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Liu Y, Cai L, Zhou Y. A case of primary central-nervous system lymphoma with no obvious effect of hormone therapy. Asian J Surg 2024; 47:2008-2009. [PMID: 38212218 DOI: 10.1016/j.asjsur.2023.12.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Yongsheng Liu
- Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lize Cai
- Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Youxin Zhou
- Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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2
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Yadav BS. High-dose methotrexate and zanubrutinib combination therapy for primary central nervous system lymphoma. World J Clin Oncol 2024; 15:371-374. [PMID: 38576595 PMCID: PMC10989265 DOI: 10.5306/wjco.v15.i3.371] [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: 11/23/2023] [Revised: 01/13/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
In this editorial I comment on the article, published in the current issue of the World Journal of Clinical Oncology. Primary central nervous system lymphoma (PCNSL) is a disease of elderly and immunocompromised patients. The authors reported clinical results of 19 patients with PCNSL treated with zanubrutinib/high dose methotrexate (HD-MTX) until disease progression. They demonstrated that the combination of zanubrutinib with HD-MTX led to a marked clinical response and tolerability among these patients. They also observed that cerebrospinal fluid liquid biopsy to detect circulating tumor DNA may be a good option for evaluating treatment response and tumor burden in patients with PCNSL. PCNSL is a challenging disease for treatment as these patients present with different neurological states and comorbidities. Treatment has evolved over the years from whole brain radiotherapy to HD-MTX followed by autologous stem cell transplant. Gradually, treatment of patients with PCNSL is going to become individualized.
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Affiliation(s)
- Budhi Singh Yadav
- Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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3
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Wang N, Chen FL, Pan L, Teng Y, Wei XJ, Guo HG, Jiang XM, Huang L, Liu SC, Liang ZL, Li WY. Clinical outcomes of newly diagnosed primary central nervous system lymphoma treated with zanubrutinib-based combination therapy. World J Clin Oncol 2023; 14:606-619. [PMID: 38179402 PMCID: PMC10762531 DOI: 10.5306/wjco.v14.i12.606] [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: 06/01/2023] [Revised: 09/05/2023] [Accepted: 11/17/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND High-dose methotrexate (HD-MTX) combined with other chemotherapeutic agents is an effective treatment for patients with newly diagnosed primary central nervous system lymphoma (PCNSL); however, some patients have adverse reactions. AIM To retrospectively evaluate disease outcomes and mutational profiles in newly diagnosed PCNSL patients treated with a zanubrutinib/HD-MTX combination regimen. METHODS Nineteen newly diagnosed PCNSL patients were treated with zanubrutinib/HD-MTX until disease progression, intolerable toxicities, or physician/patient-directed withdrawal. Safety and efficacy were assessed per the CTCAE v5.0 and RECIST v1.1 criteria, respectively. The primary endpoint was the objective response rate (ORR), and the secondary endpoints were progression-free survival, overall survival (OS), and safety. RESULTS The median follow-up duration was 14.7 mo (range, 3.9-30 mo). The ORR for all patients was 84.2%, and 2-year progression-free- and OS rates were 75.6% and 94.1%, respectively. All patients completed the induction phase, and nine patients underwent autologous stem cell transplantation as consolidation therapy, resulting in an ORR of 88.9%. Ten patients received zanubrutinib as maintenance therapy and achieved an ORR of 80%. All patients showed an acceptable safety profile. The sequencing results for cerebrospinal fluid (CSF) and tumor tissue showed that PIM1 mutations were the most frequent genetic alterations. Circulating tumor DNA was correlated with disease relapse and response. CONCLUSION Our empirical observations demonstrated that the combination of zanubrutinib with HD-MTX yielded a marked clinical response and tolerability among newly diagnosed PCNSL patients. Non-invasive CSF liquid biopsy profiling may be feasible for evaluating treatment response and tumor burden.
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Affiliation(s)
- Ning Wang
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
| | - Fei-Li Chen
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Lu Pan
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
| | - Yan Teng
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
| | - Xiao-Juan Wei
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Han-Guo Guo
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Xin-Miao Jiang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Ling Huang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Si-Chu Liu
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Zhan-Li Liang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Wen-Yu Li
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
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Chuang CH, Kuo MC, Chang H, Wu JH, Hung YS, Ou CW, Lin TL, Su YJ, Ong YC, Shih LY, Kao HW. Different patterns of failure in two treatment regimens for primary central nervous system lymphoma, a retrospective analysis of 124 cases in Taiwan. Clin Exp Med 2023; 23:5327-5336. [PMID: 37679606 PMCID: PMC10725386 DOI: 10.1007/s10238-023-01182-2] [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: 06/18/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
To explore prognostic factors and outcomes of primary central nervous system lymphoma (PCNSL) of diffuse large B-cell lymphoma (DLBCL) in Taiwan, 124 PCNSL-DLBCL patients (from 1995 to 2021) were retrospectively analyzed. Mainly, two treatment modalities including sandwich chemoradiotherapy and modified MATRix regimen were employed in these patients. Overall survival (OS) was determined by log-rank test and time-dependent Cox analysis. Median OS of all patients was 27.1 months. 47 (37.9%) patients who underwent sandwich chemoradiotherapy had a complete remission (CR) rate of 87.2%, median OS of 53.9 months, and progression free survival (PFS) of 42.9 months. 11 (8.9%) patients who underwent modified MATRix regimen had CR rate of 72.7%, median OS of 18.9, and PFS of 11.2 months. There are no significant OS differences between treatment groups or addition of Rituximab. Patients treated with the modified MATRix regimen experienced a higher early mortality rate followed by a survival plateau. IELSG low-risk group had significantly improved OS and PFS than IELSG intermediate- or high-risk group. In multivariant analysis, age > 60 years old and bilateral cerebral lesions are associated with significantly inferior OS. Sandwich chemoradiotherapy demonstrated better early survival and reduced treatment-related toxicity for PCNSL patients compared to the modified MATRix regimen. However, the long-term follow-up revealed a higher rate of treatment failure events in the sandwich chemoradiotherapy group. IELSG and MSKCC scores served as reliable risk assessment models. Incorporating bilateral cerebral lesions as a risk factor further improved risk evaluation.
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Affiliation(s)
- Chin-Hsuan Chuang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Ming-Chung Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Hou Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Yu-Shin Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Che-Wei Ou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Yi-Jiun Su
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Yuen-Chin Ong
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Lee-Yung Shih
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Wen Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC.
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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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She Z, Marzullo A, Destito M, Spadea MF, Leone R, Anzalone N, Steffanoni S, Erbella F, Ferreri AJM, Ferrigno G, Calimeri T, De Momi E. Deep learning-based overall survival prediction model in patients with rare cancer: a case study for primary central nervous system lymphoma. Int J Comput Assist Radiol Surg 2023; 18:1849-1856. [PMID: 37083973 PMCID: PMC10497660 DOI: 10.1007/s11548-023-02886-2] [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: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare, aggressive form of extranodal non-Hodgkin lymphoma. To predict the overall survival (OS) in advance is of utmost importance as it has the potential to aid clinical decision-making. Though radiomics-based machine learning (ML) has demonstrated the promising performance in PCNSL, it demands large amounts of manual feature extraction efforts from magnetic resonance images beforehand. deep learning (DL) overcomes this limitation. METHODS In this paper, we tailored the 3D ResNet to predict the OS of patients with PCNSL. To overcome the limitation of data sparsity, we introduced data augmentation and transfer learning, and we evaluated the results using r stratified k-fold cross-validation. To explain the results of our model, gradient-weighted class activation mapping was applied. RESULTS We obtained the best performance (the standard error) on post-contrast T1-weighted (T1Gd)-area under curve [Formula: see text], accuracy [Formula: see text], precision [Formula: see text], recall [Formula: see text] and F1-score [Formula: see text], while compared with ML-based models on clinical data and radiomics data, respectively, further confirming the stability of our model. Also, we observed that PCNSL is a whole-brain disease and in the cases where the OS is less than 1 year, it is more difficult to distinguish the tumor boundary from the normal part of the brain, which is consistent with the clinical outcome. CONCLUSIONS All these findings indicate that T1Gd can improve prognosis predictions of patients with PCNSL. To the best of our knowledge, this is the first time to use DL to explain model patterns in OS classification of patients with PCNSL. Future work would involve collecting more data of patients with PCNSL, or additional retrospective studies on different patient populations with rare diseases, to further promote the clinical role of our model.
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Affiliation(s)
- Ziyu She
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Aldo Marzullo
- Department of Mathematics and Computer Science, University of Calabria, Rende, Italy
| | - Michela Destito
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
| | - Riccardo Leone
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicoletta Anzalone
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Steffanoni
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Erbella
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giancarlo Ferrigno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Bazer DA, Zabrocka E, Koroneos N, Kowalska A. Central Nervous System Lymphoma: The Great Mimicker-A Single-Institution Retrospective Study. Case Rep Oncol Med 2023; 2023:8815502. [PMID: 37228706 PMCID: PMC10205403 DOI: 10.1155/2023/8815502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) is a rare, aggressive form of non-Hodgkin lymphoma contained in the brain and the spinal cord as well as the meninges, cranial nerves, eyes, and cerebrospinal fluid (CSF). Due to its variable presentation and lack of associated B-symptoms, it is quite challenging to diagnose PCNSL, if there is not a high level of suspicion. Methods This is a retrospective case series examining 13 human immunodeficiency virus- (HIV-) negative patients with PCNSL and DLBCL type, with a median age of 75 years old. Results The most common presenting symptom was altered mental status. The frontal lobes, basal ganglia, cerebellum, and corpus callosum were most affected. Prior to brain biopsy, 4/13 patients were on steroids, which did not affect biopsy results and the average time to diagnosis was 1 month. 9/13 patients who did not receive steroids had an average time to diagnosis of less than 1 month. Conclusion Although steroid administration did not appear to diminish the yield of the biopsy, it is a best practice to withhold steroids prior to biopsy to decrease the time to diagnose PCNSL.
