-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/17/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a diffuse large B cell lymphoma in which the brain, spinal cord, leptomeninges and/or eyes are exclusive sites of disease. Pathophysiology is incompletely understood, although a central role seems to comprise immunoglobulins binding to self-proteins expressed in the central nervous system (CNS) and alterations of genes involved in B cell receptor, Toll-like receptor and NF-κB signalling. Other factors such as T cells, macrophages or microglia, endothelial cells, chemokines, and interleukins, probably also have important roles. Clinical presentation varies depending on the involved regions of the CNS. Standard of care includes methotrexate-based polychemotherapy followed by age-tailored thiotepa-based conditioned autologous stem cell transplantation and, in patients unsuitable for such treatment, consolidation with whole-brain radiotherapy or single-drug maintenance. Personalized treatment, primary radiotherapy and only supportive care should be considered in unfit, frail patients. Despite available treatments, 15-25% of patients do not respond to chemotherapy and 25-50% relapse after initial response. Relapse rates are higher in older patients, although the prognosis of patients experiencing relapse is poor independent of age. Further research is needed to identify diagnostic biomarkers, treatments with higher efficacy and less neurotoxicity, strategies to improve the penetration of drugs into the CNS, and roles of other therapies such as immunotherapies and adoptive cell therapies.
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Affiliation(s)
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - Jorg Dietrich
- Cancer and Neurotoxicity Clinic and Brain Repair Research Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Khê Hoang-Xuan
- APHP, Groupe Hospitalier Salpêtrière, Sorbonne Université, IHU, ICM, Service de Neurologie 2, Paris, France
| | - Leland S Hu
- Department of Radiology, Neuroradiology Division, Mayo Clinic, Phoenix, AZ, USA
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Lakshmi Nayak
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele, Milan, Italy
| | - Tracy T Batchelor
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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42
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Pomykala KL, Fendler WP, Vermesh O, Umutlu L, Herrmann K, Seifert R. Molecular Imaging of Lymphoma: Future Directions and Perspectives. Semin Nucl Med 2023; 53:449-456. [PMID: 36344325 DOI: 10.1053/j.semnuclmed.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
More than 250,000 patients die from Hodgkin or non-Hodgkin lymphoma each year. Currently, molecular imaging with 18F-FDG-PET/CT is the standard of care for lymphoma staging and therapy response assessment. In this review, we will briefly summarize the role of molecular imaging for lymphoma diagnosis, staging, outcome prediction, and prognostication. We discuss future directions in response assessment and surveillance with quantitative PET parameters, the utility of interim assessment, and the differences with response assessment to immunomodulatory therapy. Lastly, we will cover innovations in the field regarding novel tracers and artificial intelligence.
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Affiliation(s)
- Kelsey L Pomykala
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ophir Vermesh
- Division of Nuclear Medicine in the Department of Radiology at Stanford University, Stanford, CA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
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43
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Rachdi A, Hernandez-Tost H, Herzi D, Morales-Martinez A, Hernández-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Recent advances in the diagnosis and the treatment of primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:481-489. [PMID: 37045615 DOI: 10.1016/j.neurol.2023.03.012] [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: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
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Affiliation(s)
- A Rachdi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Institut Mongi Ben Hamida de neurologie de Tunis, Tunis, Tunisia
| | - H Hernandez-Tost
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - D Herzi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - A Morales-Martinez
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | | | - C Houillier
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; LOC network, France
| | - A Alentorn
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France
| | - K Hoang-Xuan
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France.
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44
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Pons-Escoda A, Naval-Baudin P, Velasco R, Vidal N, Majós C. Imaging of Lymphomas Involving the CNS: An Update-Review of the Full Spectrum of Disease with an Emphasis on the World Health Organization Classifications of CNS Tumors 2021 and Hematolymphoid Tumors 2022. AJNR Am J Neuroradiol 2023; 44:358-366. [PMID: 36822829 PMCID: PMC10084903 DOI: 10.3174/ajnr.a7795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023]
Abstract
Lymphomas of the CNS are the second most frequent primary brain malignancy in adults after gliomas. Presurgical suspicion of lymphoma greatly impacts patient management. The radiologic features of this tumor have been widely covered in the literature for decades, but under current classifications, mainly corresponding to the most common presentations of the most frequent type: primary diffuse large B-cell lymphoma of the CNS. Nevertheless, rarer presentations of this specific lymphoma and of other World Health Organization lymphoma subtypes with different imaging features are rarely treated. Moreover, important advances in imaging techniques, changing epidemiologic factors with relevant impact on these tumors (eg, immunodeficiency/dysregulation), and recent updates of the World Health Organization Classification of CNS Tumors 2021 and Hematolymphoid Tumors 2022 may have rendered some accepted concepts outdated. In this article, the authors aim to fulfill a critical need by providing a complete update-review, emphasizing the latest clinical-radiologic features of the full spectrum of lymphomas involving the CNS.
