1
|
Guo HP, Dang XL, Kang L, Liu C, Liu XW. Bruton's Tyrosine Kinase Inhibitors in Refractory or Relapsing Primary Central Nervous System Lymphoma: A Meta-analysis and Systematic Review. World Neurosurg 2024; 188:161-169. [PMID: 38641241 DOI: 10.1016/j.wneu.2024.04.066] [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: 01/24/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is an aggressive lymphoma that primarily affects the central nervous system. Current treatments, such as surgery, chemotherapy, and whole-brain radiotherapy, often fail to achieve satisfactory results. The prognosis for patients with refractory or relapsed (R/R) PCNSL is bleak. The optimal treatment for refractory or relapsed PCNSL is poorly defined due to a limited number of studies in this setting. Bruton's tyrosine kinase (BTK) inhibitors, as part of targeted therapy regimens, have undergone testing in several clinical trials against PCNSL and have shown promising results in the treatment of R/R PCNSL. In this meta-analysis, we aim to explore and critically appraise the evidence regarding the efficacy of BTK inhibitors in the treatment of refractory or relapsed PCNSL. METHODS A systematic search was conducted on multiple databases including PubMed, Embase, Cochrane library, Wanfang Data Knowledge Service Platform, and CNKI, covering the period up to November 2023. The inclusion criteria for studies were patients with R/R PCNSL who received BTK inhibitors, and reported data on overall response rate (ORR) and complete remission (CR). The pooled rates were calculated using a random-effects or fixed-effects model with a double arcsine transformation, and 95% CIs were determined for all outcomes. RESULTS In total, 1 studies involving 185 patients were identified and included in the meta-analysis. The pooled complete remission (CR) rate of BTK inhibitors-based treatment for R/R PCNSL was found to be 50%. Subgroup analysis revealed that the CR rates for BTK inhibitor monotherapy, BTK inhibitor combined with chemotherapy, and BTK inhibitor combined with radiotherapy for R/R PCNSL were 7%, 68%, and 80%, respectively. The ORR for BTK inhibitors-based treatment for R/R PCNSL was 70%. Subgroup analysis showed that the ORR rates for BTK inhibitor monotherapy and BTK inhibitor combined with chemotherapy for R/R PCNSL were 55% and 83%, respectively. The most common adverse events (AEs) reported were hematologic AEs, including neutropenia, anemia, and thrombocytopenia. Severe nonhematologic AEs included rash, febrile neutropenia, increased levels of aspartate aminotransferase, and increased blood bilirubin. CONCLUSIONS BTK inhibitors can be regarded as a safe and effective treatment option for R/R PCNSL, thereby providing a potential new avenue for R/R PCNSL treatment. However, it is important to note that further large-sample prospective randomized controlled trials are needed to validate these findings and establish their wider applicability.
Collapse
Affiliation(s)
- Huai-Peng Guo
- Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Xue-Liang Dang
- Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Lei Kang
- Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Cong Liu
- Xi'an International Medical Center Hospital, Xi'an, Shaanxi Province, China
| | - Xiao-Wu Liu
- Xi'an Gao Xin Hospital, Xi'an, Shaanxi Province, China.
| |
Collapse
|
2
|
Menean M, Giuffrè C, Cicinelli MV, Marchese A, Modorati G, Bandello F, Miserocchi E. A comprehensive overview of diagnosis, imaging and treatment of vitreoretinal lymphoma. Eur J Ophthalmol 2024; 34:931-940. [PMID: 37956540 PMCID: PMC11295402 DOI: 10.1177/11206721231211931] [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: 01/08/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
Vitreoretinal lymphoma (VRL) is a rare B-cell intraocular neoplasia characterized by poor long-term prognosis and lack of effective therapies. It mainly involves the vitreous humor, the retina, and the retinal pigment epithelium (RPE), although anterior segment involvement can occur. VRL is classified as a lymphoma of immune privileged sites, along with testis lymphoma and primary central nervous system lymphoma (PCNSL). VRL and PCNSL are strictly connected indeed: 80% of VRL develop PCNSL, while 20% of patients with PCNSL present VRL during natural history of lymphoma. Due to the lack of worldwide consensus about diagnosis, therapy, and follow-up timing, VRL represents one of the most challenging ocular affections.VRL commonly masquerades as a posterior uveitis, and misdiagnosis often occurs because of partial response to topical steroids. Gold standard for diagnosis is cytological analysis of vitreous humor. However, this technique lacks sensitivity and supplemental molecular analyses can improve the diagnostic process. Multimodal imaging allows ophthalmologists to empower their clinical suspicion and a comprehensive examination can highlight typical features of VRL and justify further invasive procedures.There is no consensus about VRL therapy, and none of the therapeutical scheme has demonstrated to prevent cerebral involvement and improve patient's overall survival. Intravitreal injections of chemotherapeutics drugs, ocular radiation therapy and systemic chemotherapy can be considered in the treatment of VRL. Once cerebral involvement occurs, systemic chemotherapy must be included in the treatment as a life-saving therapy. Further multicentric studies are required to find out the best treatment of patients with VRL.