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Affiliation(s)
- Danielle A. Bazer
- Department of Neurology, Stony Brook University Hospital, Health Sciences Tower T12/020, Stony Brook, New York 11794-8121, USA
- Department of Neurology, Johns Hopkins University, 201 N Broadway, 9th Floor Mailbox #3, Baltimore, MD 21287, USA
| | - Ewa Zabrocka
- Department of Radiation Oncology, Stony Brook University Hospital, Level 2, Stony Brook, New York 11794-8121, USA
| | - Nicholas Koroneos
- Department of Neurology, Stony Brook University Hospital, Health Sciences Tower T12/020, Stony Brook, New York 11794-8121, USA
| | - Agnieszka Kowalska
- Department of Neurology, Stony Brook University Hospital, Health Sciences Tower T12/020, Stony Brook, New York 11794-8121, USA
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Methotrexate Drug Monitoring From Central Access: Can Blood Sample Collection From Central Venous Access Replace Peripheral Venipuncture in Adults? Ther Drug Monit 2023; 45:364-367. [PMID: 36863027 DOI: 10.1097/ftd.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/11/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Intravenous high-dose methotrexate (MTX ≥ 1 g/m2) is frequently used in patients with cerebral lymphoma or other malignancies. In addition to its potent efficacy, it is known to have pronounced toxicity and life-threatening side effects. Regular-level monitoring at short and defined intervals is mandatory. This study aimed to evaluate the possibility of replacing peripheral blood sampling with blood samples from central venous catheters for therapeutic monitoring of MTX in adults. METHODS A total of 6 patients and 7 cycles of chemotherapy (6 females; 5 with cerebral non-Hodgkin lymphoma and 1 with osteosarcoma, median age 51 years; range 33-62 years) were included. An immunoassay was used for quantitative analysis of MTX levels. The measurement points were obtained in the time intervals of 24, 42, 48, and 72 hours, and afterward, every 24 hours until the level was below <0.1 µmol/L. After flushing with 10 mL of saline solution and discarding 10 mL of venous blood, blood was drawn from the central venous access through which MTX had previously been administered. Simultaneously, MTX levels were obtained from peripheral venipuncture. RESULTS Methotrexate levels from central venous access and MTX levels from peripheral venipuncture showed a significant correlation (r = 0.998; P < 0.01; n = 35). During withdrawal from the central access group, 17 values showed a lower MTX level, 10 showed a higher level, and 8 showed no difference. However, the MTX level difference was not significant (P = 0.997, linear mixed model). No increase in the dose of calcium folinate was necessary based on the collected MTX levels. CONCLUSIONS In adults, MTX monitoring from central venous access is not inferior to monitoring from peripheral venipuncture. Repeated venipuncture to measure MTX levels can be replaced after establishing standardized instructions for proper sampling by a central venous catheter.
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Ma J, Lin Z, Ding T, Li Q, Zhang M, Kang H, Johnston PB, Ma Y, Chen B. Pemetrexed Plus Lenalidomide for Relapsed/Refractory Primary Central Nervous System Lymphoma: A Prospective Single-Arm Phase II Study. Front Oncol 2022; 12:938421. [PMID: 35898888 PMCID: PMC9309305 DOI: 10.3389/fonc.2022.938421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The prognosis of relapsed/refractory (R/R) primary central nervous system lymphoma (PCNSL) is dismal, and there are limited treatment options for these patients. This was a prospective single-arm phase II study of combined pemetrexed and lenalidomide for salvage treatment of R/R PCNSL. Patients with R/R PCNSL (n = 38) who had undergone two or more different therapeutic regimens and experienced disease progression or recurrence were enrolled. The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Patients were followed up for a median of 18 (range, 1–36) months. ORR was 68.4%, with median PFS and OS of 6 and 18 months, respectively. Adverse events (AEs) included myelosuppression, fatigue, nausea, fever, infection, cardiac disease, and thrombogenesis. Commonly observed grade ≥ 3 AEs included neutropenia (5.3%), leukopenia (2.6%), thrombocytopenia (7.9%), and infection (2.6%). Elevated lactate dehydrogenase (LDH) levels (χ2 = 13.25; P = 0.0003) and bulky disease (P = 0.032; χ2 = 4.580) were associated with short PFS. Elevated serum LDH level (P = 0.011; χ2 = 6.560), abnormal lymphoma cells in the cerebrospinal fluid (CSF) [P = 0.011; χ2 = 6.445], and multiple lesions (P = 0.036; χ2 = 4.404) were significantly associated with poorer OS. Abnormal lymphoma cells in the CSF were an independent predictor of poor prognosis on multivariate analysis (P = 0.034; hazard ratio (HR) = 2.836; 95% confidence interval, 1.082–7.434). Our results indicate that pemetrexed plus lenalidomide is effective for heavily treated R/R PCNSL, with moderate toxicity. Trial registration: #ChiCTR1900028070.
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Affiliation(s)
- Jingjing Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Zhiguang Lin
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Tianling Ding
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Qing Li
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Mengxue Zhang
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Hui Kang
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Patrick B Johnston
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Yan Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, China
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Le Dû K, Alarion N, Rabi H, Casasnovas O, Robert P, Durand A, Burlet B, Tabouret-Viaud C, Ramla S, Martin L, Rossi C. Extranodal classical Hodgkin lymphoma involving the spinal cord: case report and review of the literature. CNS Oncol 2022; 11:CNS88. [PMID: 35694977 PMCID: PMC9280417 DOI: 10.2217/cns-2021-0011] [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] [Indexed: 11/21/2022] Open
Abstract
Primary CNS involvement is very rare in Hodgkin lymphoma. Here we present two cases of spinal cord dissemination. Two women of 40 and 65 years of age presented symptoms of spinal cord injury; imaging showed an intramedullary mass in T10 and T2, respectively, without vertebral involvement and upper diaphragmatic lymph nodes. Lymph-node biopsy confirmed the diagnosis of classical Hodgkin lymphoma in both patients. The first patient received four cycles of chemotherapy (escalated BEACOPP and ABVD) with intrathecal therapy, and the second four cycles of doxorubicin, vinblastine, dacarbazine (AVD) and local irradiation after surgery decompression. Complete metabolic response was obtained at the end of treatment. After 5 and 7 years of follow-up respectively, neurological deficits persisted in both. Lymph-node infiltration is the most common presentation in Hodgkin lymphoma at diagnosis. Primary extranodal involvement is rare and spinal cord infiltration exceptional. Back pain, tingling and vesico-sphincter dysfunctions are the main symptoms. 18F-fluorodeoxyglucose (FDG) PET and MRI can detect the location and extension of neurological involvement. We present here two cases of tumoral myelitis and a review of the literature. Local treatment (surgery/radiotherapy) is often administered together with chemotherapy to optimize local control and to avoid long-term sequelae.
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Affiliation(s)
- Katell Le Dû
- Department of Hematology, Confluent Private Hospital, Nantes, France
| | - Nicolas Alarion
- Nuclear Medecine, Institut Inter-RégionaL de Cancérologie Jean Bernard, Victor Hugo Medical Center, Le Mans, France
| | - Hassan Rabi
- Radiologic Department, Maine Image Santé, Le Mans, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Philippine Robert
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Amandine Durand
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Bénédicte Burlet
- INSERM UMR1231 UFR Bourgogne, Dijon, France.,Biology Department, University Hospital Center, Dijon, France
| | | | - Selim Ramla
- Department of Pathology, University Hospital Center, Dijon, France
| | - Laurent Martin
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Cédric Rossi
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
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11
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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.
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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
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12
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Wismann J, Sommer-Sørensen RH, Kofoed MS, Halle B, Pedersen CB, Schulz MK, Grønhøj MH, Larsen TS, Møller MB, Poulsen FR. Diagnosis, treatment, and outcome of primary CNS lymphoma-a single-center experience. Acta Neurochir (Wien) 2022; 164:1365-1373. [PMID: 35257217 DOI: 10.1007/s00701-022-05170-5] [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: 12/06/2021] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary CNS lymphoma (PCNSL) is a highly aggressive non-Hodgkin lymphoma (NHL) that occurs in the CNS (e.g. brain, meninges, spinal cord, cerebrospinal fluid, or intraocular involvement) in the absence of systemic NHL. Tumor resection does not improve survival, and neurosurgical intervention is generally limited to stereotactic biopsy to provide a histopathological diagnosis. OBJECTIVE The objective of this single-center study was to evaluate the management and outcome of PCNSL patients diagnosed by biopsy, using overall survival and progression-free survival as endpoints. METHODS At our department of neurosurgery, 140 patients were diagnosed with PCNSL by biopsy between January 1, 2009, and December 31, 2018. Of these, 37 patients were included in the study and were divided into three groups according to their postoperative therapy. RESULTS Median OS was 35.7 months for the intensive treatment group, 29.5 months for the moderate treatment group, and 8.6 months for the palliative treatment group. The intensive and moderate treatment groups had similar progression-free survival, while the palliative treatment group had poor overall and progression-free survival. Six patients were long-term survivors (> 80 months). Age under 65 years was the main significant parameter affecting overall survival. CONCLUSION In this cohort, patients with PCNSL had an overall fair prognosis if they (1) were under 65 years old, (2) had a performance score < 2 at the time of diagnosis, and (3) received either intensive or moderate chemotherapeutic treatment. Biopsy is still the primary diagnostic tool; other methods have been investigated but are not yet recommended.
