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Taranto EP, Barta SK, Bhansali RS. Central Nervous System Relapse in T and NK cell Lymphomas. Curr Hematol Malig Rep 2023; 18:243-251. [PMID: 37620711 DOI: 10.1007/s11899-023-00710-x] [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] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW T and NK cell lymphomas are relatively rare and heterogeneous forms of non-Hodgkin lymphoma that are associated with high rates of mortality. Central nervous system relapse carries significant morbidity, though management is largely extrapolated from literature in B cell neoplasms. As such, outcomes for central nervous system involvement in T/NK cell lymphomas are dismal with no standard of care. In this review, we discuss the epidemiology of central nervous system relapse in T/NK cell lymphomas and critically analyze available literature regarding prophylaxis and treatment. RECENT FINDINGS Retrospective studies of central nervous system involvement in T/NK cell lymphomas have been limited by small sample sizes and heterogeneity of subtypes, though sites of extranodal involvement and disease subtypes are consistently reported as risk factors. Compelling evidence for the use of central nervous system-directed prophylactic therapy has not yet been established, though recent reports of central nervous system activity with novel agents may suggest promising therapeutic options. The overall rarity of T and NK cell lymphomas has precluded adequate study of prophylaxis and treatment of central nervous system relapse. Collaborative efforts are needed to better define strategies to address CNS disease in T/NK cell lymphomas. These should involve the use of targeted agents, which may hold an advantage over traditional cytotoxic drugs.
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Affiliation(s)
- Eleanor P Taranto
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Stefan K Barta
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rahul S Bhansali
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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2
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Modvig S, Jeyakumar J, Marquart HV, Christensen C. Integrins and the Metastasis-like Dissemination of Acute Lymphoblastic Leukemia to the Central Nervous System. Cancers (Basel) 2023; 15:cancers15092504. [PMID: 37173970 PMCID: PMC10177281 DOI: 10.3390/cancers15092504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) disseminates with high prevalence to the central nervous system (CNS) in a process resembling aspects of the CNS surveillance of normal immune cells as well as aspects of brain metastasis from solid cancers. Importantly, inside the CNS, the ALL blasts are typically confined within the cerebrospinal fluid (CSF)-filled cavities of the subarachnoid space, which they use as a sanctuary protected from both chemotherapy and immune cells. At present, high cumulative doses of intrathecal chemotherapy are administered to patients, but this is associated with neurotoxicity and CNS relapse still occurs. Thus, it is imperative to identify markers and novel therapy targets specific to CNS ALL. Integrins represent a family of adhesion molecules involved in cell-cell and cell-matrix interactions, implicated in the adhesion and migration of metastatic cancer cells, normal immune cells, and leukemic blasts. The ability of integrins to also facilitate cell-adhesion mediated drug resistance, combined with recent discoveries of integrin-dependent routes of leukemic cells into the CNS, have sparked a renewed interest in integrins as markers and therapeutic targets in CNS leukemia. Here, we review the roles of integrins in CNS surveillance by normal lymphocytes, dissemination to the CNS by ALL cells, and brain metastasis from solid cancers. Furthermore, we discuss whether ALL dissemination to the CNS abides by known hallmarks of metastasis, and the potential roles of integrins in this context.
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Affiliation(s)
- Signe Modvig
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Jenani Jeyakumar
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Hanne Vibeke Marquart
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Claus Christensen
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
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3
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Bhansali RS, Barta SK. Central Nervous System Progression/Relapse in Mature T- and NK-Cell Lymphomas. Cancers (Basel) 2023; 15:925. [PMID: 36765882 PMCID: PMC9913807 DOI: 10.3390/cancers15030925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Non-Hodgkin lymphomas (NHL) are cancers of mature B-, T-, and NK-cells which display marked biological heterogeneity between different subtypes. Mature T- and NK-cell neoplasms are an often-aggressive subgroup of NHL and make up approximately 15% of all NHL. Long-term follow up studies have demonstrated that patients with relapsed/refractory disease have dismal outcomes; in particular, secondary central nervous system (CNS) involvement is associated with higher mortality, though it remains controversial whether this independently confers worse outcomes or if it simply reflects more aggressive systemic disease. Possible risk factors predictive of CNS involvement, such as an elevated lactate dehydrogenase and more than two sites of extranodal involvement, may suggest the latter, though several studies have suggested that discrete sites of anatomic involvement or tumor histology may be independent risk factors as well. Ultimately, small retrospective case series form the basis of our understanding of this rare but devastating event but have not yet demonstrated a consistent benefit of CNS-directed prophylaxis in preventing this outcome. Nonetheless, ongoing efforts are working to establish the epidemiology of CNS progression/relapse in mature T- and NK-cell lymphomas with the goal of identifying clinicopathologic risk factors, which may potentially help discern which patients may benefit from CNS-directed prophylactic therapy or more aggressive systemic therapy.
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Affiliation(s)
| | - Stefan K. Barta
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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4
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Rezkallah EMN, Hanna RS, Elsaify WM. Adrenal Lymphoma: Case Reports and Mini-review. Int J Endocrinol Metab 2022; 20:e128386. [PMID: 36714190 PMCID: PMC9871959 DOI: 10.5812/ijem-128386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Adrenal lymphoma is a rare condition which may occur in one of two forms; either as primary adrenal lymphoma (PAL), or secondary to a systemic lymphoma. Primary adrenal lymphoma is a very rare diagnosis and the most common histological pattern is diffuse large B-cell non‑Hodgkin lymphoma. OBJECTIVES In this study, we represent two examples of adrenal lymphoma, primary and secondary. In addition, we have included a mini-review of the literature regarding this rare presentation. PATIENTS AND METHODS We retrospectively reviewed all patients who were diagnosed with adrenal lymphoma in our hospital. We represent mainly the most two challenging cases where adrenal surgery was required to confirm the diagnosis. We have included a mini-review of the literature (PubMed data base: 1990 - 2020) on the clinical presentation and management of adrenal lymphoma cases. RESULTS Seventeen patients had adrenal lymphoma in our hospital; 16 of them had secondary involvement of the adrenal gland, while the last one had primary adrenal lymphoma. Patients with adrenal lymphoma mainly present with fever, lumbar pain, and/or symptoms of adrenal insufficiency. Primary adrenal lymphoma usually appears as heterogeneous complex large masses with low density on computerized tomography (CT) scan or magnetic resonance imaging (MRI); however, there is no pathognomonic features to diagnose PAL. The diagnosis is confirmed only with tissue biopsy. Chemotherapy is generally the standard treatment for lymphoma, while the role of surgery is limited. CONCLUSIONS The prognosis of these rare cases is generally poor with only about a third of patients achieving partial or complete remission following treatment.
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Affiliation(s)
| | - Ragai Sobhi Hanna
- General Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Wael Magdy Elsaify
- General Surgery Department, James Cook University Hospital, Middlesbrough, England
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5
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Ho G, Tan C, de Mel S, Poon L, Chan EHL, Lee J, Liu X, Chng WJ, Chee YL, Soon YY, Jeyasekharan AD. Central nervous system (CNS) prophylaxis in antiCD20-CHOP treated DLBCL at intermediate to high risk for CNS relapse: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021; 167:103507. [PMID: 34656744 DOI: 10.1016/j.critrevonc.2021.103507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/10/2021] [Indexed: 12/27/2022] Open
Abstract
CNS prophylaxis is commonly used in Diffuse Large B-Cell Lymphoma (DLBCL) patients with risk features for CNS relapse. This systematic review and meta-analysis compares CNS relapse rates with and without CNS prophylaxis, for patients at intermediate to high CNS relapse risk. Studies reporting CNS relapse risk category and CNS outcomes with and without CNS prophylaxis for antiCD20-CHOP treated DLBCL patients were included. 10 studies with 3770 patients at intermediate to high CNS relapse risk were analyzed. No significant difference in the pooled Absolute Risk Difference (ARD 0.01, 95 % CI -0.01 to 0.02, P = 0.61) or Risk (RR 1.22, 95 % CI 0.81-1.83, P = 0.34) was noted in patients with and without CNS prophylaxis. There were also no differences within pre-specified subgroups of IV Methotrexate or IT chemotherapy. However, the quality of evidence supporting these observations was low. A meta-analysis of individual patient data will help evaluate the benefit of CNS prophylaxis strategies.
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Affiliation(s)
- Guiyi Ho
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Cherie Tan
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Sanjay de Mel
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Limei Poon
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Esther H L Chan
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Joanne Lee
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Xin Liu
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Wee Joo Chng
- Department of Haematology-Oncology, National University Hospital, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Hospital, Singapore.
| | - Anand D Jeyasekharan
- Department of Haematology-Oncology, National University Hospital, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore.
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6
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Timing of high-dose methotrexate CNS prophylaxis in DLBCL: an analysis of toxicity and impact on R-CHOP delivery. Blood Adv 2021; 4:3586-3593. [PMID: 32761231 DOI: 10.1182/bloodadvances.2020002421] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
High-dose methotrexate (HD-MTX) is increasingly used as prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) at high risk of central nervous system (CNS) relapse. However, there is limited evidence to guide whether to intercalate HD-MTX (i-HD-MTX) between R-CHOP-21 (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone given at 21-day intervals) or to give it at the end of treatment (EOT) with R-CHOP-21. We conducted a retrospective, multicenter analysis of 334 patients with DLBCL who received CNS prophylaxis with i-HD-MTX (n = 204) or EOT HD-MTX (n = 130). Primary end points were R-CHOP delay rates and HD-MTX toxicity. Secondary end points were CNS relapse rate, progression-free survival, and overall survival. The EOT group had more patients with a high CNS international prognostic index (58% vs 39%; P < .001) and more concurrent intrathecal prophylaxis (56% vs 34%; P < .001). Of the 409 cycles of i-HD-MTX given, 82 (20%) were associated with a delay of next R-CHOP (median, 7 days). Delays were significantly increased when i-HD-MTX was given after day 9 post-R-CHOP (26% vs 16%; P = .01). On multivariable analysis, i-HD-MTX was independently associated with increased R-CHOP delays. Increased mucositis, febrile neutropenia, and longer median inpatient stay were recorded with i-HD-MTX delivery. Three-year cumulative CNS relapse incidence was 5.9%, with no differences between groups. There was no difference in survival between groups. We report increased toxicity and R-CHOP delay with i-HD-MTX compared with EOT delivery but no difference in CNS relapse or survival. Decisions on HD-MTX timing should be individualized and, where i-HD-MTX is favored, we recommend scheduling before day 10 of R-CHOP cycles.