Collapse
Affiliation(s)
- Matteo Menean
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Giuffrè
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Modorati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
3
|
Velicu MA, Lavrador JP, Sibtain N, Vergani F, Bhangoo R, Gullan R, Ashkan K. Neurosurgical Management of Central Nervous System Lymphoma: Lessons Learnt from a Neuro-Oncology Multidisciplinary Team Approach. J Pers Med 2023; 13:jpm13050783. [PMID: 37240953 DOI: 10.3390/jpm13050783] [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: 03/29/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Central nervous system lymphoma (CNSL) represents one of the most aggressive forms of extranodal lymphoma. The gold standard for CNSL diagnosis remains the stereotactic biopsy, with a limited role for cytoreductive surgery that has not been supported by historical data. Our study aims to provide a comprehensive overview of neurosurgery's role in the diagnosis of systemic relapsed and primary CNSL, with an emphasis on the impact on management and survival. This is a single center retrospective cohort study with data collected between August 2012 and August 2020, including patients referred with a potential diagnosis of CNSL to the local Neuro-oncology Multidisciplinary Team (MDT). The concordance between the MDT outcome and histopathological confirmation was assessed using diagnostic statistics. A Cox regression is used for overall survival (OS) risk factor analysis, and Kaplan-Meier statistics are performed for three prognostic models. The diagnosis of lymphoma is confirmed in all cases of relapsed CNSL, and in all but two patients who underwent neurosurgery. For the relapsed CNSL group, the highest positive predictive value (PPV) is found for an MDT outcome when lymphoma had been considered as single or topmost probable diagnosis. Neuro-oncology MDT has an important role in establishing the diagnosis in CNSL, not only to plan tissue diagnosis but also to stratify the surgical candidates. The MDT outcome based on history and imaging has good predictive value for cases where lymphoma is considered the most probable diagnosis, with the best prediction for cases of relapsed CNSL, questioning the need for invasive tissue diagnosis in the latter group.
Collapse
Affiliation(s)
- Maria Alexandra Velicu
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Naomi Sibtain
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| |
Collapse
|
4
|
Wu Z, Wang C, Lyu Y, Lin Z, Lu M, Wang S, Wang B, Yang N, Li Y, Wang J, Duan X, Zhang N, Gao J, Zhang Y, Hao M, Wang Z, Gao G, Liang R. A novel inflammation-related prognostic model for predicting the overall survival of primary central nervous system lymphoma: A real-world data analysis. Front Oncol 2023; 13:1104425. [PMID: 37056341 PMCID: PMC10086228 DOI: 10.3389/fonc.2023.1104425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundPrimary central nervous system lymphoma (PCNSL) is a type of extranodal non-Hodgkin lymphoma. Although there are widely used prognostic scores, their accuracy and practicality are insufficient. Thus, a novel prognostic prediction model was developed for risk stratification of PCNSL patients in our research.MethodsWe retrospectively collected 122 patients with PCNSL from two medical centers in China from January 2010 to June 2022. Among them, 72 patients were used as the development cohort to construct a new model, and 50 patients were used for the validation. Then, by using univariate and multivariate Cox regression analsis and Lasso analysis, the Xijing model was developed and composed of four variables, including lesion number, β2-microglobulin (β2-MG), systemic inflammation response index (SIRI) and Karnofsky performance status (KPS). Finally, we evaluated the Xijing model through internal and external validation.ResultsCompared with the original prognostic scores, the Xijing model has an overall improvement in predicting the prognosis of PCNSL according to the time-dependent area under the curve (AUC), Harrell’s concordance index (C-index), decision curve analysis (DCA), integrated discrimination improvement (IDI) and continuous net reclassification index (NRI). For overall survival (OS) and progression-free survival (PFS), the Xijing model can divide PCNSL patients into three groups, and shows more accurate stratification ability. In addition, the Xijing model can still stratify and predict prognosis similarly better in the elderly with PCNSL and subgroups received high-dose methotrexate (HD-MTX) or Bruton’s tyrosine kinase inhibitors (BTKi). Finally, external validation confirmed the above results.ConclusionsIntegrating four prognostic factors, including imaging findings, tumor burden, systemic inflammation response index, and comprehensive physical condition, we provided a novel prognostic model for PCNSL based on real-world data and evaluated its predictive capacity.