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Affiliation(s)
- Joakim Wismann
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark.
| | - Rune Hørlykke Sommer-Sørensen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
| | - Mikkel Seremet Kofoed
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
| | - Christian Bonde Pedersen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
| | - Mette Katrine Schulz
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
| | - Mads Hjortdal Grønhøj
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Michael Boe Møller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE - Brain Research Inter-Disciplinary Guided Excellence, Odense, Denmark
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13
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DeAtkine AB, Abdelrashid M, Tucker Z, Mehta A, Markert JM, Kim J, Fiveash JB, Oster RA, Lobbous M, Nabors LB. High-dose methotrexate and rituximab induction regimen in immunocompetent patients with primary CNS lymphoma: a retrospective single-center study of survival predictors. J Neurooncol 2022; 158:33-40. [PMID: 35441948 DOI: 10.1007/s11060-022-04004-9] [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: 01/11/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Primary Central Nervous System Lymphoma (PCNSL) is an aggressive tumor that is confined to the CNS. Although the provision of high-dose methotrexate (HD-MTX) has remarkably improved outcomes in PCNSL patients, the optimal treatment regimens and standard MTX dose for induction therapy have been largely controversial. Herein, we sought to explore the impact of adjuvant rituximab and different dosages of induction HD-MTX on survival outcomes of immunocompetent patients with PCNSL. METHODS In this study, we examined patients with PCNSL treated at a single NCI-designated comprehensive cancer center to evaluate their survival outcomes. We conducted a retrospective analysis of 51 immunocompetent patients with PCNSL who received their induction chemotherapy at the University of Alabama at Birmingham (UAB) between 2001 and 2019. Only adult patients with a confirmed diagnosis of PCNSL who had either HD-MTX alone or in combination with rituximab were included. Patients' demographics, clinical characteristics, and survival data were collected and analyzed. RESULTS There is no significant difference in survival among patients who received MTX alone versus MTX plus rituximab (HR = 0.996 (95% CI: 0.398-2.493), p = 0.994). Lower doses of MTX were associated with worse survival outcomes (HR = 0.680 (95% CI: 0.530-0.872), p = 0.002); however, this difference in survival was not significant when adjusted to age (HR = 0.797 (95% CI: 0.584-1.088), p = 0.153). CONCLUSION Our experience challenges the role of rituximab in PCNSL during induction therapy. Our study also highlights the shorter survival in elderly patients with PCNSL which can be related, to some extent, to the relatively lower doses of HD-MTX. There is an unmet need to establish a consensus on the most effective upfront regimen in PCNSL through prospective studies.
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Affiliation(s)
- Andrew B DeAtkine
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Moaaz Abdelrashid
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zach Tucker
- Division of Neuro-Oncology, Department of Neurology, University of Alabama at Birmingham, FOT 1020
- 510 20th Street South, Birmingham, AL, 35233, USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jinsuh Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mina Lobbous
- Division of Neuro-Oncology, Department of Neurology, University of Alabama at Birmingham, FOT 1020
- 510 20th Street South, Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L Burt Nabors
- Division of Neuro-Oncology, Department of Neurology, University of Alabama at Birmingham, FOT 1020
- 510 20th Street South, Birmingham, AL, 35233, USA. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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14
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Frigault MJ, Dietrich J, Gallagher K, Roschewski M, Jordan JT, Forst D, Plotkin SR, Cook D, Casey KS, Lindell KA, Depinho GD, Katsis K, Elder EL, Leick MB, Choi B, Horick N, Preffer F, Saylor M, McAfee S, O'Donnell PV, Spitzer TR, Dey B, DeFilipp Z, El-Jawahri A, Batchelor TT, Maus MV, Chen YB. Safety and efficacy of tisagenlecleucel in primary CNS lymphoma: a phase 1/2 clinical trial. Blood 2022; 139:2306-2315. [PMID: 35167655 PMCID: PMC9012129 DOI: 10.1182/blood.2021014738] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/02/2022] [Indexed: 12/14/2022] Open
Abstract
CD19-directed chimerical antigen receptor T-cell (CAR-T) products have gained US Food and Drug Administration approval for systemic large B-cell lymphoma. Because of concerns about potential immune cell-associated neurotoxicity syndrome (ICANS), patients with primary central nervous system (CNS) lymphoma (PCNSL) were excluded from all pivotal CAR-T studies. We conducted a phase 1/2 clinical trial of tisagenlecleucel in a highly refractory patients with PCNSL and significant unmet medical need. Here, we present results of 12 relapsed patients with PCNSL who were treated with tisagenlecleucel and followed for a median time of 12.2 months (range, 3.64-23.5). Grade 1 cytokine release syndrome was observed in 7/12 patients (58.3%), low-grade ICANS in 5/12 (41.6%) patients, and only 1 patient experienced grade 3 ICANS. Seven of 12 patients (58.3%) demonstrated response, including a complete response in 6/12 patients (50%). There were no treatment-related deaths. Three patients had ongoing complete remission at data cutoff. Tisagenlecleucel expanded in the peripheral blood and trafficked to the CNS. Exploratory analysis identified T-cell, CAR T, and macrophage gene signatures in cerebrospinal fluid following infusion when compared with baseline. Overall, tisagenlecleucel was well tolerated and resulted in a sustained remission in 3/7 (42.9%) of initial responders. These data suggest that tisagenlecleucel is safe and effective in this highly refractory patient population. This trial was registered at www.clinicaltrials.gov as #NCT02445248.
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Affiliation(s)
- Matthew J Frigault
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen Gallagher
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD
| | - Justin T Jordan
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Deborah Forst
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Scott R Plotkin
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Daniella Cook
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Keagan S Casey
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Kevin A Lindell
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Gabriel D Depinho
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Katelin Katsis
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Eva Lynn Elder
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Mark B Leick
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Bryan Choi
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Nora Horick
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Frederic Preffer
- Department of Pathology, Massachusetts General Hospital, Boston, MA; and
| | - Meredith Saylor
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven McAfee
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Paul V O'Donnell
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Thomas R Spitzer
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bimalangshu Dey
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Areej El-Jawahri
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Tracy T Batchelor
- Department of Neurology, Brigham's and Women Hospital & Dana Farber Harvard Cancer Institute, Boston, MA
| | - Marcela V Maus
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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15
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Anvari K, Welsh JS, Molaie F. Case series on patients with primary central nervous system lymphoma: From clinical presentations to outcomes. Clin Case Rep 2022; 10:e05447. [PMID: 35228878 PMCID: PMC8859860 DOI: 10.1002/ccr3.5447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/09/2022] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kazem Anvari
- Cancer Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - James S. Welsh
- Edward Hines Jr VA Hospital and Loyola University Chicago Stritch School of Medicine Chicago Illinois USA
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16
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Liu R, Cheng Q, Kang L, Wang E, Li Y, Zhang J, Xiao H, Zhang Y, Chu L, Chen X, Zhang C, Tan J, Xu N, Li M, Yu L, Li X. CD19 or CD20 CAR T-cell Therapy Demonstrates Durable Antitumor Efficacy in Patients with CNS Lymphoma. Hum Gene Ther 2022; 33:318-329. [PMID: 35152726 DOI: 10.1089/hum.2021.249] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rui Liu
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, China
| | - Qian Cheng
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Liqing Kang
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Shanghai, China
| | - Erhua Wang
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Ying Li
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Jian Zhang
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Han Xiao
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Yi Zhang
- Central South University Third Xiangya Hospital, 504354, Department of Gastrointestinal Surgery, Changsha, Hunan, China
| | - Ling Chu
- Central South University Third Xiangya Hospital, 504354, Department of Pathology, Changsha, Hunan, China
| | - Xin Chen
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Chang Zhang
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
| | - Jingwen Tan
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Shanghai, China
- East China Normal University School of Chemistry and Molecular Engineering, 539566, Institute of Biomedical Engineering and Technology, Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai, China
| | - Nan Xu
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Shanghai, China
- East China Normal University School of Chemistry and Molecular Engineering, 539566, Institute of Biomedical Engineering and Technology, Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai, China
| | - Minghao Li
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Shanghai, China
- East China Normal University School of Chemistry and Molecular Engineering, 539566, Institute of Biomedical Engineering and Technology, Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai, China
| | - Lei Yu
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Shanghai, China
- East China Normal University School of Chemistry and Molecular Engineering, 539566, Institute of Biomedical Engineering and Technology, Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai, China
| | - Xin Li
- Central South University Third Xiangya Hospital, 504354, Department of Hematology, Changsha, Hunan, China
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17
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Wang A, Cirrone F, De Los Reyes FA, Papadopoulos J, Saint Fleur-Lominy S, Xiang E. High-dose methotrexate dosing strategy in primary central nervous system lymphoma. Leuk Lymphoma 2022; 63:1348-1355. [PMID: 35120432 DOI: 10.1080/10428194.2021.2024818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The backbone induction therapy for primary central nervous system lymphoma (PCNSL) is high dose methotrexate (HD-MTX) and rituximab, which can be combined with other chemotherapeutic agents. The optimal dose of HD-MTX remains unclear, as doses between 3 and 8 g/m2 have been shown to be effective. In this retrospective study, HD-MTX dosed at 3-5 g/m2 demonstrated an overall response of 81.8%, with 11 (50%) complete responses. The median overall survival was not met at 29 months and median progression free survival was 12.5 months.There were two discontinuations due to nephrotoxicity. The most common adverse event was hepatotoxicity (18.5%), with no treatment-related mortality events observed.Overall, HD-MTX dosed at 3-5 g/m2 demonstrated similar efficacy and lower toxicity compared to higher doses in PCNSL patients. Reducing the initial HD-MTX dose may help ensure tolerability and completion of induction therapy, especially in patients with co-morbidities or older age who have poorer outcomes.