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Abstract
Central nervous system lymphoma (CNSL) is a rare form of extranodal non-Hodgkin lymphoma. Central nervous system lymphoma can be primary (isolated to the central nervous space) or secondary in the setting of systemic disease. Treatment of CNSL has improved since the introduction of high-dose methotrexate and aggressive consolidation regimens. However, results after treatment are durable in only half of patients, and long-term survivors may experience late neurotoxicity, impacting quality of life. Given the rarity of this disease, few randomized prospective trials exist. This leaves many questions unanswered regarding optimal first-line and salvage treatments. Recent advances in the knowledge of pathophysiology of CNSL will hopefully help the development of future treatments. This review gives an overview of the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of immunocompetent patients with CNSL.
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Al Feghali KA, Fang P, Gule-Monroe M, Milgrom S, Khoury JD, Gunther JR, Sheu T, Nair R, Ahmed S, Steiner R, Strati P, Shpall EJ, Nieto YL, Hosing C, Nastoupil LJ, Westin JR, Neelapu SS, Fowler N, Flowers C, Pinnix CC, Dabaja BS. Prognostic value of disease distribution in secondary central nervous system diffuse large B cell lymphoma treated with radiation therapy. Leuk Lymphoma 2021; 62:2400-2407. [PMID: 33942701 DOI: 10.1080/10428194.2021.1919656] [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: 10/21/2022]
Abstract
This study aimed to assess the prognostic value of baseline disease distribution for patients with the secondary central nervous system (CNS) diffuse large B-cell lymphoma (DLBCL) treated with chemotherapy and radiation (RT). 44 patients with secondary CNS DLBCL were reviewed. Twenty patients had leptomeningeal disease (LMD), and 24 had localized/targetable disease (LTD). Of 8 patients who received stem cell transplantation (SCT) after RT, 6 had LTD with a complete or partial response after RT. Median time to CNS relapse after RT was 10.1 months; 3/24 patients with LTD and 5/15 with LMD had CNS relapse. The median overall survival (OS) was 8 and 20 months for patients with LMD and LTD, respectively (p = 0.20). On multivariable analysis, LTD, receipt of SCT, and response after RT were associated with better OS and CNS-disease-free survival. Patients with localized secondary CNS DLBCL may benefit from RT serving as a bridge to SCT.
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Affiliation(s)
| | - Penny Fang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sarah Milgrom
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Joseph D Khoury
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Tommy Sheu
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Ranjit Nair
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sairah Ahmed
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raphael Steiner
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Strati
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Yago L Nieto
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra Hosing
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jason R Westin
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan Fowler
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chelsea C Pinnix
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Walburn T, Grover NS, Shen CJ, Ranganathan R, Dittus C, Beaven AW, Wang AZ, Wang K. Consolidative or palliative whole brain radiation for secondary CNS diffuse large B-Cell lymphoma. Leuk Lymphoma 2020; 62:68-75. [PMID: 32935601 DOI: 10.1080/10428194.2020.1821014] [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] [Indexed: 01/05/2023]
Abstract
We analyzed 25 patients receiving whole brain radiation (WBRT) for secondary CNS lymphoma (SCNSL), grouped by consolidative intent (after complete/partial response, n = 13) vs. palliative intent (initial CNS treatment, primary refractory disease, or CNS progression, n = 12). Median WBRT dose for the consolidative and palliative cohorts were 24 Gy and 30 Gy, respectively. For 13 patients receiving consolidative WBRT, median OS was 24 months from WBRT and 2-year OS was 64%. Three patients had CNS relapse at 2, 9, and 24 months after consolidative WBRT. For 12 patients receiving palliative WBRT, median OS was 3 months from WBRT and two-year OS was 8%. All 10 patients with neurologic symptoms had documented improvement. In conclusion, consolidative WBRT after chemotherapy response led to reasonable long-term survival and may be an effective strategy for SCNSL, especially transplant-ineligible patients and/or isolated CNS recurrence. Palliative WBRT effectively improved neurologic symptoms, but survival was usually only months.
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Affiliation(s)
- Tyler Walburn
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Natalie S Grover
- Department of Medicine, Division of Hematology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Raghuveer Ranganathan
- Department of Medicine, Division of Hematology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Christopher Dittus
- Department of Medicine, Division of Hematology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Anne W Beaven
- Department of Medicine, Division of Hematology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Andrew Z Wang
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
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10
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McKay P, Wilson MR, Chaganti S, Smith J, Fox CP, Cwynarski K. The prevention of central nervous system relapse in diffuse large B-cell lymphoma: a British Society for Haematology good practice paper. Br J Haematol 2020; 190:708-714. [PMID: 32433789 DOI: 10.1111/bjh.16866] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Pamela McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Matthew R Wilson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Jeffery Smith
- Department of Haematology, Aintree University Hospital, Liverpool, UK
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Cancer and Stem Cells, University of Nottingham, Nottingham, UK
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
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11
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Kuitunen H, Kaprio E, Karihtala P, Makkonen V, Kauppila S, Haapasaari KM, Kuusisto M, Jantunen E, Turpeenniemi-Hujanen T, Kuittinen O. Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma. Ann Hematol 2020; 99:1823-1831. [PMID: 32577843 PMCID: PMC7340636 DOI: 10.1007/s00277-020-04140-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/10/2020] [Indexed: 12/22/2022]
Abstract
Although overall survival in diffuse large B cell lymphomas (DLBCL) has improved, central nervous system (CNS) relapse is still a fatal complication of DLBCL. For this reason, CNS prophylaxis is recommended for patients at high risk of CNS disease. However, no consensus exists on definition of high-risk patient and optimal CNS prophylaxis. Systemic high-dose methotrexate in combination with R-CHOP has been suggested as a potential prophylactic method, since methotrexate penetrates the blood-brain barrier and achieves high concentration in the CNS. In this retrospective analysis, we report treatment outcome of 95 high-risk DLBCL/FL grade 3B patients treated with R-CHOP or its derivatives with (N = 57) or without (N = 38) CNS prophylaxis. At a median follow-up time (51 months), CNS relapses were detected in twelve patients (12.6%). Ten out of twelve (83%) of CNS events were confined to CNS system only. Median overall survival after CNS relapse was 9 months. Five-year isolated CNS relapse rates were 5% in the prophylaxis group and 26% in the group without prophylaxis. These findings suggest that high-dose methotrexate-containing prophylaxis decreases the risk of CNS failure.
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Affiliation(s)
- Hanne Kuitunen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Elina Kaprio
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland. .,Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
| | - Peeter Karihtala
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O. Box 100, FI-00029, Helsinki, Finland
| | - Ville Makkonen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,The North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Saila Kauppila
- Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Medical Research Center, Department of Pathology, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Kirsi-Maria Haapasaari
- Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Medical Research Center, Department of Pathology, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Milla Kuusisto
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,The North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Taina Turpeenniemi-Hujanen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Outi Kuittinen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.,Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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12
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Wang W, Zhang Y, Zhang L, Yang C, Feng J, Cai H, Chen M, Cao X, Zhuang J, Zhu T, Duan M, Zhang W, Li J, Zhou D. Intravenous methotrexate at a dose of 1 g/m 2 incorporated into RCHOP prevented CNS relapse in high-risk DLBCL patients: A prospective, historic controlled study. Am J Hematol 2020; 95:E80-E83. [PMID: 31925808 DOI: 10.1002/ajh.25723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/09/2019] [Accepted: 01/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Wei Wang
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Yan Zhang
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Lu Zhang
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Chen Yang
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Jun Feng
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Huacong Cai
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Miao Chen
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Xinxin Cao
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Junling Zhuang
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Tienan Zhu
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Minghui Duan
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Wei Zhang
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Jian Li
- Department of Hematology Peking Union Medical College Hospital Beijing China
| | - Daobin Zhou
- Department of Hematology Peking Union Medical College Hospital Beijing China
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13
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Kohn M, Karras A, Zaidan M, Bénière C, de Fréminville JB, Laribi K, Perrin MC, Malphettes M, Le Calloch R, Anglaret B, Martiniuc J, Bailly S, Chevret S, Molina T, Thervet E, Thieblemont C. Lymphomas with kidney involvement: the French multicenter retrospective LyKID study. Leuk Lymphoma 2020; 61:887-895. [PMID: 32037948 DOI: 10.1080/10428194.2019.1697811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The LyKID study is a nationwide survey in France of lymphoma patients with renal involvement based on biopsy and/or imaging, to evaluate its impact on disease outcome and renal function. A total of 87 adult cases of B or T-cell lymphomas were retrospectively analyzed. Interstitial topography was observed in most of the kidney biopsies (54/66; 80%). Kidney failure (glomerular filtration rate <60 mL/min/1.73 m2) was present in 47% of patients and was associated with non-significantly different outcome. After lymphoma treatment, 44% of patients had persistent chronic kidney failure (CKF); kidney failure at diagnosis was the only parameter associated with CKF in multivariate analysis. DLBCL (diffuse large B-cell lymphomas) represented half of the series, with noticeably CNS (central neurological system) relapse in 17% patients, while fewer than one of two patients had received CNS prophylaxis. To our knowledge, the LyKID study represents the largest published non-autopsy lymphoma series with renal involvement.