Collapse
Affiliation(s)
- Zhentian Wu
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Chenyi Wang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yao Lyu
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Zheshen Lin
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Ming Lu
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Shixiong Wang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Bingxuan Wang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Na Yang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yeye Li
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jianhong Wang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaohui Duan
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Na Zhang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jing Gao
- Department of Hematology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yuan Zhang
- Department of Respiratory, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Miaowang Hao
- Department of Hematology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Zhe Wang
- Department of Pathology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Guangxun Gao
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Rong Liang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
- *Correspondence: Rong Liang,
| |
Collapse
|
5
|
Jin Q, Jiang H, Han Y, Li C, Zhang L, Zhang Y, Chai Y, Zeng P, Yue L, Wu C. Frequent Gene Mutations and Their Possible Roles in the Pathogenesis, Treatment and Prognosis of Primary Central Nervous System Lymphoma. World Neurosurg 2023; 170:99-106. [PMID: 36396049 DOI: 10.1016/j.wneu.2022.11.056] [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: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma with poor prognosis. In recent years, the emergence of genetic subtypes of systematic diffuse large B-cell lymphoma has highlighted the importance of molecular genetics, but large-scale research on the molecular genetics of PCNSL is lacking. Herein, we summarize the frequent gene mutations and discuss the possible pathogenesis of PCNSL. Myeloid differentiation primary response gene 88 (MYD88) and CD79B mutations, which cause abnormal activation of noncanonical nuclear factor-κB, are prominent genetic abnormalities in PCNSL. They are considered to play a major role in the pathogenesis of PCNSL. Other genes, such as caspase recruitment domain family member 11 (CARD11), tumor necrosis factor alpha induced protein 3 (TNFAIP3), transducin (β)-like 1 X-linked receptor 1, cyclin dependent kinase inhibitor 2A, PR domain zinc finger protein 1, and proviral insertion in murine malignancies 1, are also frequently mutated. Notably, the pathogenesis of immune insufficiency-associated PCNSL is related to Epstein-Barr virus infection, and its progression may be affected by different signaling pathways. The different mutational patterns in different studies highlight the heterogeneity of PCNSL. However, existing research on the molecular genetics of PCNSL is still limited, and further research into PCNSL is required to clarify the genetic characteristics of PCNSL.
Collapse
Affiliation(s)
- Qiqi Jin
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Haoyun Jiang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ye Han
- Department of Hematology, Xi'an Central Hospital, Xi'an, China
| | - Cuicui Li
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Litian Zhang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Yurong Zhang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ye Chai
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Pengyun Zeng
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Lingling Yue
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Chongyang Wu
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China.
| |
Collapse
|
6
|
Zhai Y, Zhou X, Wang X. Novel insights into the biomarkers and therapies for primary central nervous system lymphoma. Ther Adv Med Oncol 2022; 14:17588359221093745. [PMID: 35558005 PMCID: PMC9087239 DOI: 10.1177/17588359221093745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and highly aggressive extranodal type of non-Hodgkin lymphoma. After the introduction and widespread use of high-dose-methotrexate (HD-MTX)-based polychemotherapy, treatment responses of PCNSL have been improved. However, long-term prognosis for patients who have failed first-line therapy and relapsed remains poor. Less invasive diagnostic markers, including the circulating tumor DNAs (ctDNAs), microRNAs, metabolomic markers, and other novel biomarkers, such as a proliferation inducing ligand (APRIL) and B-cell activating factor of the TNF family (BAFF), have shown potential to distinguish PCNSL at an early stage, and some of them are related with prognosis to a certain extent. Recent insights into novel therapies, including Bruton tyrosine kinase (BTK) inhibitors, immunomodulatory drugs, immune checkpoint inhibitors, PI3K/mTOR inhibitors, and chimeric antigen receptor (CAR) T cells, have revealed encouraging efficacy in treatment response, whereas the duration of response and long-term survival of patients with relapsed or refractory PCNSL (r/r PCNSL) need further improvement. In addition, the diagnostic efficiency of novel markers and the antitumor efficacy of novel therapies are needed to be assessed further in larger clinical trials. This review provides an overview of recent research on novel diagnostic markers and therapeutic strategies for PCNSL.