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Affiliation(s)
- Alexander Wang
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Frank Cirrone
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | | | - John Papadopoulos
- Department of Pharmacy, NYU Langone Health, New York, NY, USA.,Department of Medicine, NYU Langone Health, New York, NY, USA
| | | | - Elaine Xiang
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
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18
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Galazky I, Büntjen L, Voges J, Sandalcioglu IE, Mawrin C, Haghikia A. Brain biopsy in patients with CLIPPERS syndrome: why and when. Ther Adv Neurol Disord 2022; 15:17562864211062821. [PMID: 35126669 PMCID: PMC8808022 DOI: 10.1177/17562864211062821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disorder of the central nervous system (CNS), predominantly involving the brainstem with a characteristic magnetic resonance imaging (MRI) appearance and clinical and radiological responsiveness to glucocorticosteroids. Yet diagnostic biomarkers are missing and other immune-mediated, (para-) infectious and malignant causes mimic CLIPPERS-like MRI presentations. We report the case of a 51-year-old male patient with CLIPPERS who repeatedly responded well to high-dose corticosteroids. After 7 months, however, treatment failed, and he had a biopsy-confirmed diagnosis of a CNS B-cell lymphoma. Clinical and MRI signs of CLIPPERS include a wide spectrum of differential diagnoses which often arise only later during the course of disease. Similar to the case presented here, delayed diagnosis and specific therapy may contribute to an unfavorable outcome. Hence, we propose that in the absence of other diagnostic markers, brain biopsy should be performed as early as possible in CLIPPERS patients.
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Affiliation(s)
- Imke Galazky
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Lars Büntjen
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Disease (DZNE), Bonn, Germany
| | - I. Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Disease (DZNE), Bonn, Germany
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19
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Lebel E, Vainstein V, Ashkenazi M, Zimran E, Stepensky P, Grisariu S, Avni B. Neutrophil decline rate following autologous transplant for lymphoma is a predictor of patients' outcome. Leuk Lymphoma 2021; 63:1144-1151. [PMID: 34963410 DOI: 10.1080/10428194.2021.2018580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neutropenia postchemotherapy is associated with favorable outcomes, which was attributed to optimal dosing. However, little is known about the neutrophil decline rate as a predictor of cancer outcomes, which may reflect a dynamic marker of chemosensitivity. We assessed the association between the neutrophil decline rate and disease outcomes in a known cohort of 212 lymphoma patients, treated with thiotepa, etoposide, cyclophosphamide, cytarabine, and melphalan (TECAM) conditioning followed by autologous transplant in our center between 2000 and 2013. Slower neutrophil decline rate was correlated with worse overall survival, mediated not by shorter time to progression (TTP), but rather by worse survival post-progression, possibly pointing to chemosensitivity at each line of therapy as the responsible mechanism. The effect was seen across histologies and was independent of stronger predictors of outcome like performance status (PS) and response before transplant. Prospective research is needed to confirm our results and expand their validity to other clinical scenarios.
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Affiliation(s)
- Eyal Lebel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Vainstein
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maayan Ashkenazi
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Zimran
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Polina Stepensky
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sigal Grisariu
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Batia Avni
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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20
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Calderon-Castro A, Enciso L, Tejada-Cabrera R. Primary Leptomeningeal B-cell Lymphoma in an Immunocompetent Adult: Case Report. Cureus 2021; 13:e19619. [PMID: 34956753 PMCID: PMC8674856 DOI: 10.7759/cureus.19619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/05/2022] Open
Abstract
Primary leptomeningeal lymphoma (PLML) is a rare disease, comprising less than 1% of all lymphomas. Clinical manifestations include headache, encephalopathy, ataxia, cranial nerve palsy, and myelitis. Diagnosis requires a combination of magnetic resonance images (MRI), cytology, flow cytometry of cerebrospinal fluid (CSF), and an extensive workup to rule out systemic lymphoma. We describe the case of a 49-year-old man who developed subacute onset headache, encephalopathy, and blindness. Whole-body examinations, including a bone marrow trephine biopsy, excluded systemic lymphoma. Brain MRI showed leptomeningeal enhancement. Cytology and flow cytometry of CSF found a clonal B-cell population making a diagnosis of PLML. He began treatment with rituximab and high-dose methotrexate (HD-MTX), with progressive clinical improvement. CSF analysis after two cycles and one intrathecal methotrexate dose was normal. Brain and spinal MRI images plus CSF analysis, along with an extensive workup to exclude systemic lymphoma, are necessary to diagnose PLM. Early treatment with HD-MTX alone or in combination with rituximab improves clinical outcomes.
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Affiliation(s)
| | - Leonardo Enciso
- Hematology, Hospital Universitario Clínica San Rafael, Bogotá, COL.,Hematology, Hospital Universitario de La Samaritana, Bogotá, COL
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21
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Doi Y, Yokota T, Shibayama H, Matsumoto K, Kurashige M, Nozaki K, Fujita J, Fukushima K, Hosen N. A forodesine-based regimen as a therapeutic option for PTCL-NOS with Central nervous system involvement. Leuk Lymphoma 2021; 63:1013-1015. [PMID: 34852707 DOI: 10.1080/10428194.2021.2005043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yukiko Doi
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takafumi Yokota
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirohiko Shibayama
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kana Matsumoto
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Masako Kurashige
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Nozaki
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jiro Fujita
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kentaro Fukushima
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Hosen
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
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22
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Benitez CM, Rahimy E, Panjwani N, Maeda LS, Soltys SG. Stereotactic Radiotherapy for Recurrent Post-Transplant Primary Central Nervous System Lymphoma. Cureus 2021; 13:e16537. [PMID: 34430145 PMCID: PMC8378593 DOI: 10.7759/cureus.16537] [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] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Post-transplant primary central nervous system lymphoma (PCNSL) is a rare complication of solid organ transplantation. The optimal therapy for post-transplant PCNSL is not well established and generally includes reduction of immunosuppression and chemotherapy. Progression after front-line chemotherapy is common, and whole-brain radiotherapy (WBRT) is a standard salvage treatment as there is a concern that localized treatment fields would not prevent out-of-field recurrences. However, WBRT is associated with neurotoxicity and morbidity in these patients with inherently poor prognoses. Here, we report a patient with local recurrence of post-transplant PCNSL who was treated with fractionated stereotactic radiotherapy (SRT). He had no clinical toxicity from treatment and maintained pre-treatment neurocognition and performance status. Local control was achieved for 20 months following SRT, at which point he developed an in-field recurrence. He restarted lymphoma therapy but died one month later from fungal pneumonia. For central nervous system (CNS) lymphoma, further data are needed to optimize tumor control and toxicity outcomes and identify patients in whom localized radiotherapy fields may be beneficial, avoiding the potential toxicity of WBRT.
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Affiliation(s)
- Cecil M Benitez
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, USA
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, USA
| | - Neil Panjwani
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, USA
| | - Lauren S Maeda
- Department of Hematology and Oncology, Stanford University School of Medicine, Stanford, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, USA
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Shao L, Xu C, Wu H, Jamal M, Pan S, Li S, Chen F, Yu D, Liu K, Wei Y. Recent Progress on Primary Central Nervous System Lymphoma-From Bench to Bedside. Front Oncol 2021; 11:689843. [PMID: 34485125 PMCID: PMC8416460 DOI: 10.3389/fonc.2021.689843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare subtype of extra-nodal lymphoma. The high relapse rate of PCNSL remains a major challenge to the hematologists, even though patients exhibit high sensitivity to the methotrexate-based chemotherapeutic regimens. Recently, the advent of Bruton's tyrosine kinase inhibitor (BTKi) and CAR T treatment has made more treatment options available to a proportion of patients. However, whether BTKi monotherapy should be given alone or in combination with conventional chemotherapy is still a clinical question. The status of CAR T therapy for PCNSLs also needs to be elucidated. In this review, we summarized the latest progress on the epidemiology, pathology, clinical manifestation, diagnosis, and treatment options for PCNSLs.