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Affiliation(s)
- A Pons-Escoda
- From the Radiology (A.P.-E., P.N.-B., C.M.)
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | | | - R Velasco
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Vidal
- Pathology Departments (N.V.), Hospital Universitari de Bellvitge, Barcelona, Spain
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - C Majós
- From the Radiology (A.P.-E., P.N.-B., C.M.)
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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45
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Dufour J, Choquet S, Hoang-Xuan K, Schmitt A, Ahle G, Houot R, Taillandier L, Gressin R, Casasnovas O, Marolleau JP, Tamburini J, Serrier C, Perez E, Paillassa J, Gyan E, Chauchet A, Ursu R, Kas A, Soussain C, Houillier C. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 2023; 102:1159-1169. [PMID: 36991231 DOI: 10.1007/s00277-023-05108-6] [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: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtrière, Service d'Hématologie clinique, Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - A Schmitt
- Institut de Bergonie, Service d'Hématologie, Bordeaux, France
| | - G Ahle
- Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Service d'Hématologie, Rennes, France
| | - L Taillandier
- Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France
| | - R Gressin
- Hôpital Universitaire de Grenoble, Service d'Hématologie, Grenoble, France
| | - O Casasnovas
- Hôpital Universitaire de Dijon, Service d'hematologie clinique, Dijon, France
| | - J P Marolleau
- Hôpital Universitaire d'Amiens, Service d'Hematologie clinique, Amiens, France
| | - J Tamburini
- Hôpital Cochin, Service d'Hématologie, Paris, France
| | - C Serrier
- Centre Hospitalier de Perpignan, Service d'Hématologie, Perpignan, France
| | - E Perez
- Hôpital Universitaire de la Réunion, Service d'oncologie-hématologie, Paris, La Réunion, France
| | - J Paillassa
- Hôpital Universitaire d'Angers, Service d'Hématologie, Angers, France
| | - E Gyan
- Hôpital Universitaire de Tours, Service d'Hématologie, Tours, France
| | - A Chauchet
- Hôpital Universitaire de Besançon, Service d'Hématologie, Besançon, France
| | - R Ursu
- Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France
| | - A Kas
- Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - C Soussain
- Institut Curie, Service d'Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - C Houillier
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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46
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Mutter JA, Alig SK, Esfahani MS, Lauer EM, Mitschke J, Kurtz DM, Kühn J, Bleul S, Olsen M, Liu CL, Jin MC, Macaulay CW, Neidert N, Volk T, Eisenblaetter M, Rauer S, Heiland DH, Finke J, Duyster J, Wehrle J, Prinz M, Illerhaus G, Reinacher PC, Schorb E, Diehn M, Alizadeh AA, Scherer F. Circulating Tumor DNA Profiling for Detection, Risk Stratification, and Classification of Brain Lymphomas. J Clin Oncol 2023; 41:1684-1694. [PMID: 36542815 PMCID: PMC10419411 DOI: 10.1200/jco.22.00826] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Clinical outcomes of patients with CNS lymphomas (CNSLs) are remarkably heterogeneous, yet identification of patients at high risk for treatment failure is challenging. Furthermore, CNSL diagnosis often remains unconfirmed because of contraindications for invasive stereotactic biopsies. Therefore, improved biomarkers are needed to better stratify patients into risk groups, predict treatment response, and noninvasively identify CNSL. PATIENTS AND METHODS We explored the value of circulating tumor DNA (ctDNA) for early outcome prediction, measurable residual disease monitoring, and surgery-free CNSL identification by applying ultrasensitive targeted next-generation sequencing to a total of 306 tumor, plasma, and CSF specimens from 136 patients with brain cancers, including 92 patients with CNSL. RESULTS Before therapy, ctDNA was detectable in 78% of plasma and 100% of CSF samples. Patients with positive ctDNA in pretreatment plasma had significantly shorter progression-free survival (PFS, P < .0001, log-rank test) and overall survival (OS, P = .0001, log-rank test). In multivariate analyses including established clinical and radiographic risk factors, pretreatment plasma ctDNA concentrations were independently prognostic of clinical outcomes (PFS HR, 1.4; 95% CI, 1.0 to 1.9; P = .03; OS HR, 1.6; 95% CI, 1.1 to 2.2; P = .006). Moreover, measurable residual disease detection by plasma ctDNA monitoring during treatment identified patients with particularly poor prognosis following curative-intent immunochemotherapy (PFS, P = .0002; OS, P = .004, log-rank test). Finally, we developed a proof-of-principle machine learning approach for biopsy-free CNSL identification from ctDNA, showing sensitivities of 59% (CSF) and 25% (plasma) with high positive predictive value. CONCLUSION We demonstrate robust and ultrasensitive detection of ctDNA at various disease milestones in CNSL. Our findings highlight the role of ctDNA as a noninvasive biomarker and its potential value for personalized risk stratification and treatment guidance in patients with CNSL. [Media: see text].