Collapse
Affiliation(s)
- Yujia Zhai
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiangxiang Zhou
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, ChinaSchool of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
| |
Collapse
|
7
|
Lu G, Li Y, Liang X, Zhao Z. Diagnosis and analysis of primary central nervous system lymphoma based on MRI segmentation algorithm. Pak J Med Sci 2021; 37:1585-1589. [PMID: 34712287 PMCID: PMC8520370 DOI: 10.12669/pjms.37.6-wit.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: This paper summarizes the MRI imaging findings of primary central nervous system lymphoma (PCNSL) in the posterior cranial fossa to improve the accuracy of PCNSL diagnosis in the posterior cranial fossa. Methods: This study retrospectively analyzed the MRI imaging manifestations of 15 PCNSL posterior cranial fossa cases confirmed by puncture or surgical pathology from June 2017 to May 2018, including their occurrence sites, the number of lesions, MRI plain and enhanced manifestations, and diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy. Imaging (MRS) performance. Results: A total of 15 cases were enrolled, including 10 cases of single lesion and five cases of multiple lesions. The total number of lesions was 25, which were in the cerebellar hemisphere and cerebellar vermis, midbrain, fourth ventricle, and pontine cerebellum. The lesions were round, irregular, nodular, patchy, with low or medium signals on T1WI, equal or slightly higher signals on T2WI, and enhanced with 25 meningiomas-like gray matter signals. All of them were significantly strengthened. “Acupoint sign” and “umbilical depression sign” were seen in eight lesions. There were 17 massive and nodular enhancements, four striped enhancements, three patchy enhancements, and one circular enhancement. five cases of DWI showed homogeneous high signal, two cases showed uneven high signal, and 3 cases showed medium signal. The ADC value of tumor parenchyma in 10 patients was (0.62±0.095)×10-3mm2/s. MRS examination showed obvious Lip peak in two cases. Conclusion: PCNSL in posterior cranial fossa has certain characteristics. DWI, ADC value and MRS are helpful to improve the correct diagnosis rate of PCNSL.
Collapse
Affiliation(s)
- Guanping Lu
- Guanping Lu, Master of Medicine. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| | - Ying Li
- Ying Li, Master of Medicine. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| | - Xinqiang Liang
- Xinqiang Liang, Master of Medicine. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| | - Zhengjun Zhao
- Zhengjun Zhao, Bachelor's Degrees. Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, China
| |
Collapse
|
8
|
Lv L, Sun X, Wu Y, Cui Q, Chen Y, Liu Y. Efficacy and Safety of Ibrutinib in Central Nervous System Lymphoma: A PRISMA-Compliant Single-Arm Meta-Analysis. Front Oncol 2021; 11:707285. [PMID: 34277452 PMCID: PMC8280788 DOI: 10.3389/fonc.2021.707285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background Central nervous system lymphoma (CNSL) is an aggressive lymphoma. Studies investigating primary CNSL determined that the Bruton tyrosine kinase (BTK) played an important role in pathogenesis. Ibrutinib, an oral BTK inhibitor, is a new treatment strategy for CNSL. The purpose of this meta-analysis was to clarify the effectiveness and safety of ibrutinib in the treatment of CNSL. Methods A systematic search of PubMed, Embase, Cochrane library, Wanfang Data Knowledge Service Platform, and China National Knowledge Infrastructure databases was conducted through to 31 October 2019. Studies involving patients with CNSL who received ibrutinib that reported the overall response (OR), complete remission (CR), and partial response (PR) were included. The random-effects or fixed-effects model with double arcsine transformation was used for the pooled rates and 95% confidence intervals (CI) were determined for all outcomes. Results Eight studies including 162 patients were identified and included in the meta-analysis. The pooled OR rate after treatment with ibrutinib was 69% (95% CI, 61-79%, I2 = 47.57%, p = 0.06), while the pooled CR and PR was 52% (95% CI, 35-68%, I2 = 74.95%, p = 0.00) and 17% (95% CI, 7-30%, I2 = 67.85%, p = 0.00), respectively. Among PCNSL patients, including new diagnoses PCNSL and R/R PCNSL, the pooled OR rate was 72% (95% CI, 63-80%, I2 = 49.20%, p = 0.06) while the pooled CR and PR rates were 53% (95% CI, 33-73%, I2 = 75.04%, p = 0.00) and 22% (95% CI, 14-30%, I2 = 46.30%, p = 0.07), respectively. Common adverse events above grade 3 included cytopenia and infections. Conclusions The ibrutinib-containing therapy was well tolerated and offered incremental benefit to patients with CNSL. However, randomized-controlled studies that directly compare efficacy and adverse events of ibrutinib are still needed. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42020218974.