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Affiliation(s)
- Liang Shao
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chengshi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huijing Wu
- Department of Lymphoma Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Muhammad Jamal
- Department of Immunology, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Shan Pan
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Sirui Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fei Chen
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ding Yu
- Department of Lymphoma Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kui Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
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24
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Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Tantiworawit A, Norasetthada L. Outcome of patients with newly diagnosed primary CNS lymphoma after high-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine: an 8-year cohort study. Int J Clin Oncol 2021; 26:1805-1811. [PMID: 34236556 DOI: 10.1007/s10147-021-01982-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Addition of cytarabine to high-dose methotrexate (HD-MTX) chemotherapy improves outcome of primary CNS lymphoma (PCNSL); however, the combination therapy increases toxicity. Sequential chemotherapy and cranial radiation may decrease toxicity without altering efficacy. METHODS This was a single-center, retrospective cohort study of consecutive newly diagnosed immunocompetent PCNSL patients treated with HD-MTX (5 cycles of 3 g/m2 every 2 weeks) followed by consolidation whole-brain radiotherapy (WBRT) and cytarabine (2 cycles of 3 g/m2/d for 2 days every 3 weeks) from January 2013 to December 2020. Initial WBRT before HD-MTX was allowed in patients with significant disability or brain edema at presentation. Primary outcome was progression-free survival (PFS). Key secondary outcomes were response rate, treatment-related toxicity, and overall survival (OS). RESULTS Of 41 patients, 25 patients had a complete response (CR) and ten patients had a partial response, inferring an overall response rate (ORR) of 85.4% and a CR rate of 60.9%. More than 90% of patients were able to tolerate and complete the HD-MTX. The incidence of ≥ grade 3 hematologic and non-hematologic toxicities were 4.8% and 17.1%, respectively. Treatment-related mortality rate was 2.4%. There was no difference in toxicity between patients with age < 60 and ≥ 60 years. At the median follow-up duration of 39.8 months, the median PFS was 35.2 months (95% CI 12.4-69.3) and median OS was 46.5 months (95% CI 21.8-NR). CONCLUSION High-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine has acceptable efficacy, great tolerability, and low toxicity in newly diagnosed PCNSL patients.
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Affiliation(s)
- Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
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25
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Is There an Indication for First Line Radiotherapy in Primary CNS Lymphoma? Cancers (Basel) 2021; 13:cancers13112580. [PMID: 34070309 PMCID: PMC8197540 DOI: 10.3390/cancers13112580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Primary CNS Lymphoma is a rare and severe but potentially curable disease. In the last thirty years treatment has changed significantly. Survival times increased due to high-dose methotrexate-based chemotherapy. With intensive regimens involving autologous stem cell transplantation (ASCT), 4-year survival rates of more than 80% can be reached. However, this treatment regimen is not feasible in all patients, and is associated with some mortality. Methods: In this review, current evidence regarding the efficacy and toxicity of radiotherapy in PCNSL shall be summarized and discussed mainly based on data of controlled trials. Results: Being the first feasible treatment whole brain radiotherapy (WBRT) was initially used alone, and later as a consolidating treatment after high-dose methotrexate-based chemotherapy. More recently, concerns regarding activity and neurotoxicity of standard dose WBRT limited its use. On the contrary, latest evidence of some phase II trials suggests efficacy of consolidating WBRT is comparable to ASCT. After complete remission reduced dose WBRT appears as a feasible concept with decreased neurotoxicity. Evidence for use of local stereotactic radiotherapy is very limited. Conclusion: Radiotherapy has a role in the treatment of PCNSL patients not suitable to ASCT, e.g., as consolidating reduced dose WBRT after complete response. Local stereotactic radiotherapy for residual disease should be examined in future trials.
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26
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Raval V, Binkley E, Aronow ME, Valenzuela J, Peereboom DM, Singh AD. Primary central nervous system lymphoma - ocular variant: an interdisciplinary review on management. Surv Ophthalmol 2021; 66:1009-1020. [PMID: 33762182 DOI: 10.1016/j.survophthal.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
Primary central nervous system lymphoma-ophthalmic variant (PCNSL-O) is an ocular subset of PCNSL predominantly involving subretinal pigment epithelium space, retina, and vitreous. The ophthalmic manifestations can precede, occur simultaneously, or follow other compartments of the CNS. Clinical trials have resulted in a significantly improved outcome in PCNSL patients over the past 2 decades, with a higher proportion of patients receiving frontline high dose methotrexate-based polychemotherapy regimens with curative intent; however, the current management of PCNSL-O remains controversial owing to lack of prospective data. The goals of PCNSL-O treatment are both to achieve local (ocular) control and to prevent tumor-specific mortality from further CNS involvement. Despite achieving high rates of ocular control with intravitreal agents like methotrexate and rituximab, the overall survival is poor, as 65-85% of patients eventually succumb to CNS disease. Few studies define the role of systemic chemotherapy with/without local treatment as a first line induction treatment for PCNSL-O considering limiting factors such as ocular penetration of systemically administered drugs and treatment related neurotoxicity. Also, the role of adjuvant treatment for PCNSL-O to prevent CNS progression and to improve overall survival is unknown. In this systematic review of the literature, we analyze treatment outcomes of various regimens (local, systemic, and combination) in terms of local control, CNS progression, and overall survival.
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Affiliation(s)
- Vishal Raval
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elaine Binkley
- Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Mary E Aronow
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Juan Valenzuela
- Department of Retina and Ophthalmic Oncology, Consultores Oftalmológicos, Buenos Aires, Argentina
| | - David M Peereboom
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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27
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Liu Y, Yao Q, Zhang F. Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review). Int J Oncol 2021; 58:371-387. [PMID: 33650642 PMCID: PMC7864151 DOI: 10.3892/ijo.2021.5180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 12/14/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma that is unique and different from systemic diffuse large B-cell lymphomas. The median age at diagnosis of PCNSL is 65 years and its incidence is rising rapidly in the elderly population. A total of ≥20% of all patients with PCNSL are ≥80 years old. Notably, age has been identified as an independent poor prognostic factor for PCNSL. Elderly patients have an inferior prognosis to that of younger patients and are more severely affected by iatrogenic toxicity; therefore, elderly patients represent a unique and vulnerable treatment subgroup. The present review summarized the available literature to provide an improved understanding of the epidemiology, clinical characteristics, diagnosis, prognosis and management of PCNSL in the elderly population. Notably, the incidence of PCNSL in immunocompetent elderly patients, predominantly in men, is increasing. For the diagnosis of CNSL, imaging-guided stereotactic biopsy is considered the gold standard. When stereotactic biopsy is not possible or conclusive, certain biomarkers have been described that can help establish a diagnosis. PCNSL has a very poor prognosis in the elderly, even though several prognostic scoring systems exist and several prognostic markers have been reported in patients with PCNSL. Furthermore, the treatment of elderly patients remains challenging; it is unlikely that a novel agent could be used as a curative monotherapy; however, a combination of novel agents with polychemotherapy or its combination with other novel drugs may have therapeutic potential.
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Affiliation(s)
- Yanxia Liu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Qingmin Yao
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Feng Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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28
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Zhao Y, Zheng W. Deciphering the antitumoral potential of the bioactive metabolites from medicinal mushroom Inonotus obliquus. JOURNAL OF ETHNOPHARMACOLOGY 2021; 265:113321. [PMID: 32877719 DOI: 10.1016/j.jep.2020.113321] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/09/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The crude extracts of the medicinal mushroom Inonotus obliquus have been used as an effective traditional medicine to treat malicious tumors, gastritis, gastric ulcers, and other inflammatory conditions in Russia and most Baltic countries. AIM OF THIS REVIEW Deciphering the antitumoral potential of the bioactive metabolites from I. obliquus and addressing its possibility to be used as effective agents for tumor treatment, restoration of compromised immunity and protection of gastrointestinal damage caused by chemotherapy. MATERIALS AND METHODS We analysed the current achievements and dilemma in tumor chemo- or immunotherapy. In this context, we searched the published literatures on I. obliquus covering from 1990 to 2020, and summarized the activities of antitumor, antioxidation, and immunomodulation by the polysaccharides, triterpenoids, small phenolic compounds, and hispidin polyphenols. By comparing the merits and shortcomings of current and traditional methodology for tumor treatment, we further addressed feasibility for the use of I. obliquus as an effective natural drug for tumor treatment and prevention. RESULTS The diverse bioactive metabolites confer I. obliquus great potential to inhibit tumor growth and metastasis. Its antitumor activities are achieved either through suppressing multiple oncogenic signals including but not limited to the activation of NF-κB and FAK, and the expression of RhoA/MMP-9 via ERK1/2 and PI3K/Akt signaling pathway. The antitumor activities can also be achieved by inhibiting tyrosinase activity via PAK1-dependent signaling pathway or altering lysosomal membrane permeabilization through blocking tubulin polymerization and/or disturbing energy metabolism through LKB1/AMPK pathway. In addition, the metabolites from I. obliquus also harbour the potentials to reverse MDR either through selective inhibition on P-gp/ABCB1 or MRP1/ABCC1 proteins or the induction of G2/M checkpoint arrest in tumor cells of chemoresistant phenotypes mediated by Nox/ROS/NF-kB/STAT3 signaling pathway. In addition to the eminent effects in tumor inhibition, the metabolites in I. obliquus also exhibit immunomodulatory potential to restore the compromised immunity and protect against ulcerative damage of GI tract caused by chemotherapy. CONCLUSIONS I. obliquus possesses the potential to reduce incidence of tumorigenesis in healthy people. For those whose complete remission has been achieved by chemotherapy, administration of the fungus will inhibit the activation of upstream oncogenic signals and thereby prevent metastasis; for those who are in the process of chemotherapy administration of the fungus will not only chemosensitize the tumor cells and thereby increasing the chemotherapeutic effects, but also help to restore the compromised immunity and protect against ulcerative GI tract damage and other side-effects induced by chemotherapy.