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Affiliation(s)
- Jurik A. Mutter
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- University of Freiburg, Faculty of Biology, Freiburg, Germany
| | - Stefan K. Alig
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Mohammad S. Esfahani
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Eliza M. Lauer
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Mitschke
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David M. Kurtz
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Julia Kühn
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabine Bleul
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mari Olsen
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Chih Long Liu
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Michael C. Jin
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Charles W. Macaulay
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme for Clinician Scientists Medical Center, University of Freiburg, Freiburg, Germany
| | - Timo Volk
- Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter H. Heiland
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Gerald Illerhaus
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Elisabeth Schorb
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford School of Medicine, Stanford, CA
| | - Ash A. Alizadeh
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Florian Scherer
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
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47
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Horowitz T, Tabouret E, Graillon T, Salgues B, Chinot O, Verger A, Guedj E. Contribution of nuclear medicine to the diagnosis and management of primary brain tumours. Rev Neurol (Paris) 2023; 179:394-404. [PMID: 36934021 DOI: 10.1016/j.neurol.2023.03.002] [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: 02/18/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
Positron emission tomography (PET) is a powerful tool that can help physicians manage primary brain tumours at diagnosis and follow-up. In this context, PET imaging is used with three main types of radiotracers: 18F-FDG, amino acid radiotracers, and 68Ga conjugated to somatostatin receptor ligands (SSTRs). At initial diagnosis, 18F-FDG helps to characterize primary central nervous system (PCNS) lymphomas and high-grade gliomas, amino acid radiotracers are indicated for gliomas, and SSTR PET ligands are indicated for meningiomas. Such radiotracers provide information on tumour grade or type, assist in directing biopsies and help with treatment planning. During follow-up, in the presence of symptoms and/or MRI modifications, the differential diagnosis between tumour recurrence and post-therapeutic changes, in particular radiation necrosis, may be challenging, and there is strong interest in using PET to evaluate therapeutic toxicity. PET may also contribute to identifying specific complications, such as postradiation therapy encephalopathy, encephalitis associated with PCNS lymphoma, and stroke-like migraine after radiation therapy (SMART) syndrome associated with glioma recurrence and temporal epilepsy, originally illustrated in this review. This review summarizes the main contribution of PET to the diagnosis, management, and follow-up of brain tumours, specifically gliomas, meningiomas, and primary central nervous system lymphomas.
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Affiliation(s)
- T Horowitz
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - E Tabouret
- Neuro-oncology department, Timone hospital, AP-HM, Marseille, France; Team 8 GlioME, CNRS 7051, Inst. neurophysiopathol, Aix-Marseille university, Marseille, France
| | - T Graillon
- Inserm, MMG, neurosurgery department, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - B Salgues
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France
| | - O Chinot
- Neuro-oncology department, Timone hospital, AP-HM, Marseille, France
| | - A Verger
- IADI, Inserm, UMR 1254, department of nuclear medicine & nancyclotep imaging platform, université de Lorraine, CHRU-Nancy, Nancy, France
| | - E Guedj
- CNRS, CERIMED, nuclear medicine department, Centrale Marseille, Institut Fresnel, Timone hospital, Aix-Marseille university, AP-HM, Marseille, France.
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48
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Bobillo S, Khwaja J, Ferreri AJM, Cwynarski K. Prevention and management of secondary central nervous system lymphoma. Haematologica 2023; 108:673-689. [PMID: 36384246 PMCID: PMC9973486 DOI: 10.3324/haematol.2022.281457] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
Secondary central nervous system (CNS) lymphoma (SCNSL) is defined by the involvement of the CNS, either at the time of initial diagnosis of systemic lymphoma or in the setting of relapse, and can be either isolated or with synchronous systemic disease. The risk of CNS involvement in patients with diffuse large B-cell lymphoma is approximately 5%; however, certain clinical and biological features have been associated with a risk of up to 15%. There has been growing interest in improving the definition of patients at increased risk of CNS relapse, as well as identifying effective prophylactic strategies to prevent it. SCNSL often occurs within months of the initial diagnosis of lymphoma, suggesting the presence of occult disease at diagnosis in many cases. The differing presentations of SCNSL create the therapeutic challenge of controlling both the systemic disease and the CNS disease, which uniquely requires agents that penetrate the blood-brain barrier. Outcomes are generally poor with a median overall survival of approximately 6 months in retrospective series, particularly in those patients presenting with SCNSL after prior therapy. Prospective studies of intensive chemotherapy regimens containing high-dose methotrexate, followed by hematopoietic stem cell transplantation have shown the most favorable outcomes, especially for patients receiving thiotepa-based conditioning regimens. However, a proportion of patients will not respond to induction therapies or will subsequently relapse, indicating the need for more effective treatment strategies. In this review we focus on the identification of high-risk patients, prophylactic strategies and recent treatment approaches for SCNSL. The incorporation of novel agents in immunochemotherapy deserves further study in prospective trials.