Collapse
Affiliation(s)
- Liwei Lv
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuchen Wu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qu Cui
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuedan Chen
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
9
|
Huang S, Jin L, Yang J, Duan YL, Zhang M, Zhou CJ, Zhang YH. Treatment outcome in children with central nervous system-positive Burkitt lymphoma using only intrathecal and systemic chemotherapy combined with rituximab. Chin Med J (Engl) 2021; 134:1329-1334. [PMID: 33734131 PMCID: PMC8183724 DOI: 10.1097/cm9.0000000000001386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND With current chemotherapy treatment, >90% of survival has been obtained for Burkitt lymphoma (BL). In this study, the demographic characteristics and treatment outcomes are presented for 78 children in China with central nervous system-positive (CNS+) BL. METHODS This retrospective study consecutively enrolled 78 CNS+ BL patients in Beijing Children's Hospital (BCH) from 2007 to 2019 who received the BCH B-cell non-Hodgkin's lymphoma regimen (modified by French-American-British mature lymphoma B-cell 96 [FAB/LMB96] C1 arm ± rituximab). Clinical characteristics, methods of disease detection in the CNS, and outcomes were evaluated. Univariate and multivariate analyses were used to assess prognostic factors. RESULTS The median age of 65 boys and 13 girls at the time of diagnosis was 5.7 years (ranging from 1 to 14 years). Patients were followed up for a median time of 34 months (ranging from 1 to 72 months). Bone marrow invasion was found in 38 (48.7%) patients. There were 48 (61.5%), 44 (56.4%), and 25 (32%) patients with cranial nerve palsy, intracerebral mass (ICM), and para-meningeal extension, respectively. Abnormal cerebrospinal fluid (CSF) morphology and CSF immunophenotype appeared in 15 (19.2%) and 15 (19.2%) patients, respectively. There were 69 (88.5%) patients treated with chemotherapy combined with rituximab, and nine patients were treated solely with chemotherapy. Finally, five patients died of treatment-related infection, recurrence occurred for 13, and one developed a second tumor. The 3-year overall survival and event-free survival rates were 78.9% ± 4.7% and 71.4% ± 6.0%, respectively. Treatment with chemotherapy only, ICM positivity, and >4 organs involved at diagnosis were independent risk factors. CONCLUSIONS Rituximab combined with a modified LMB96 regimen has greatly increased the efficacy of treatment for Chinese children with CNS+ BL, and with the continuous collection of outcome data, treatment-related complications are decreasing. For further verification, a large sample multicentre randomized controlled study should be performed to explore a treatment scheme for Chinese children with even greater efficacy.
Collapse
Affiliation(s)
- Shuang Huang
- Beijing Key Laboratory of Pediatric Haematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Haematology Oncology Center, Beijing Children's Hospital, Beijing 100045, China
| | - Lin Jin
- Beijing Key Laboratory of Pediatric Haematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Haematology Oncology Center, Beijing Children's Hospital, Beijing 100045, China
| | - Jing Yang
- Beijing Key Laboratory of Pediatric Haematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Haematology Oncology Center, Beijing Children's Hospital, Beijing 100045, China
| | - Yan-Long Duan
- Beijing Key Laboratory of Pediatric Haematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Haematology Oncology Center, Beijing Children's Hospital, Beijing 100045, China
| | - Meng Zhang
- Beijing Key Laboratory of Pediatric Haematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Haematology Oncology Center, Beijing Children's Hospital, Beijing 100045, China
| | - Chun-Ju Zhou
- Pathology Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yong-Hong Zhang
- Beijing Key Laboratory of Pediatric Haematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Haematology Oncology Center, Beijing Children's Hospital, Beijing 100045, China
| |
Collapse
|