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Affiliation(s)
- Yanxia Zhao
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, Jiangsu Normal University, Xuzhou, 221116, China.
| | - Weifa Zheng
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, Jiangsu Normal University, Xuzhou, 221116, China.
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29
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Alvarez-Pinzon AM, Wolf A, Valerio JE, Borro M, Herrera D, Alonso JR. Gamma knife stereotactic radiosurgery as an effective tool in primary CNS lymphoma: Evaluation of stereotactic radiosurgery and methotrexate treatment in a prospective and observational clinical research study. Clin Neurol Neurosurg 2020; 201:106457. [PMID: 33418336 DOI: 10.1016/j.clineuro.2020.106457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the progression of Primary Central Nervous System Lymphoma (PCNSL) in patients treated with methotrexate (MTX) versus those treated with a combination of Stereotactic Radiosurgery (SRS) and MTX. Progression was measured via brain lesion count and tumor volume. METHODS This observational and prospective cohort study evaluated the outcome of SRS treatment of PCNSL in one hundred twenty-eight subjects. We analyzed baseline, prospective, and retrospective data of patients enrolled in the brain tumor registry between June 2010 and August 2017. Seventy-three patients were treated exclusively with MTX while the remaining fifty-five patients received a combination of SRS and MTX. Strict inclusion and exclusion criteria were established. RESULTS Mean survival rate for patients receiving combined SRS and MTX treatment was significantly higher (52.6 months) compared to the MTX group (19.8 months); p = 0.0029. At the 36 months follow-up, patients treated with SRS and MTX also had a lower rate of tumor progression (32.7 %) than the MTX group (95.9 %); p = 0.00192. Local tumor control was achieved in all patients treated with SRS. No clinical toxicity was observed in this group. CONCLUSIONS Clinical results obtained from this observational study highlight the potential effectiveness of SRS in the treatment of PCNSL. Although treatment outcomes have improved in the past years, additional evidence in the clinical design of randomized trials is needed to evaluate the strength of this treatment in specific situations.
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Affiliation(s)
- Andres M Alvarez-Pinzon
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States; The Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca (USAL), Salamanca, Spain; University California, San Francisco, Department of Neurological Surgery, Skull Base and Cerebrovascular Laboratory, CA, United States.
| | - Aizik Wolf
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States
| | - Jose E Valerio
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States
| | - Matteo Borro
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States
| | - Daniela Herrera
- Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jose Ramon Alonso
- The Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca (USAL), Salamanca, Spain
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30
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Nachtsheim L, Wittersheim M, Kreissl S, Klussmann JP, Grosheva M. Facial nerve paralysis caused by a T-cell lymphoma. Clin Case Rep 2020; 8:2965-2968. [PMID: 33363860 PMCID: PMC7752436 DOI: 10.1002/ccr3.3285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/22/2020] [Accepted: 08/01/2020] [Indexed: 12/01/2022] Open
Abstract
Facial nerve paralysis due to the infiltration by a lymphoma is rare and the prognosis remains poor. If perineural spread and meningeosis are suspected, quick interdisciplinary diagnostic work-up is recommended. It should include magnetic resonance imaging, biopsy of the lesion, bone marrow biopsy, and lumbar puncture. Therapy should be initiated immediately.
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Affiliation(s)
- Lisa Nachtsheim
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical FacultyUniversity of CologneCologneGermany
| | - Maike Wittersheim
- Department of PathologyMedical FacultyUniversity of CologneCologneGermany
| | - Stefanie Kreissl
- Department I of Internal Medicine and Center of Integrated OncologyMedical FacultyUniversity of CologneCologneGermany
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical FacultyUniversity of CologneCologneGermany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical FacultyUniversity of CologneCologneGermany
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31
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Chen F, Pang D, Guo H, Ou Q, Wu X, Jiang X, Wei X, Liu S, Huang L, Liang Z, Zhou D, Li W. Clinical outcomes of newly diagnosed primary CNS lymphoma treated with ibrutinib-based combination therapy: A real-world experience of off-label ibrutinib use. Cancer Med 2020; 9:8676-8684. [PMID: 33068336 PMCID: PMC7666749 DOI: 10.1002/cam4.3499] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Ibrutinib‐based combination therapy with high‐dose methotrexate (HD‐MTX) has recently shown clinical activity against relapse/refractory (R/R) primary central nervous system lymphoma (PCNSL). Herein, we report our real‐world experience of treating 11 newly diagnosed PCNSL patients with the ibrutinib/MTX combination. HD‐MTX was given at 3.5 g/m2 every 2‐week for eight doses. Ibrutinib was held upon HD‐MTX infusion until clearance and was administered daily post‐induction until disease progression, intolerable toxicity, or death. Nine out of 11 patients completed the induction phase and received ibrutinib as maintenance therapy. An objective response rate (ORR) of 82% (9/11) was observed including complete response (64%) and partial response (18%). The median progression‐free survival (PFS) was 7.4 months while the median overall survival (OS) was not reached. The ibrutinib/MTX combination was well tolerated in these treatment‐naïve PCNSL patients with an acceptable safety profile. Moreover, the longitudinal analysis of cerebrospinal fluid (CSF) circulating tumor DNA (ctDNA) revealed that CSF ctDNA detection was closely associated with tumor response, and sustained tumor responses correlated with the clearance of ctDNA from the CSF. In sum, our data not only demonstrated the clinical benefit of the ibrutinib and HD‐MTX combination regimen in treating newly diagnosed PCNSL patients in a real‐world setting, but also highlighted the significance of liquid biopsy including CSF ctDNA in tracing tumor burden and assessing treatment response.
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Affiliation(s)
- Feili Chen
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Diwen Pang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hanguo Guo
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qiuxiang Ou
- Translational Medicine Research Institute, Geneseeq Technology Inc, Toronto, ON, Canada
| | - Xue Wu
- Translational Medicine Research Institute, Geneseeq Technology Inc, Toronto, ON, Canada
| | - Xinmiao Jiang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaojuan Wei
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Sichu Liu
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ling Huang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhanli Liang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Dong Zhou
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenyu Li
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
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Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy. Support Care Cancer 2020; 28:5363-5369. [PMID: 32140974 DOI: 10.1007/s00520-020-05376-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a very rare type of malignancy with a poor prognosis. The role of whole brain radiotherapy (WBRT) in PCNSL has been questioned due to the significant neurotoxicity and lack of convincing data for survival benefit. Even its role in a palliative setting remains to be clearly elucidated. Our study aims to investigate the benefit of WBRT in patients who are ineligible for systemic therapy. METHODS A single-institution retrospective study was conducted on patients diagnosed with PCNSL between 2002 and 2017. Patients were excluded if they received systemic therapy or focal radiation only. Data on patient demographics and WBRT were collected and correlated with clinical outcomes. RESULTS A total of 48 patients were selected for analysis, among which 31 (64.6%) patients received WBRT and 17 (35.4%) patients received supportive care only. Patient baseline characteristics were similar between the two groups. Median overall survival (OS) was 4.3 months among the entire cohort. WBRT was associated with improved median OS (8.0 months, range 1.4-62.3 months) compared with supportive care only (3.3 months, range 0.7-18.3 months) (HR 0.39, 95% CI 0.20-0.75, p = 0.005). Among patients who received WBRT, higher radiation dose to the whole brain was not associated with survival (p = 0.10), but higher radiation dose to the gross tumor was associated with improved survival (p = 0.007). CONCLUSION Patients with PCNSL who are ineligible for systemic therapy may still benefit from WBRT with improvement in survival, compared with the best supportive care. Dose escalation through the addition of a gross tumor boost in these patients was associated with improved overall survival. Further studies in the prospective setting are necessary to confirm the findings from the study.
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Galarza Fortuna GM, Dvir K, Febres-Aldana C, Schwartz M, Medina AM. Primary Central Nervous System Lymphoma in an Immunocompetent Patient Presenting as Multiple Cerebellar Lesions: A Case Report and Review of Literature. J Investig Med High Impact Case Rep 2019; 7:2324709619893548. [PMID: 31818145 PMCID: PMC6904776 DOI: 10.1177/2324709619893548] [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] [Indexed: 11/20/2022] Open
Abstract
Primary central nervous system (CNS) lymphoma (PCNSL) is an uncommon extranodal
non-Hodgkin lymphoma often presenting as a single brain lesion within the CNS.