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Affiliation(s)
- Milena Kohn
- Hémato-Oncologie, APHP, Hôpital Saint-Louis, Paris, France
| | - Alexandre Karras
- Néphrologie, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | | | | | | | | | | | - Marion Malphettes
- Immuno-Pathologie Clinique, APHP, Hôpital Saint-Louis, Paris, France
| | - Ronan Le Calloch
- Service des Maladies du Sang, Médecine Interne, Maladies Infectieuses, CH de Quimper Cornouailles, Quimper, France
| | | | | | - Sarah Bailly
- Hématologie, Cliniques Universitaires Saint Luc Université catholique de Louvain, Bruxelles, Belgium
| | - Sylvie Chevret
- Biostatistiques, APHP, Hôpital Saint-Louis, Paris, France
| | | | - Eric Thervet
- Néphrologie, APHP, Hôpital Européen Georges Pompidou, Paris, France
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Hutchings M, Ladetto M, Buske C, de Nully Brown P, Ferreri AJM, Pfreundschuh M, Schmitz N, Balari AS, van Imhoff G, Walewski J. ESMO Consensus Conference on malignant lymphoma: management of 'ultra-high-risk' patients. Ann Oncol 2019; 29:1687-1700. [PMID: 29924296 DOI: 10.1093/annonc/mdy167] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on malignant lymphoma was held on 20 June 2015 in Lugano, Switzerland, and included a multidisciplinary panel of 25 leading experts. The aim of the conference was to develop recommendations on critical subjects difficult to consider in detail in the ESMO Clinical Practice Guidelines. The following areas were identified: (1) the elderly patient, (2) prognostic factors suitable for clinical use and (3) the 'ultra-high-risk' group. Before the conference, the expert panel was divided into three working groups; each group focused on one of these areas in order to address clinically relevant questions relating to that topic. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, each working group developed recommendations to address each of the questions devised by their group. These recommendations were then presented to the entire multidisciplinary panel and a consensus was reached. This manuscript presents recommendations regarding the management of the following 'ultra-high-risk' situations: (1) early central nervous system relapse of diffuse large B-cell lymphoma, (2) primary refractory Hodgkin lymphoma and (3) plasmablastic lymphoma. Results, including a summary of evidence supporting each recommendation, are detailed in this manuscript. All expert panel members approved this final article.
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Affiliation(s)
- M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
| | - M Ladetto
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - C Buske
- Comprehensive Cancer Center Ulm and Department of Internal Medicine III, Institute of Experimental Cancer Research University Hospital, Ulm, Germany
| | | | - A J M Ferreri
- Department of Onco-Hematology Medicine, Unit of Lymphoid Malignancies, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Pfreundschuh
- Innere Medizin I, University Klinik des Saarlandes, Hamburg, Germany
| | - N Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany
| | - A Sureda Balari
- Servei d'Hematologia, Institut Català d'Oncologia - Hospital Duran i Reynals, Barcelona, Spain
| | - G van Imhoff
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
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15
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Wu Y, Wang Y, Sun X, Bai X, Qian J, Zhu H, Cui Q, Xing R, Chen Y, Liu Q, Guo J, Ji N, Sun S, Liu Y. Parenchymal central nervous system involvement in aggressive B-cell lymphoma: retrospective analysis of clinical and MRI features in a Chinese population. BMC Neurol 2019; 19:268. [PMID: 31684888 PMCID: PMC6829840 DOI: 10.1186/s12883-019-1511-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Secondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. It is considered a profoundly adverse complication with inferior clinical outcome. Parenchymal involvement in the CNS in aggressive B-cell lymphoma is not frequently seen and remains a diagnostic dilemma. METHODS In our study, we retrospectively analyzed the clinical and magnetic resonance imaging (MRI) features of 26 parenchymal SCNSL patients. In addition, we compared MRI features of SCNSL and primary CNS lymphoma (PCNSL) patients after 1:1 propensity score matching. Also we presented two SCNSL cases with atypical MRI appearance. RESULTS Among SCNSL patients, the median CNS relapse time was 3 months, and multiple lesions were found in 76.9% of the cases. In PCNSL, this percentage was 42.3% (p = 0.011). None of the SCNSL patients and 23.1% of the PCNSL patients had solitary infratentorial lesions (p = 0.003). CONCLUSIONS The majority of parenchymal involvement occurred within the first year of systemic lymphoma, in which mostly cases presenting with multiple and supratentorial locations, unlike what was found in PCNSL.
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Affiliation(s)
- Yuchen Wu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Yaming Wang
- Department of Neurosurgery, Navy General Hospital of PLA, Beijing, China
| | - Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Xueyan Bai
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Jun Qian
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Hong Zhu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Qu Cui
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Ruixian Xing
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Yuedan Chen
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Qing Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Jiayuan Guo
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China.
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16
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Santambrogio E, Nicolosi M, Vassallo F, Castellino A, Novo M, Chiappella A, Vitolo U. Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence. Expert Rev Hematol 2019; 12:787-796. [DOI: 10.1080/17474086.2019.1643232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Elisa Santambrogio
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Maura Nicolosi
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Francesco Vassallo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alessia Castellino
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Mattia Novo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Annalisa Chiappella
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Umberto Vitolo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
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17
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Liu X, Mo F, Zeng H, Zhu S, Ma X. Quantitative proteomic analysis of cerebrospinal fluid from patients with diffuse large B-cell lymphoma with central nervous system involvement: A novel approach to diagnosis. Biomed Rep 2019; 11:70-78. [PMID: 31338193 PMCID: PMC6610216 DOI: 10.3892/br.2019.1222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/10/2019] [Indexed: 02/05/2023] Open
Abstract
The outcome of patients with diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) recurrence is poor. However, there is currently no consensus regarding diagnostic techniques. The aim of the present study was to investigate the cerebrospinal fluid (CSF) protein profile of DLBCL and identify a potential novel method for the early diagnosis of patients with DLBCL at high risk for subsequent CNS involvement. The CSF proteomic profiling of patients with DLBCL and a control group were compared using label-free liquid chromatography-tandem mass spectrometry. Gene Ontology and pathway analyses were conducted using the Database for Annotation, Visualization and Integrated Discovery. The protein interactions were analyzed using the Search Tool for the Retrieval of Interacting Genes/Proteins database. In the present study, a total of 53 differentially expressed proteins with >1 log2 fold change (false discovery rate <0.01, P<0.05) were identified and quantified. These proteins appeared to be involved in platelet degranulation, innate immune response and cell adhesion. Two hub gene network modules were obtained by protein-protein interaction network analysis. Of these proteins, secreted protein acidic and rich in cysteine (SPARC) and proenkephalin (PENK) were significantly decreased in the CSF of patients with DLBCL, which appeared to be correlated with CNS involvement. The findings of the present study indicate that decreased expression levels of SPARC and PENK in the CSF may serve as early-phase biomarkers to evaluate the risk of CNS involvement in patients with DLBCL, enabling clinicians to offer prophylactic therapy at the time of diagnosis.
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Affiliation(s)
- Xiaobei Liu
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Fei Mo
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hao Zeng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Sha Zhu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xuelei Ma
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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18
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Ban Y, Jing Z, Zou J. Multiple secondary cauda equina non-Hodgkin's lymphoma: a case report and literature review. BMC Cancer 2019; 19:594. [PMID: 31208357 PMCID: PMC6580493 DOI: 10.1186/s12885-019-5800-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Secondary central nervous system involvement of non-Hodgkin’s lymphoma (NHL) is rare and with poor prognosis, the most common pathological type is diffuse large B cell lymphoma (DLBCL). Although it can occur in any part of central nervous system, it rarely directly infiltrates the spinal cord or cauda equina. Case presentation We present the case of 64-year-old immunocompetent man with a worsening pain of waist and left lower extremity, accompanied by numbness and paresis of bilateral lower extremity for 20 days. His previous medical history included a resection of painless mass in the left groin in another hospital 7 months ago, and the pathological diagnosis was non-Hodgkin small B cell lymphoma. Gd-enhanced MRI and F-18 FDG PET-CT scan demonstrated multiple infiltrations in the cauda equina. During the operation, we removed as many as 11 subdural-extramedullary bean-size lesions involving multiple nerve roots. The paralysis of his left leg recovered rapidly after the operation. During the follow-up period of more than one year, he underwent standard R-CHOP chemical therapy, no evidence of recurrence was noted until the 13th month, the patient died because of intracranial relapse. Conclusions Imaging examination is important in the diagnosis of multiple secondary cauda equina non-Hodgkin’s lymphoma, and we highlight the significance of gadolinium-enhanced MRI and F-18 FDG-PET/CT in preoperative diagnosis as well as the previous history.
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Affiliation(s)
- Yunchao Ban
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Nanjingbei street 155, Heping District, Shenyang, China
| | - Zhitao Jing
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Nanjingbei street 155, Heping District, Shenyang, China
| | - Jingyu Zou
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Nanjingbei street 155, Heping District, Shenyang, China.