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Affiliation(s)
- Sabela Bobillo
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona
| | - Jahanzaib Khwaja
- Department of Haematology, University College London Hospitals, London
| | - Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Haematology, IRCCS San Raffaele Scientific Institute, Milan
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London
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Radiomics-Based Machine Learning Model for Predicting Overall and Progression-Free Survival in Rare Cancer: A Case Study for Primary CNS Lymphoma Patients. Bioengineering (Basel) 2023; 10:bioengineering10030285. [PMID: 36978676 PMCID: PMC10045100 DOI: 10.3390/bioengineering10030285] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Primary Central Nervous System Lymphoma (PCNSL) is an aggressive neoplasm with a poor prognosis. Although therapeutic progresses have significantly improved Overall Survival (OS), a number of patients do not respond to HD–MTX-based chemotherapy (15–25%) or experience relapse (25–50%) after an initial response. The reasons underlying this poor response to therapy are unknown. Thus, there is an urgent need to develop improved predictive models for PCNSL. In this study, we investigated whether radiomics features can improve outcome prediction in patients with PCNSL. A total of 80 patients diagnosed with PCNSL were enrolled. A patient sub-group, with complete Magnetic Resonance Imaging (MRI) series, were selected for the stratification analysis. Following radiomics feature extraction and selection, different Machine Learning (ML) models were tested for OS and Progression-free Survival (PFS) prediction. To assess the stability of the selected features, images from 23 patients scanned at three different time points were used to compute the Interclass Correlation Coefficient (ICC) and to evaluate the reproducibility of each feature for both original and normalized images. Features extracted from Z-score normalized images were significantly more stable than those extracted from non-normalized images with an improvement of about 38% on average (p-value < 10−12). The area under the ROC curve (AUC) showed that radiomics-based prediction overcame prediction based on current clinical prognostic factors with an improvement of 23% for OS and 50% for PFS, respectively. These results indicate that radiomics features extracted from normalized MR images can improve prognosis stratification of PCNSL patients and pave the way for further study on its potential role to drive treatment choice.
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Kim JH, An YJ, Kim TM, Kim JE, Park S, Choi SH. Ex vivo NMR metabolomics approach using cerebrospinal fluid for the diagnosis of primary CNS lymphoma: Correlation with MR imaging characteristics. Cancer Med 2023; 12:4679-4689. [PMID: 35941814 PMCID: PMC9972060 DOI: 10.1002/cam4.5083] [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: 03/28/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin's lymphoma. Here, the feasibility of nuclear magnetic resonance (NMR) metabolomics for the diagnosis and prognosis prediction of PCNSL, as well as its correlation with magnetic resonance imaging (MRI) characteristics, was assessed. PATIENTS AND METHODS Cerebrospinal fluid (CSF) samples from PCNSL and normal groups (n = 41 for each) were obtained along with MRI data including pre- and postcontrast as well as T1-, T2-, and diffusion-weighted imaging for the treatment-naïve PCNSL patients (n = 24). The CSF samples were analyzed using nuclear magnetic resonance (NMR). RESULTS The CSF NMR metabolomic exhibited clear differences with a diagnostic sensitivity of 100% and a specificity of 97.6%. The citrate level of the leptomeningeal enhancement (LE) (+) group was significantly lower than that of the LE (-) group (p = 0.018). In addition, the MRI apparent diffusion coefficient (ADC) value of the tumor was positively correlated with the glucose level (p = 0.025). However, none of the marker metabolites were significant prognosis predictors in univariate analysis. CONCLUSIONS In conclusion, the NMR metabolomics could be helpful to diagnose PCNSL, but not for the prognosis, and MRI features (LE or ADC) can reflect the metabolic profiles of PCNSL.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Jin An
- College of Pharmacy, Natural Product Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sunghyouk Park
- College of Pharmacy, Natural Product Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea
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