On histopathological evaluation of PCNSL a positive CD10, which is frequently
observed in systemic diffuse large B-cell lymphoma, is present in approximately
10% of PCNSL. We describe a case of CD10-positive PCNSL presenting with multiple
posterior fossa enhancing lesions in an immunocompetent older woman with a
history of breast cancer successfully treated by the RTOG 0227 protocol
consisting of pre-irradiation chemotherapy with high-dose methotrexate,
rituximab, and temozolomide for 6 cycles, followed by low-dose whole-brain
radiation and post-irradiation temozolomide.
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Affiliation(s)
| | - Kathrin Dvir
- Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | | | - Ana Maria Medina
- Mount Sinai Medical Center, Miami Beach, FL, USA.,Florida International University, Miami, FL, USA
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Perry C, Ben Barouch S, Goldschmidt N, Sarid N, Herishanu Y, Shvidel L, Bairey O, Lavi N, Horowitz N, Avigdor A, Lebel E, Sofer O, Ram R, Avivi I. Characteristics, management and outcome of DLBCL patients, presenting with simultaneous systemic and CNS disease at diagnosis: A retrospective multicenter study. Am J Hematol 2019; 94:992-1001. [PMID: 31211434 DOI: 10.1002/ajh.25558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 02/01/2023]
Abstract
The incidence of systemic diffuse large B cell lymphoma (DLBCL) concurrently involving the central nervous system (CNS) at diagnosis, is very low and data regarding the clinical course of these patients are scarce. We investigated characteristics, efficacy of treatment regimens including consolidative autologous stem cell transplantation and outcome of patients presenting with concomitant systemic and CNS DLBCL. The records of 44 patients, diagnosed between 2004 and 2017, who fulfilled the inclusion criteria, were retrospectively reviewed. CNS involvement was diagnosed as solely parenchymal in 41%, solely leptomeningeal in 43%, and paranchymal with leptomeningeal in 11% of the patients. Induction regimens were anthracycline-based combined with high-dose methotrexate (HD-MTX) in 80% (n = 35) of patients, anthracycline-based combined with intrathecal MTX in 3, cytarabine-based (without antracyclines) in 2, HD-MTX in 1 and palliative in three. Five of 41 patients treated with chemotherapy died of treatment-related toxicity, all due to infections. Nineteen patients had consolidative autologous transplantation. Overall response rate following induction was 80% (complete responses 66% and partial responses 15%). All relapses (n = 11) occurred within less than 2 years. Within a median follow-up of 26.8 months, 3-years projected overall survival (OS) and progression free survival rates for the entire cohort were 56% ± 8.3 and 42% ± 8.9, respectively. In multivariate analysis, RCHOP-HD MTX-based induction [HR = 0.228, (0.054-0.964)], administration of 3.5 g/m2 MTX [HR = 0.735 (0.620-0.871)], and attaining CR following induction [HR = 0.185, (0.051-0.667)] predicted longer OS. RCHOP-HD MTX can provide prolonged remissions in DLBCL patients presenting with concomitant systemic and CNS involvement whereas role of autograft remains uncertain.
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Affiliation(s)
- Chava Perry
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | | | - Neta Goldschmidt
- Department of HematologyHadassah Medical Center Jerusalem Israel
| | - Nadav Sarid
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Yair Herishanu
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Lev Shvidel
- Department of HematologyKaplan Medical Centre Rehovot Israel
| | - Osnat Bairey
- Davidoff Cancer Center, Rabin Medical CenterInstitute of Hematology Petah‐Tikva Israel
| | - Noa Lavi
- Department of Hematology and Bone Marrow TransplantationRambam Health Care Campus Haifa Israel
| | - Netanel Horowitz
- Department of Hematology and Bone Marrow TransplantationRambam Health Care Campus Haifa Israel
| | - Avraham Avigdor
- Division of Hematology and Bone Marrow TransplantationChaim Sheba Medical Center Tel Hashomer Israel
| | - Eyal Lebel
- Department of HematologyHadassah Medical Center Jerusalem Israel
| | - Orit Sofer
- Hillel Yaffe Medical CenterInstitute of Hematology Hadera Israel
| | - Ron Ram
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Irit Avivi
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
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35
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R-CHOP preceded by blood-brain barrier permeabilization with engineered tumor necrosis factor-α in primary CNS lymphoma. Blood 2019; 134:252-262. [PMID: 31118164 DOI: 10.1182/blood.2019000633] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/25/2019] [Indexed: 12/22/2022] Open
Abstract
Patients with primary central nervous system lymphoma (PCNSL) are treated with high-dose methotrexate-based chemotherapy, which requires hospitalization and extensive expertise to manage related toxicity. The use of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) could overcome these difficulties, but blood-brain barrier (BBB) penetration of related drugs is poor. Tumor necrosis factor-α coupled with NGR (NGR-hTNF), a peptide targeting CD13+ vessels, induces endothelial permeabilization and improves tumor access of cytostatics. We tested the hypothesis that NGR-hTNF can break the BBB, thereby improving penetration and activity of R-CHOP in patients with relapsed/refractory PCNSL (NCT03536039). Patients received six R-CHOP21 courses, alone at the first course and preceded by NGR-hTNF (0.8 μg/m2) afterward. This trial included 2 phases: an "explorative phase" addressing the effect of NGR-hTNF on drug pharmacokinetic parameters and on vessel permeability, assessed by dynamic contrast-enhanced magnetic resonance imaging and 99mTc-diethylene-triamine-pentacetic acid-single-photon emission computed tomography, and the expression of CD13 on tumor tissue; and an "expansion phase" with overall response rate as the primary end point, in which the 2-stage Simon Minimax design was used. At the first stage, if ≥4 responses were observed among 12 patients, the study accrual would have continued (sample size, 28). Herein, we report results of the explorative phase and the first-stage analysis (n = 12). CD13 was expressed in tumor vessels of all cases. NGR-hTNF selectively increased vascular permeability in tumoral/peritumoral areas, without interfering with drug plasma/cerebrospinal fluid concentrations. The NGR-hTNF/R-CHOP combination was well tolerated: there were only 2 serious adverse events, and grade 4 toxicity was almost exclusively hematological, which were resolved without dose reductions or interruptions. NGR-hTNF/R-CHOP was active, with 9 confirmed responses (75%; 95% confidence interval, 51-99), 8 of which were complete. In conclusion, NGR-hTNF/R-CHOP was safe in these heavily pretreated patients. NGR-hTNF enhanced vascular permeability specifically in tumoral/peritumoral areas, which resulted in fast and sustained responses.
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Ferreri AJM, Holdhoff M, Nayak L, Rubenstein JL. Evolving Treatments for Primary Central Nervous System Lymphoma. Am Soc Clin Oncol Educ Book 2019; 39:454-466. [PMID: 31099614 DOI: 10.1200/edbk_242547] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary central nervous system (CNS) lymphoma (PCNSL) is an aggressive form of non-Hodgkin lymphoma that remains confined to the CNS neuroaxis during its natural history of disease and is therefore considered stage IE disease. PCNSL is diffuse large B-cell lymphoma (DLBCL) morphology in more than 95% of patients and is designated primary diffuse large B-cell lymphoma of the CNS on the basis of the 2017 World Health Organization classification of hematopoietic and lymphoid tumors. Rapidly evolving therapeutic paradigms have been linked to evidence of progress in PCNSL, a disease long considered to be incurable. Increasing evidence supports the need for efficient diagnosis, staging, and initiation of therapy, ideally at centers with experience with this type of brain cancer. High-dose methotrexate (MTX) remains a cornerstone of induction regimens, and most data support the use of rituximab. However, clinical research challenges must address key questions, including the development of ever more effective and less toxic induction regimens and the selection of the most appropriate and effective consolidation approaches, as well as the fact that, increasingly, PCNSL affects older patients who do not tolerate strong genotoxic irradiation or high-dose chemotherapy (HDC)-based strategies. Maintenance therapy, immunotherapy, and the implementation of targeted agents on the basis of the molecular and biologic properties of the disease create opportunities for precision medicine and the potential for long-term disease-free survival and cure, with minimal treatment-related neurotoxicity, for a greater fraction of patients.
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Affiliation(s)
- Andrés J M Ferreri
- 1 Lymphoma Unit, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Matthias Holdhoff
- 2 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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Chen C, Sun P, Cui J, Yan S, Chen H, Xia Y, Bi X, Liu P, Wang Y, Yang H, Nie M, Zhang XW, Jiang W, Li ZM. High-dose Methotrexate plus temozolomide with or without rituximab in patients with untreated primary central nervous system lymphoma: A retrospective study from China. Cancer Med 2019; 8:1359-1367. [PMID: 30821418 PMCID: PMC6488123 DOI: 10.1002/cam4.1906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/03/2018] [Accepted: 11/14/2018] [Indexed: 12/18/2022] Open
Abstract
The purpose of this retrospective study was to compare the efficacy and toxicity of high-dose methotrexate plus temozolomide (MT regimen) and rituximab plus MT (RMT regimen) in patients with untreated primary central nervous system lymphoma (PCNSL). A total of 62 patients with untreated PCNSL were enrolled between January 2005 and December 2015, with the median age of 53.5 years (range 29-77).In this study, 32 patients received RMT as induction therapy, and 30 received MT. Objective responses were noted in 93.7% of the patients in the RMT group and in 69.0% of the patients in the MT group (P = 0.018), while complete responses were noted in 53.2% of the patients in the RMT group and 27.6% of the patients in the MT group (P < 0.001). The 2- and 5-year PFS rates were 81.3% and 53.3%, respectively, for the RMT group and 46.5% and 29.1%, respectively, for the MT group (P = 0.019). The 2- and 5-year overall survival (OS) rates were 82.3% and 82.3%, respectively, for the RMT group and 65.7% and 50.0%, respectively, for the MT group (P = 0.015). Multivariate analyses showed that therapeutic regimen (RMT vs MT) was an independent prognostic factor for PFS and OS. Our encouraging results suggest that the RMT regimen may be a feasible and safe therapeutic approach for first-line treatment of PCNSL.