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19
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Godfrey JK, Nabhan C, Karrison T, Kline JP, Cohen KS, Bishop MR, Stadler WM, Karmali R, Venugopal P, Rapoport AP, Smith SM. Phase 1 study of lenalidomide plus dose-adjusted EPOCH-R in patients with aggressive B-cell lymphomas with deregulated MYC and BCL2. Cancer 2019; 125:1830-1836. [PMID: 30707764 DOI: 10.1002/cncr.31877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dual translocation of MYC and BCL2 or the dual overexpression of these proteins in patients with aggressive B-cell lymphomas (termed double-hit lymphoma [DHL] and double-expressor lymphoma [DEL], respectively) have poor outcomes after chemoimmunotherapy with the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Retrospective reports have suggested improved outcomes with dose-intensified regimens. In the current study, the authors conducted a phase 1 study to evaluate the feasibility, toxicity, and preliminary efficacy of adding lenalidomide to dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin with rituximab (DA-EPOCH-R) in patients with DHL and DEL. METHODS The primary objective of the current study was to determine the maximum tolerated dose of lenalidomide in combination with DA-EPOCH-R. A standard 3+3 design was used with lenalidomide administered on days 1 to 14 of each 21-day cycle (dose levels of 10 mg, 15 mg, and 20 mg). Patients attaining a complete response after 6 cycles of induction therapy proceeded to maintenance lenalidomide (10 mg daily for 14 days every 21 days) for 12 additional cycles. RESULTS A total of 15 patients were enrolled, 10 of whom had DEL and 5 of whom had DHL. Two patients experienced dose-limiting toxicities at a lenalidomide dose of 20 mg, consisting of grade 4 sepsis. The maximum tolerated dose of lenalidomide was determined to be 15 mg. The most common nonhematologic grade ≥3 adverse events included thromboembolism (4 patients; 27%) and hypokalemia (2 patients; 13%) (toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). The preliminary efficacy of the regimen was encouraging, especially in the DEL cohort, in which all 10 patients achieved durable and complete metabolic responses with a median follow-up of 24 months. CONCLUSIONS The combination of lenalidomide with DA-EPOCH-R appears to be safe and feasible in patients with DHL and DEL. These encouraging results have prompted an ongoing phase 2 multicenter study.
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Affiliation(s)
- James K Godfrey
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Chadi Nabhan
- Cardinal Health Specialty Solutions, Waukegan, Illinois
| | - Theodore Karrison
- Department of Health Studies, University of Chicago, Chicago, Illinois
| | - Justin P Kline
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Kenneth S Cohen
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Michael R Bishop
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Walter M Stadler
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Reem Karmali
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Parameswaran Venugopal
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University, Chicago, Illinois
| | - Aaron P Rapoport
- Blood and Marrow Transplant Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sonali M Smith
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
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20
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Allan JN, Van Besien K. It's not all about the CNS. High dose methotrexate in DLBCL. Leuk Lymphoma 2019; 60:1845-1847. [PMID: 31120336 DOI: 10.1080/10428194.2019.1613544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- John N Allan
- a Division of Hematology and Medical Oncology, Department of Medicine , New York-Presbyterian Hospital/Weill Cornell Medicine , New York , NY , USA
| | - Koen Van Besien
- a Division of Hematology and Medical Oncology, Department of Medicine , New York-Presbyterian Hospital/Weill Cornell Medicine , New York , NY , USA
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21
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Li JJ, Qiu BS, Chen JX, Liu DW, Xing SH, Chen HB, Zeng JS, Feng HY, Fan YH. Multiple cranial nerve deficits as preceding symptoms of systemic non-Hodgkin's lymphoma. CNS Neurosci Ther 2019; 25:409-411. [PMID: 30600649 PMCID: PMC6488885 DOI: 10.1111/cns.13097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jing-Jing Li
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bao-Shan Qiu
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Xin Chen
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Da-Wei Liu
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shi-Hui Xing
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong-Bing Chen
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jin-Sheng Zeng
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hui-Yu Feng
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Hua Fan
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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22
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Buchholtz ML, Bücklein V, Brendel M, Paal M. Superior vena cava syndrome related to mediastinal lymphoma in late pregnancy: A case report. Case Rep Womens Health 2018; 19:e00065. [PMID: 30094193 PMCID: PMC6071368 DOI: 10.1016/j.crwh.2018.e00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022] Open
Abstract
We report the initial diagnosis in a 28-year-old nulliparous woman of a primary mediastinal B-cell lymphoma in late pregnancy. For several weeks the patient had had symptoms of mediastinal obstruction, such as dyspnea, cough, swelling of the face and upper limbs. However, these symptoms had been misattributed to the pregnancy and a common cold. Due to a rapid decline in the patient's cardiovascular performance, she was transferred to the closest perinatal center in the 34th week of pregnancy, whereupon a cesarean section was performed. The diagnosis of a primary mediastinal B-cell lymphoma was made postpartum from a biopsy. This case emphasizes the importance of timely antenatal investigation in pregnant women with symptoms consistent with mediastinal obstruction. Thoracic ultrasonography can be a valuable tool for the detection of tumor-associated pleural and pericardial effusions. The incidence of primary mediastinal B-cell lymphoma (PMBCL) is disproportionately high in women of reproductive age. The diagnosis is made at a median age of 35 years. Physiological changes during pregnancy can mask mediastinal malignancies since both conditions share similar clinical signs. Symptoms of mediastinal obstruction during pregnancy should therefore lead to immediate diagnostic workup. Thoracic ultrasound examination can aid in the diagnosis of lymphoma-associated pleural and pericardial effusions.
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Affiliation(s)
- M L Buchholtz
- Institute of Laboratory Medicine, University Hospital, LMU, Munich, Germany
| | - V Bücklein
- Department of Internal Medicine III, University Hospital, LMU, Munich, Germany
| | - M Brendel
- Department of Nuclear Medicine, University Hospital, LMU, Munich, Germany
| | - M Paal
- Institute of Laboratory Medicine, University Hospital, LMU, Munich, Germany
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23
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Yang H, Li C, Chen Z, Mou H, Gu L. Determination of chidamide in rat plasma and cerebrospinal fluid. Regul Toxicol Pharmacol 2018; 98:24-30. [PMID: 30008379 DOI: 10.1016/j.yrtph.2018.07.001] [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: 02/28/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
Chidamide is a new subtype-selective histone deacetylase inhibitor (HDACi), which has been approved for the treatment of recurrent or refractory peripheral T-cell lymphoma (PTCL) in China. However, there are few studies about the application of chidamide in PTCL with central nervous system (CNS) involvement. It is essential to investigate the penetration of chidamide in the blood brain barrier (BBB). LC-MS methods were established firstly to determine the concentration of chidamide in rat plasma and CSF. Then five rats were anaesthetized and the plasma and CSF samples were collected at the time of 5, 15, 30, 60, 120, 180, 240, 360 and 480 min after being administered 1 mg/kg chidamide by intravenous injection, respectively. All samples were analyzed with the established LC-MS method by using the precursor/product transitions (m/z) of 391.1/265.1 for chidamide and 441.1/138.2 for internal standard (IS). The PK parameters were calculated after both of the concentrations of chidamide in plasma and CSF were determined. The penetration ratio of chidamide in BBB ranged from 0.19% to 0.67%. Result indicated chidamide could pass through the BBB, enter into the CNS and have the potential to be utilized in PTCL with CNS involvement.
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Affiliation(s)
- Haiyan Yang
- Chemotherapy Center, Zhejiang Province Cancer Hospital, 1 Banshandong Road, Gongshu District, Hangzhou, 310012, PR China
| | - Cong Li
- Chemotherapy Center, Zhejiang Province Cancer Hospital, 1 Banshandong Road, Gongshu District, Hangzhou, 310012, PR China
| | - Zhongjian Chen
- Zhejiang Cancer Research Institute, Zhejiang Province Cancer Hospital, 1 Banshandong Road, Gongshu District, Hangzhou, 310012, PR China
| | - Hanzhou Mou
- Zhejiang Cancer Research Institute, Zhejiang Province Cancer Hospital, 1 Banshandong Road, Gongshu District, Hangzhou, 310012, PR China.
| | - Liqiang Gu
- Center of Safety Evaluation, Zhejiang Academy of Medical Sciences, 587 Binkang Road, Binjiang District, Hangzhou, 310053, PR China; College of Pharmaceutical Science, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, PR China.
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Extranodal Diffuse Large B Cell Lymphoma: Molecular Features, Prognosis, and Risk of Central Nervous System Recurrence. Curr Treat Options Oncol 2018; 19:38. [PMID: 29931605 DOI: 10.1007/s11864-018-0555-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Diffuse large B cell lymphoma (DLBCL) arises from extranodal organs in about 30% of cases. Its prognosis and risk of recurrence in the central nervous system (CNS) vary according to the primary site of origin. Recent studies begin to clarify these differences using molecular classification. Testicular, breast, and uterine DLBCL (as well as possibly primary cutaneous DLBCL, leg-type) share a high prevalence of the non-germinal center B cell (non-GCB) phenotype and the MYD88/CD79B-mutated (MCD) genotype. These biologic features, which resemble primary CNS lymphoma, may underlie their stage-independent propensity for CNS involvement. Management of these lymphomas should involve CNS prophylaxis, preferably using systemic high-dose methotrexate to prevent intraparenchymal recurrence. Involvement of the kidneys, adrenal glands, ovary, bone marrow, lung, or pleura usually indicates disseminated disease, conferring worse prognosis. Involvement of these sites is often associated with high CNS-International Prognostic Index (IPI), concurrent MYC and BCL2 or BCL6 rearrangements, or intravascular lymphoma-risk factors warranting CNS prophylaxis. In contrast, craniofacial, thyroid, localized bone, or gastric lymphomas have a variable prevalence of the non-GCB phenotype and lack MYD88 mutations. Their outcomes with standard immunochemotherapy are excellent, and the risk of CNS recurrence is low. We recommend individualized consideration of CNS prophylaxis based on the CNS-IPI score and anatomical proximity in cases of epidural, orbital, or skull involvement. Rituximab-containing immunochemotherapy is a standard approach for all extranodal DLBCLs. Surgery is no longer required for any primary site, but routine consolidative radiation therapy is recommended for testicular lymphoma. Radiation therapy also appears to be associated with better progression-free survival in primary bone DLBCL. Future studies should better distinguish primary from secondary sites of extranodal involvement, and investigate the association of newly identified genotypes with the risk of CNS or systemic recurrence.