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Affiliation(s)
- Cui Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Oncology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Peng Sun
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Juan Cui
- Ward One, Department of Chemotherapy, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Shumei Yan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hao Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yi Xia
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiwen Bi
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Panpan Liu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hang Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Man Nie
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xue-Wen Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenqi Jiang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Ming Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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38
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Chen F, Guo H, Mao C, Jiang X, Liu S, Huang L, Wei X, Liang Z, Zhou D, Li W. Unusual Relapse of Primary Central Nervous System Lymphoma Both Inside and Outside Central Nervous System in Patient with Ventriculoperitoneal Shunt. World Neurosurg 2019; 127:625-628. [PMID: 30794971 DOI: 10.1016/j.wneu.2019.01.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Relapse of primary central nervous system (CNS) lymphoma (PCNSL) occurs primarily at the initial site. Relapse outside the CNS is rare. CASE DESCRIPTION We present the case of a 62-year-old immunocompetent man who underwent a stereotactic biopsy to diagnose PCNSL and subsequent placement of ventriculoperitoneal shunt (VPS) for symptom relief in November 2012. He got complete remission after 6 cycles of high-dose methotrexate-based chemotherapy. In August 2017, relapse of lymphoma occurred in the abdomen, left basal ganglia, and bilateral ventricle with the largest lesion being around the VPS in the abdomen. He got complete remission after 6 cycles of R-CHOP (rituximab, cyclophosphamide, epirubicin, vincristine and prednisolone) plus 8 cycles of high-dose methotrexate chemotherapy. CONCLUSIONS Here we report the first case of extra-CNS relapse of PCNSL around the site of VPS in the abdomen after intensive chemotherapy. Neurosurgeons should be aware of a potential risk of PCNSL spread along the VPS.
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Affiliation(s)
- Feili Chen
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Hanguo Guo
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Chengliang Mao
- Neurosurgery Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Xinmiao Jiang
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Sichu Liu
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Ling Huang
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Xiaojuan Wei
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Zhanli Liang
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Dong Zhou
- Neurosurgery Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Wenyu Li
- Lymphoma Division, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China.
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39
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Ibrutinib for the treatment of Bing-Neel syndrome: a multicenter study. Blood 2019; 133:299-305. [DOI: 10.1182/blood-2018-10-879593] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/29/2018] [Indexed: 11/20/2022] Open
Abstract
Abstract
The treatment of patients with Bing-Neel syndrome (BNS) is not standardized. We included patients with Waldenström macroglobulinemia (WM) and a radiologic and/or cytologic diagnosis of BNS treated with ibrutinib monotherapy. Response assessment was based on criteria for BNS from the 8th International Workshop for WM. Survival from BNS diagnosis (BNS survival), survival from ibrutinib initiation to last follow-up or death (ibrutinib survival), and time from ibrutinib initiation to ibrutinib discontinuation for toxicity, progression, or death (event-free survival [EFS]) were estimated. Twenty-eight patients were included in our study. The median age at BNS diagnosis was 65 years. Ibrutinib was the first line of treatment for BNS in 39% of patients. Ibrutinib was administered orally at a dose of 560 and 420 mg once daily in 46% and 54% of patients, respectively; symptomatic and radiologic improvements were seen in 85% and 60% of patients within 3 months of therapy. At best response, 85% of patients had improvement or resolution of BNS symptoms, 83% had improvement or resolution of radiologic abnormalities, and 47% had cleared the disease in the cerebrospinal fluid. The 2-year EFS rate with ibrutinib was 80% (95% confidence interval [CI], 58%-91%), the 2-year ibrutinib survival rate was 81% (95% CI, 49%-94%), and the 5-year BNS survival rate was 86% (95% CI, 63%-95%). Ibrutinib therapy is effective in patients with BNS and should be considered as a treatment option in these patients.
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40
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Hu NN, Zhang MM, Chen YY, Zhu BL. Primary central nervous system lymphoma with no enhancement initially and no significant progression over a long term: a case report and review of the literature. Int J Neurosci 2018; 129:303-307. [PMID: 30207801 DOI: 10.1080/00207454.2018.1523159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ning-ning Hu
- Department of Medicine, First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Man-man Zhang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan-yan Chen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bei-lei Zhu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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41
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Mao C, Chen F, Li Y, Jiang X, Liu S, Guo H, Huang L, Wei X, Liang Z, Li W, Tang K. Characteristics and Outcomes of Primary Central Nervous System Lymphoma: A Retrospective Study of 91 Cases in a Chinese Population. World Neurosurg 2018; 123:e15-e24. [PMID: 30326304 DOI: 10.1016/j.wneu.2018.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare disease affecting the brain, leptomeninges, spinal cord, cerebrospinal fluid, or vitreoretinal compartment, without evidence of systemic disease. Prognosis is still poor after intensive methotrexate-based chemotherapy. METHODS Clinical data of 91 patients treated in a tertiary referral center during a 13-year period were retrospectively reviewed. RESULTS The estimated median progression-free survival and overall survival (OS) for the entire cohort were 39.1 months (95% confidence interval [CI], 14.1-64.0 months) and 54.5 months (95% CI, 28.9-80.1 months), respectively. Estimated 5-year progression-free survival and OS were 37.0% ± 6.5% and 47.5% ± 7.5%. Survival was associated with cycles of methotrexate only in multivariate analysis. Seventy-four patients received methotrexate-based chemotherapy after diagnosis. Thirty-nine patients experienced disease progression. Patients with relapsed/refractory disease had a poor survival, with median second OS (calculated from the date of first disease progression to the time of death from any cause) being 7.2 months (95% CI, 2.5-12.00 months). Three patients responded to ibrutinib after disease progression and incurred no fungal infection. CONCLUSIONS The outcomes of patients with PCNSL treated in our cohort are still poor. Relapse or refractory PCNSL and those not tolerating aggressive chemotherapy urgently require new approaches to improve their still dismal prognosis. Novel agents such as ibrutinib have shown promising clinical activity. Future studies should focus on the predictive biomarkers for the treatment of PCNSL with novel agents to provide precision medicine for PCNSL.
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Affiliation(s)
- Chengliang Mao
- Division of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Feili Chen
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yanwen Li
- Division of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xinmiao Jiang
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Sichu Liu
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hanguo Guo
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ling Huang
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiaojuan Wei
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zhanli Liang
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wenyu Li
- Division of Lymphoma, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Kai Tang
- Division of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
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42
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Peña C, Russo M, Martinez V, Cabrera ME. Extranodal lymphomas in the public health system in Chile: Analysis of 1251 patients from the National Adult Cancer Program. Hematol Oncol 2018; 37:47-53. [PMID: 30117170 DOI: 10.1002/hon.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/26/2018] [Accepted: 06/30/2018] [Indexed: 12/17/2022]
Abstract
The aim of the study was to describe the clinical and epidemiological characteristics, anatomic and histologic distribution, and treatment results of extranodal lymphomas (ENLs), diagnosed and treated in the public health system in Chile. We included patients with ENL diagnosed from 1998 to 2014, in 17 cancer centers, registered prospectively in the database of the National Adult Cancer Program (PANDA) of the Ministry of Health. Treatment was based on the local protocols for each lymphoma subtype. Extranodal lymphoma was documented in 1215 of 4907 non-Hodgkin lymphomas diagnosed in that period (25%). Median age was 59 years (range, 16-95), and 55% were female. The gastrointestinal (GI) tract was the most common location (38%), followed by the head and neck (24%) and the skin (15%). B-cell lymphomas accounted for 78% of cases, diffuse large B-cell lymphoma being the most common histologic subtype (68%). Mycosis fungoides/Sezary syndrome was the most frequent T-cell subtype (36%), followed by NK/T-cell lymphomanasal type (24%). In comparison with western countries, Chile showed a significantly high prevalence of NK/T-cell lymphoma nasal type, while the frequency of B-cell ENL and the anatomic distribution appeared similar, being GI the most commonly involved site.
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Affiliation(s)
- Camila Peña
- Medicine Service, Hematology Section, Hospital del Salvador, Santiago, Chile
| | - Moises Russo
- Radiation Oncology, Fundación Arturo Lopez Perez, Faculty of Medicine, Diego Portales University, Santiago, Chile
| | | | - Maria Elena Cabrera
- Medicine Service, Hematology Section, Hospital del Salvador, University of Chile, Santiago, Chile
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