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Szczepanek D, Wąsik-Szczepanek E, Szymczyk A, Gromek T, Grywalska E, Podhorecka M, Hus M. Intraventricular treatment of secondary central nervous system lymphoma - Case study and literature overview. Neurol Neurochir Pol 2018; 52:410-414. [PMID: 29703403 DOI: 10.1016/j.pjnns.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/12/2017] [Accepted: 01/27/2018] [Indexed: 11/20/2022]
Abstract
Secondary nervous system lymphoma (SCNSL) is a rare extranodal form of non-Hodgkin lymphoma (NHL). This applies to a particular form of lymphoma that does not originally derive from the central nervous system (CNS); it can be both an isolated form of relapse or a systemic part of disease progression. Due to poor prognosis and a lack of established algorithms of therapeutic procedures, it is a big challenge for physicians from many specializations. In our study, we present an interesting case of a patient with a relapsed form of SCNSL for whom a unique form of treatment was used - intraventricular administration of rituximab and methotrexate.
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Affiliation(s)
- Dariusz Szczepanek
- Chair and Department of Neurosurgery and Paediatric Neurosurgery Medical University of Lublin, Poland
| | - Ewa Wąsik-Szczepanek
- Chair and Department of Haematooncology and Bone Marrow Transplantation Medical University of Lublin, Poland
| | - Agnieszka Szymczyk
- Chair and Department of Haematooncology and Bone Marrow Transplantation Medical University of Lublin, Poland; Independent Clinical Transplantology Unit Medical University of Lublin, Poland.
| | - Tomasz Gromek
- Chair and Department of Haematooncology and Bone Marrow Transplantation Medical University of Lublin, Poland
| | - Ewelina Grywalska
- Chair and Department of Clinical Immunology Medical University of Lublin, Poland
| | - Monika Podhorecka
- Chair and Department of Haematooncology and Bone Marrow Transplantation Medical University of Lublin, Poland
| | - Marek Hus
- Chair and Department of Haematooncology and Bone Marrow Transplantation Medical University of Lublin, Poland
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Murthy H, Anasetti C, Ayala E. Diagnosis and Management of Leukemic and Lymphomatous Meningitis. Cancer Control 2018; 24:33-41. [DOI: 10.1177/107327481702400105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hemant Murthy
- From the University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Claudio Anasetti
- From the University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ernesto Ayala
- From the University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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27
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Milgrom SA, Pinnix CC, Chi TL, Vu TH, Gunther JR, Sheu T, Fowler N, Westin JR, Nastoupil LJ, Oki Y, Fayad LE, Neelapu S, Rodriguez MA, Hagemeister FB, Fanale MA, Lee HJ, Hosing C, Ahmed S, Nieto Y, Shpall EJ, Dabaja BS. Radiation Therapy as an Effective Salvage Strategy for Secondary CNS Lymphoma. Int J Radiat Oncol Biol Phys 2018; 100:1146-1154. [PMID: 29452771 DOI: 10.1016/j.ijrobp.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE We assessed the efficacy of radiation therapy (RT) in the management of secondary central nervous system (CNS) lymphoma. METHODS AND MATERIALS The cohort comprised 44 patients with systemic diffuse large B-cell lymphoma (DLBCL) secondarily involving the brain and/or leptomeninges at initial diagnosis or relapse that was treated with RT. RESULTS Of these patients, 29 (66%) were in systemic remission when CNS disease was diagnosed. The overall response rate to RT by magnetic resonance imaging was 88% (42% complete, 46% partial). The median overall survival (OS) after RT initiation was 7 months (95% confidence interval 4-10 months). The OS curve plateaued at 31% from 2 to 8 years. OS was superior in patients who achieved a complete or partial response to RT, underwent stem cell transplantation after RT, and had brain parenchymal (vs leptomeningeal) disease. Eight cases of CNS disease progression occurred after RT: 1 involved the brain parenchyma, and 7 involved the spine and/or cerebrospinal fluid and/or meninges. CONCLUSIONS We conclude that RT is associated with high response rates and may contribute to long-term OS. In addition, RT may provide CNS disease control that facilitates successful salvage with stem cell transplantation in patients with chemotherapy-refractory disease.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - T Linda Chi
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thinh H Vu
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tommy Sheu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hun J Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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28
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Singh RB, Thakur S, Ichhpujani P, Kumar S. Ethics of a therapeutic trial: addressing limitations of an active intervention in optic nerve lymphoma. BMJ Case Rep 2018; 2018:bcr-2018-224217. [PMID: 29599383 DOI: 10.1136/bcr-2018-224217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a unique case of optic nerve lymphoma after completion of chemotherapy for non-Hodgkin's lymphoma. The uncommon nature of presentation, our therapeutic dilemma and the further course of treatment are reported. In cases with extremely poor prognosis, unnecessary treatment puts additional strain both financially and psychologically on the patients and their family. Therapeutic focus should be on hospice care and family counselling. The decision to not treat is a crucial component of cancer management; however, the ethics of this decision are yet to be suitably addressed by the literature.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Sahil Thakur
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, Punjab, India
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29
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Meng X, Yu J, Fan Q, Li L, Li W, Song Z, Liu X, Jiang Y, Gao M, Zhang H. Characteristics and outcomes of non-Hodgkin's lymphoma patients with leptomeningeal metastases. Int J Clin Oncol 2018; 23:783-789. [PMID: 29558001 PMCID: PMC6097078 DOI: 10.1007/s10147-018-1268-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/13/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Leptomeningeal metastasis is an uncommon but devastating complication. The incidence of non-Hodgkin's lymphoma has been increasing in recent decades, due to the poor central nervous system penetration of drugs and the prolonged overall survival of patients, leptomeningeal metastases has gradually increased over time. Patients with leptomeningeal metastases have short survival durations and poor quality of life; there are few studies about non-Hodgkin's lymphoma with leptomeningeal metastases. We investigated characteristics and outcomes of non-Hodgkin's lymphoma patients with leptomeningeal metastases. METHODS This study included 27 non-Hodgkin's lymphoma patients with leptomeningeal metastases diagnosed at Tianjin Medical University Cancer Institute and Hospital between 2013 and 2016. Statistical analysis was performed to investigate the overall survival of non-Hodgkin's lymphoma with leptomeningeal metastases. RESULTS Diffuse large B cell lymphoma was the most common cancer subtype (21/27, 78%), and more than half of the patients showed extranodal involvement (18/27, 67%). Survival analysis has shown extranodal involvement (P = 0.0205), International Prognostic Index (P = 0.0112), performance status (P < 0.0001), parenchymal involvement (P = 0.0330) and received radiotherapy (P = 0.0056) were predictive factors of prognosis for these patients with leptomeningeal metastases. Cox regression analysis has shown patients with concurrent parenchymal involvement and received radiotherapy are correlated with good prognosis. CONCLUSIONS Given the small number of patients who were included, this study exhibited limitations with respect to analytical power and the random selection of patients. Nevertheless, this investigation revealed characteristics of non-Hodgkin's lymphoma patients with leptomeningeal metastases and suggested that such patients could benefit from multimodal therapy.
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Affiliation(s)
- Xiangrui Meng
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Jingwei Yu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Qian Fan
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Lanfang Li
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Wei Li
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Zheng Song
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Xianming Liu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Yanyang Jiang
- Department of Social Science, Florida State University, Tallahassee, FL, 32306, USA
| | - Ming Gao
- Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China. .,Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China. .,Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.
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30
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Cabannes-Hamy A, Peyrade F, Jardin F, Emile JF, Delwail V, Mounier N, Haioun C, Perrot A, Fitoussi O, Lara D, Delarue R, André M, Offner F, Ghesquières H, Pascal L, Soussain C, Lazarovici J, Schiano JM, Gaulard P, Tilly H, Thieblemont C. Central nervous system relapse in patients over 80 years with diffuse large B-cell lymphoma: an analysis of two LYSA studies. Cancer Med 2018; 7:539-548. [PMID: 29473343 PMCID: PMC5852369 DOI: 10.1002/cam4.1139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 06/09/2017] [Indexed: 11/28/2022] Open
Abstract
CNS relapse is reported in 2–5% of diffuse large B‐cell lymphoma (DLBCL) patients, dramatically decreasing overall survival (OS). Very few studies address incidence and risk factors of CNS relapse in very elderly patients, a challenging population to treat given their commonly associated comorbidities. A retrospective analysis was performed of 270 DLBCL patients >80 years treated between 2004 and 2013 in two multicentre phase II LYSA trials (LNH03‐7B, LNH09‐7B) evaluating the addition of rituximab or ofatumumab to mini‐CHOP as front‐line therapy. No patients received CNS prophylaxis. CNS relapse was evaluated according to cumulative incidence, patient characteristics, risk factors, and survival. Median age was 83 years (range: 79–95). After a median follow‐up of 28.7 months, eight patients had CNS relapse (3.0%). Median time between inclusion and CNS relapse was 19.2 months (range: 3.2–32.6). Patients survived a median of 1.5 months after CNS relapse (range: 0.4–4.1). Median OS from relapse was significantly lower in CNS relapse patients (1.5 months, 95% CI: 0.4–3.5) compared to patients with non‐CNS relapse (6.6 months; 95% CI: 4.6–11.9). No baseline characteristics were associated with CNS relapse. The proportion of patients with CNS disease did not differ significantly between patients with low‐intermediate risk according to CNS‐IPI and patients with high risk (3% vs. 2.8%, P = 1.00). CNS relapse cumulative incidence in very elderly treatment‐naive patients is 1.8% at 2 years and is associated with poor survival. This population had a long median time to CNS relapse. Absence of prophylaxis did not strongly impact CNS relapse incidence.
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Affiliation(s)
- Aurélie Cabannes-Hamy
- APHP, Hôpital Saint-Louis, Hemato-Oncologie, Paris, France.,Université Diderot, Sorbonne Paris-Cité, Paris, France.,EA7324, Université Descartes, Paris, France
| | | | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Jean-François Emile
- APHP, Hôpital universitaire Ambroise Paré, Service d'anatomie pathologique, Boulogne, France
| | - Vincent Delwail
- Department of Oncology-Hematology and Cell Therapy, University Hospital, CIC INSERM 1402, Poitiers, France
| | | | - Corinne Haioun
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Mondor, Créteil, France
| | - Aurore Perrot
- Hematology Department, University Hospital, Vandoeuvre Les Nancy, France
| | - Olivier Fitoussi
- Polyclinique Bordeaux-Nord, Service d'onco-hématologie, Bordeaux, France
| | - Diane Lara
- Service d'Hematologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | | | - Marc André
- Department of Hematology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Fritz Offner
- CHU, Department of internal medicine, Ghent, Belgium
| | - Hervé Ghesquières
- Hematologie, Centre hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Benite, France
| | - Laurent Pascal
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Hematologie, Lille, France
| | - Carole Soussain
- Hematologie, CLCC Hôpital René Huguenin - Institut Curie, Saint-Cloud, France
| | - Julien Lazarovici
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif
| | | | - Philippe Gaulard
- Département de Pathologie, Hôpital Henri Mondor, AP-HP, Créteil, France.,INSERM U955, Créteil, France.,Université Paris-Est, Créteil, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Catherine Thieblemont
- APHP, Hôpital Saint-Louis, Hemato-Oncologie, Paris, France.,Université Diderot, Sorbonne Paris-Cité, Paris, France.,EA7324, Université Descartes, Paris, France
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31
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Cabanillas F, Shah B. Advances in Diagnosis and Management of Diffuse Large B-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:783-796. [PMID: 29126866 DOI: 10.1016/j.clml.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 12/16/2022]
Abstract
The management of diffuse large B-cell lymphoma (DLBCL) has been gradually evolving since the discovery of its 2 major forms, the germinal center B-like (GCB) and activated B-cell (ABC) types. Although the reference standard for the identification of these cell types is considered gene expression profiling (GEP), currently the only method commercially available is immunohistochemistry (IHC). The application of various IHC-based algorithms and their correlation with GEP and clinical outcome are discussed. Because of the adverse prognostic implications of the non-GCB type and its potential effects on treatment selection, the recently revised World Health Organization classification has included these biologic cell types. The management of double hit lymphomas, which almost exclusively fall under the GCB category, is discussed, together with the double expresser phenotype, which is usually grouped under the non-GCB type. The role of lenalidomide and ibrutinib in the management of the non-GCB type is examined. We also discuss the front-line management of primary mediastinal large cell lymphoma using the EPOCH (etoposide, prednisolone, Oncovin [vincristine], cyclophosphamide, hydroxydaunorubicin [doxorubicin]) regimen and examine new salvage data on immune checkpoint inhibitors for this clinical subtype. The prognosis, clinical features, and management of de novo CD5+ DLBCL are discussed, and newer and promising developments in the management of primary central nervous system lymphomas are presented in detail. The most popular salvage regimens and the application of high-dose chemotherapy with stem cell transplantation are assessed in detail. Finally, data on new treatment tactics such as CART (chimeric antigen receptor T-cell) cells and promising new drugs, including blinatumomab and venetoclax, are presented.
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Affiliation(s)
- Fernando Cabanillas
- Auxilio Mutuo Cancer Center, San Juan, Puerto Rico; Hematology-Oncology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX; Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Bijal Shah
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Malecek MK, Petrich AM, Rozell S, Chu B, Trifilio S, Galanina N, Maurer M, Farooq U, Link BK, Nowakowski GS, Nabhan C, Ayed AO. Frequency, risk factors, and outcomes of central nervous system relapse in lymphoma patients treated with dose-adjusted EPOCH plus rituximab. Am J Hematol 2017; 92:1156-1162. [PMID: 28719025 PMCID: PMC11339869 DOI: 10.1002/ajh.24864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) is a rare but serious complication that carries a poor prognosis. The use of infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) for frontline treatment of diffuse large B cell lymphoma (DLBCL) is increasing, though little is known about incidence of and risk factors for CNS relapse with this regimen PATIENTS AND METHODS: We completed a chart review of patients with NHL who received EPOCH-R as front line therapy. Data obtained included baseline and treatment characteristics including if patients received CNS directed therapy. We measured overall survival (OS), progression free survival (PFS), and progression to CNS involvement. RESULTS We identified 223 patients who met the inclusion criteria, 72% had DLBCL. Of all the patients, 5.8% experienced CNS relapse, and 38.6% were treated with CNS prophylaxis. There was no difference in rate of CNS relapse, OS, or PFS between patients who had and had not received CNS prophylaxis. Patients whose serum lactate dehydrogenase was greater than twice the upper limit of normal at diagnosis and those with extranodal disease were significantly more likely to have CNS relapse (P = .0247 and 0.022, respectively) than their counterparts. CONCLUSIONS The rate of CNS relapse in this patient population approaches 6%, not significantly different from reports on those receiving R-CHOP. The results of this study suggest that CNS prophylaxis might be more selectively used among patients treated with EPOCH-R with certain high-risk features.
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Affiliation(s)
| | - Adam M. Petrich
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Shaina Rozell
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Benjamin Chu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Steven Trifilio
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Natalie Galanina
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Matthew Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Brian K. Link
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | - Ayed O. Ayed
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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33
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Lemma SA, Kuusisto M, Haapasaari KM, Sormunen R, Lehtinen T, Klaavuniemi T, Eray M, Jantunen E, Soini Y, Vasala K, Böhm J, Salokorpi N, Koivunen P, Karihtala P, Vuoristo J, Turpeenniemi-Hujanen T, Kuittinen O. Integrin alpha 10, CD44, PTEN, cadherin-11 and lactoferrin expressions are potential biomarkers for selecting patients in need of central nervous system prophylaxis in diffuse large B-cell lymphoma. Carcinogenesis 2017; 38:812-820. [PMID: 28854563 PMCID: PMC5862348 DOI: 10.1093/carcin/bgx061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/21/2017] [Indexed: 12/13/2022] Open
Abstract
Central nervous system (CNS) relapse is a devastating complication that occurs in about 5% of diffuse large B-cell lymphoma (DLBCL) patients. Currently, there are no predictive biological markers. We wanted to study potential biomarkers of CNS tropism that play a role in adhesion, migration and/or in the regulation of inflammatory responses. The expression levels of ITGA10, CD44, PTEN, cadherin-11, CDH12, N-cadherin, P-cadherin, lactoferrin and E-cadherin were studied with IHC and IEM. GEP was performed to see whether found expressional changes are regulated at DNA/RNA level. IHC included 96 samples of primary CNS lymphoma (PCNSL), secondary CNS lymphoma (sCNSL) and systemic DLBCL (sDLBCL). IEM included two PCNSL, one sCNSL, one sDLBCL and one reactive lymph node samples. GEP was performed on two DLBCL samples, one with and one without CNS relapse. CNS disease was associated with enhanced expression of cytoplasmic and membranous ITGA10 and nuclear PTEN (P < 0.0005, P = 0.002, P = 0.024, respectively). sCNSL presented decreased membranous CD44 and nuclear and cytoplasmic cadherin-11 expressions (P = 0.001, P = 0.006, P = 0.048, respectively). In PCNSL lactoferrin expression was upregulated (P < 0.0005). IEM results were mainly supportive of the IHC results. In GEP CD44, cadherin-11, lactoferrin and E-cadherin were under-expressed in CNS disease. Our results are in line with previous studies, where gene expressions in extracellular matrix and adhesion-related pathways are altered in CNS lymphoma. This study gives new information on the DLBCL CNS tropism. If further verified, these markers might become useful in predicting CNS relapses.
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Affiliation(s)
- Siria A Lemma
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Milla Kuusisto
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Kirsi-Maria Haapasaari
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Department of Pathology, Institute of Diagnostics, Medical Research Center Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
| | - Raija Sormunen
- Department of Pathology, Institute of Diagnostics, Medical Research Center Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland.,Biocenter Oulu, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Tuula Lehtinen
- Department of Oncology, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland
| | - Tuula Klaavuniemi
- Department of Oncology, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland.,Department of Oncology and Radiotherapy, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Mine Eray
- Department of Pathology, FIMLAB, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Ylermi Soini
- Department of Clinical Pathology and Forensic Medicine, Cancer Center of Eastern Finland, University of Eastern Finland, Puijonlaaksontie 2, 70210 Kuopio, Finland.,Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Kaija Vasala
- Department of Oncology and Radiotherapy, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Jan Böhm
- Department of Pathology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Niina Salokorpi
- Department of Neurosurgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Peeter Karihtala
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Jussi Vuoristo
- Department of Pathology, Institute of Diagnostics, Medical Research Center Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland.,Biocenter Oulu, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Taina Turpeenniemi-Hujanen
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
| | - Outi Kuittinen
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
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Barraclough AA, Cheah CY. Three different hematologists, three different answers: how should we treat concurrent systemic and central nervous system lymphoma? Leuk Lymphoma 2017; 58:1-3. [DOI: 10.1080/10428194.2017.1307364] [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)
- Allison A. Barraclough
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- The Medical School, University of Western Australia, Crawley, Western Australia, Australia
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35
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How I treat patients with aggressive lymphoma at high risk of CNS relapse. Blood 2017; 130:867-874. [PMID: 28611025 DOI: 10.1182/blood-2017-03-737460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/11/2017] [Indexed: 12/25/2022] Open
Abstract
Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis.
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36
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Schmitz N, Nickelsen M, Savage KJ. Central Nervous System Prophylaxis for Aggressive B-cell Lymphoma: Who, What, and When? Hematol Oncol Clin North Am 2017; 30:1277-1291. [PMID: 27888881 DOI: 10.1016/j.hoc.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Central nervous system (CNS) relapse of aggressive B-cell lymphoma is a rare but serious complication with poor survival. Different approaches have been used to define risks factors for CNS relapse and establish prophylactic measures. Although patients with low or intermediate risk of CNS relapse should not undergo special diagnostic or therapeutic measures, CNS MRI as well as cytology and flow cytometry of the cerebrospinal fluid are suggested for high-risk patients (and patients with testicular involvement) at diagnosis, and prophylactic high-dose methotrexate in patients without proven CNS involvement. Future risk and treatment models may include molecular features and new treatment options.
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Affiliation(s)
- Norbert Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, Hamburg D-20099, Germany.
| | - Maike Nickelsen
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, Hamburg D-20099, Germany
| | - Kerry J Savage
- Department of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada.
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37
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El-Galaly TC, Villa D, Michaelsen TY, Hutchings M, Mikhaeel NG, Savage KJ, Sehn LH, Barrington S, Hansen JW, Smith D, Rady K, Mylam KJ, Larsen TS, Holmberg S, Juul MB, Cordua S, Clausen MR, Jensen KB, Johnsen HE, Seymour JF, Connors JM, de Nully Brown P, Bøgsted M, Cheah CY. The number of extranodal sites assessed by PET/CT scan is a powerful predictor of CNS relapse for patients with diffuse large B-cell lymphoma: An international multicenter study of 1532 patients treated with chemoimmunotherapy. Eur J Cancer 2017; 75:195-203. [PMID: 28237865 DOI: 10.1016/j.ejca.2016.12.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE Development of secondary central nervous system involvement (SCNS) in patients with diffuse large B-cell lymphoma is associated with poor outcomes. The CNS International Prognostic Index (CNS-IPI) has been proposed for identifying patients at greatest risk, but the optimal model is unknown. METHODS We retrospectively analysed patients with diffuse large B-cell lymphoma diagnosed between 2001 and 2013, staged with PET/CT and treated with R-CHOP(-like) regimens. Baseline clinicopathologic characteristics, treatments, and outcome data were collected from clinical databases and medical files. We evaluated the association between candidate prognostic factors and modelled different risk models for predicting SCNS. RESULTS Of 1532 patients, 62 (4%) subsequently developed SCNS. By multivariate analysis, disease stage III/IV, elevated serum LDH, kidney/adrenal and uterine/testicular involvement were independently associated with SCNS. There was a strong correlation between absolute number of extranodal sites and risk of SCNS; the 144 patients (9%) with >2 extranodal sites had a 3-year cumulative incidence of SCNS of 15.2% (95% confidence interval [CI] 9.2-21.2%) compared with 2.6% (95% CI 1.7-3.5) among those with ≤2 sites (P < 0.001). The 3-year cumulative risks of SCNS for CNS-IPI defined risk groups were 11.2%, 3.1% and 0.4% for high-, intermediate- and low-risk patients, respectively. All risk models analysed had high negative predictive values, but only modest positive predictive values. CONCLUSIONS Patients with >2 extranodal sites or high-risk disease according to the CNS-IPI should be considered for baseline CNS staging. Clinical risk prediction models suffer from limited positive predictive ability, highlighting the need for more sensitive biomarkers to identify patients at highest risk of this devastating complication.
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Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, DK-9100 Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark.
| | - Diego Villa
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | | | - Martin Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 DK-2100 Copenhagen, Denmark
| | - Nabegh George Mikhaeel
- Department of Clinical Oncology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Kerry J Savage
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | - Laurie H Sehn
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | - Sally Barrington
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Jakob W Hansen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 DK-2100 Copenhagen, Denmark
| | - Daniel Smith
- Department of Clinical Oncology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Kirsty Rady
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia
| | - Karen J Mylam
- Department of Hematology, Odense University Hospital, Søndre Boulevard 29, DK-5000 Odense, Denmark
| | - Thomas S Larsen
- Department of Hematology, Odense University Hospital, Søndre Boulevard 29, DK-5000 Odense, Denmark
| | - Staffan Holmberg
- Department of Hematology, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Maja B Juul
- Department of Hematology, Vejle Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Sabrina Cordua
- Department of Hematology, Roskilde Hospital, Zealand University Hospital, Sygehusvej 10, DK-4000 Roskilde, Denmark
| | - Michael R Clausen
- Department of Hematology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark
| | - Kristina B Jensen
- Department of Hematology, Holstebro Hospital, Lægårdvej, DK-7500 Holstebro, Denmark
| | - Hans E Johnsen
- Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, DK-9100 Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia
| | - Joseph M Connors
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 DK-2100 Copenhagen, Denmark
| | - Martin Bøgsted
- Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, DK-9100 Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark
| | - Chan Y Cheah
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia; Department of Hematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Hospital Ave, Nedlands WA 6009, Australia; University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
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38
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Liang Y, Ding L, Li X, Wang W, Zhang X. Oculomotor nerve palsy as a preceding symptom of adult sporadic Burkitt lymphoma: A case report and review of the literature. Oncol Lett 2017; 13:1315-1318. [PMID: 28454254 DOI: 10.3892/ol.2017.5583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 08/19/2016] [Indexed: 12/21/2022] Open
Abstract
Adult sporadic Burkitt lymphoma (BL) is a rare aggressive neoplasm and represents ~1-5% of all lymphomas diagnosed in adults. The disease exhibits an aggressive clinical manifestation, which frequently involves the central nervous system (CNS) in the early stages, and is usually accompanied by abnormalities in cerebrospinal fluid (CSF) examinations and/or neuroradiography. The current study describes the rare case of a 29-year-old man who presented with oculomotor nerve palsy without palpated masses, B symptoms, peripheral blood anomaly and abnormalities of the nervous system. The patient was initially misdiagnosed with abducens diplopia, but was subsequently confirmed to have BL with early CNS invasion. Epstein-Barr virus and human immunodeficiency virus infection were negative. Intensive systemic chemotherapy with hyperfractionated cyclophosphamide, vincristine, therarubicin and dexamethasone (hyper-CVAD, cyclophosphamide 600 mg/m2 on days 2-4; vincristine 1.4 mg/m2 on days 5 and 12, therarubicin 50 mg/m2 on day 5 and dexamethasone 40 mg on days 2-5 and 12-15), including intrathecal chemotherapy with methotrexate (5 mg), arabinocytidine (5 mg) and dexamethasone (5 mg), was determined as an appropriate treatment. Rituximab (375 mg/m2 on day 1) was administered alongside chemotherapy to increase treatment efficacy. The patient temporarily underwent complete remission, but subsequently relapsed as no suitable bone marrow donor was available. Adult sporadic BL with early CNS invasion, which traditional tests such as neuroradiography and CSF examination fail to identify, is uncommon. Therefore, appropriate diagnostic tests are critical for accurate diagnosis and must be performed immediately, particularly in patients that present with unusual image and laboratory manifestations.
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Affiliation(s)
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Luyin Ding
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xian Li
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Weiqin Wang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiaohong Zhang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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39
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El-Galaly TC, Cheah CY, Hutchings M, Mikhaeel NG, Savage KJ, Sehn LH, Barrington S, Hansen JW, Poulsen MØ, Smith D, Rady K, Mylam KJ, Larsen TS, Holmberg S, Juul MB, Cordua S, Clausen MR, Jensen KB, Bøgsted M, Johnsen HE, Seymour JF, Connors JM, Brown PDN, Villa D. Uterine, but not ovarian, female reproductive organ involvement at presentation by diffuse large B-cell lymphoma is associated with poor outcomes and a high frequency of secondary CNS involvement. Br J Haematol 2016; 175:876-883. [PMID: 27681999 DOI: 10.1111/bjh.14325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/13/2016] [Indexed: 01/19/2023]
Abstract
Involvement of the internal female reproductive organs by diffuse large B-cell lymphoma (DLBCL) is uncommon, and there are sparse data describing the outcomes of such cases. In total, 678 female patients with DLBCL staged with positron emission tomography/computed tomography and treated with rituximab-containing chemotherapy were identified from databases in Denmark, Great Britain, Australia, and Canada. Overall, 27/678 (4%) had internal reproductive organ involvement: uterus (n = 14), ovaries (n = 10) or both (n = 3). In multivariate analysis, women with uterine DLBCL experienced inferior progression-free survival and overall survival compared to those without reproductive organ involvement, whereas ovarian DLBCL was not predictive of outcome. Secondary central nervous system (CNS) involvement (SCNS) occurred in 7/17 (41%) women with uterine DLBCL (two patients with concomitant ovarian DLBCL) and 0/10 women with ovarian DLBCL without concomitant uterine involvement. In multivariate analysis adjusted for other risk factors for SCNS, uterine involvement by DLBCL remained strongly associated with SCNS (Hazard ratio 14·13, 95% confidence interval 5·09-39·25, P < 0·001). Because involvement of the uterus by DLBCL appears to be associated with a high risk of SCNS, those patients should be considered for CNS staging and prophylaxis. However, more studies are needed to determine whether the increased risk of secondary CNS involvement also applies to women with localized reproductive organ DLBCL.
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Affiliation(s)
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Martin Hutchings
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Kerry J Savage
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada
| | - Laurie H Sehn
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada
| | - Sally Barrington
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Jakob W Hansen
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Ø Poulsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Daniel Smith
- Department of Clinical Oncology, Guy's and St Thomas' Hospital, London, UK
| | - Kirsty Rady
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - Karen J Mylam
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Thomas S Larsen
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Staffan Holmberg
- Department of Haematology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maja B Juul
- Department of Haematology, Vejle Hospital, Vejle, Denmark
| | - Sabrina Cordua
- Department of Haematology, Roskilde Hospital, Roskilde, Denmark
| | - Michael R Clausen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Martin Bøgsted
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Hans E Johnsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - Joseph M Connors
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada
| | - Peter D N Brown
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Diego Villa
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Columbia, Canada
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40
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Schmitz N, Zeynalova S, Nickelsen M, Kansara R, Villa D, Sehn LH, Glass B, Scott DW, Gascoyne RD, Connors JM, Ziepert M, Pfreundschuh M, Loeffler M, Savage KJ. CNS International Prognostic Index: A Risk Model for CNS Relapse in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP. J Clin Oncol 2016; 34:3150-6. [PMID: 27382100 DOI: 10.1200/jco.2015.65.6520] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To develop and validate a risk score for relapse in the CNS in patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS A total of 2,164 patients (18 to 80 years old) with aggressive B-cell lymphomas (80% DLBCL) treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-like chemotherapy, who were enrolled in studies from the German High-Grade Non-Hodgkin Lymphoma Study Group and the MabThera International Trial, were analyzed for occurrence of relapse/progression in the CNS. The resulting risk model was validated in an independent data set of 1,597 patients with DLBCL identified in the British Columbia Cancer Agency Lymphoid Cancer database. RESULTS The risk model consists of the International Prognostic Index (IPI) factors in addition to involvement of kidneys and/or adrenal glands (CNS-IPI). In a three-risk group model, the low-risk group (46% of all patients analyzed), the intermediate-risk group (41%), and the high-risk group (12%) showed 2-year rates of CNS disease of 0.6% (CI, 0% to 1.2%), 3.4% (CI, 2.2% to 4.4%), and 10.2% (CI, 6.3% to 14.1%), respectively. Patients from the validation British Columbia Cancer Agency data set showed similar rates of CNS disease for low-risk (0.8%; CI, 0.0% to 1.6%), intermediate-risk (3.9%; CI, 2.3% to 5.5%), and high-risk (12.0%; CI, 7.9% to 16.1%) groups. CONCLUSION The CNS-IPI is a robust, highly reproducible tool that can be used to estimate the risk of CNS relapse/progression in patients with DLBCL treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Close to 90% of patients with DLBCL belong to the low- and intermediate-risk groups and have a CNS relapse risk < 5%; they may be spared any diagnostic and therapeutic intervention. In contrast, those in the high-risk group have a > 10% risk of CNS relapse and should be considered for CNS-directed investigations and prophylactic interventions.
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Affiliation(s)
- Norbert Schmitz
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
| | - Samira Zeynalova
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Maike Nickelsen
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Roopesh Kansara
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Diego Villa
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Bertram Glass
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - David W Scott
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Randy D Gascoyne
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marita Ziepert
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Michael Pfreundschuh
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Markus Loeffler
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Kanemasa Y, Shimoyama T, Sasaki Y, Tamura M, Sawada T, Omuro Y, Hishima T, Maeda Y. Central nervous system relapse in patients with diffuse large B cell lymphoma: analysis of the risk factors and proposal of a new prognostic model. Ann Hematol 2016; 95:1661-9. [PMID: 27370993 DOI: 10.1007/s00277-016-2744-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/25/2016] [Indexed: 12/31/2022]
Abstract
Central nervous system (CNS) relapse in patients with diffuse large B cell lymphoma (DLBCL) is an uncommon event, and the outcome of patients with CNS relapse is poor. However, no reliable prediction models for CNS relapse have been developed. We retrospectively analyzed consecutive de novo DLBCL patients referred to our department between September 2004 and August 2015 and treated with R-CHOP or R-CHOP-like regimens. Of 413 patients analyzed in this study, a total of 27 patients (6.5 %) eventually developed CNS relapse. The 5-year probability of CNS relapse was 8.4 %. The median time from diagnosis of DLBCL to CNS relapse was 15 months, and the median survival after CNS relapse was 7 months. In univariate analysis, the risk factors significantly associated with CNS relapse were Ann Arbor stage 3 or 4, albumin level <3.2 mg/L, number of extranodal sites >1, and involvement of retroperitoneal lymph node. We developed a new prognostic model consisting of these four factors. The 5-year probability of CNS relapse was significantly higher in patients with at least three of these four factors than in those with two or fewer factors (26.4 vs. 3.0 %, P < 0.001). Using this model, we evaluated the incidence and the risk factors of CNS relapse in DLBCL patients. The new risk model consisting of the four factors demonstrated good risk stratification for CNS relapse, and could help to identify high-risk patients for whom CNS prophylaxis is warranted.
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Affiliation(s)
- Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan.
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Yuki Sasaki
- Department of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Miho Tamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Sawada
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshiharu Maeda
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
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42
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Herr MM, Mohile NA, Barr PM, van Wijngaarden E, Brown EB, Rich DQ. Survival of Secondary Central Nervous System Lymphoma Patients in the Rituximab Era. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e123-e127. [PMID: 27375157 DOI: 10.1016/j.clml.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/03/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Megan M Herr
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
| | - Nimish A Mohile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Paul M Barr
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Edward B Brown
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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43
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Qiu Y, Zhang D, Zhang M. Long-term remission of subcutaneous panniculitis-like T-cell lymphoma with central nervous system involvement: A case report. Oncol Lett 2016; 12:611-614. [PMID: 27347188 DOI: 10.3892/ol.2016.4635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/12/2016] [Indexed: 11/06/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an indolent cutaneous T-cell lymphoma with a favourable prognosis. The reported incidence of central nervous system (CNS) involvement in SPTCL is extremely low. SPTCL with CNS involvement is a fatal disease with no optimal treatment. The present study presents the case of a 27-year-old man who initially presented with erythematous nodules on the left buttock and left inguinal lymph node enlargement. A skin biopsy resulted in a diagnosis of SPTCL. Subsequent to diagnosis, the patient developed CNS involvement and underwent treatment of fotemustine, teniposide and dexamethasone, and complete remission was achieved for 78 months. To the best of our knowledge, this is the first case report of secondary CNS SPTCL with long-term remission. Accumulating evidence shows that this CNS-directed regimen can be effective in SPTCL with CNS involvement and in other CNS lymphomas.
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Affiliation(s)
- Yajuan Qiu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Dandan Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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44
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Zahid MF, Khan N, Hashmi SK, Kizilbash SH, Barta SK. Central nervous system prophylaxis in diffuse large B-cell lymphoma. Eur J Haematol 2016; 97:108-20. [PMID: 27096423 DOI: 10.1111/ejh.12763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/20/2022]
Abstract
Central nervous system (CNS) involvement with diffuse large B-cell lymphoma (DLBCL) is a relatively uncommon manifestation; with most cases of CNS involvement occuring during relapse after primary therapy. CNS dissemination typically occurs early in the disease course and is most likely present subclinically at the time of diagnosis in many patients who later relapse in the CNS. CNS relapse in these patients is associated with poor outcomes. Based on a CNS relapse rate of 5% in DLBCL and weighing the benefits against the toxicities, universal application of CNS prophylaxis is not justified. The introduction of rituximab has significantly reduced the incidence of CNS relapse in DLBCL. Different studies have employed other agents for CNS prophylaxis, such as intrathecal chemotherapy and high-dose systemic agents with sufficient CNS penetration. If CNS prophylaxis is to be given, it should be preferably administered during primary chemotherapy. However, there is no strong evidence that supports any single approach for CNS prophylaxis. In this review, we outline different strategies of administering CNS prophylaxis in DLBCL patients reported in literature and discuss their advantages and drawbacks.
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Affiliation(s)
| | - Nadia Khan
- Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shahrukh K Hashmi
- Blood and Marrow Transplant Program, Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN, USA
| | | | - Stefan K Barta
- Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.,Temple Bone Marrow Transplantation Program, Temple University Health System, Philadelphia, PA, USA
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Gurion R, Mehta N, Migliacci JC, Zelenetz A, Moskowitz A, Lunning M, Moskowitz C, Hamlin P, Horwitz S. Central nervous system involvement in T-cell lymphoma: A single center experience. Acta Oncol 2016; 55:561-6. [PMID: 27046135 DOI: 10.3109/0284186x.2015.1118656] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background We characterized the incidence of central nervous system (CNS) involvement, risk factors and outcome in a large single institution dataset of peripheral T-cell lymphoma (PTCL). Methods Retrospective review of the PTCL database at Memorial Sloan Kettering Cancer Center. We identified 231 patients with any subtype of PTCL between 1994-2011 with a minimum six months of follow-up or an event defined as relapse or death. Results Histologies included peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) (31.6%), angioimmunoblastic (16.9%), anaplastic large cell lymphoma (ALCL), ALK- (12.1%), ALCL, ALK + (6.1%), extranodal NK/T-cell lymphoma (7.4%), adult T-cell leukemia/lymphoma (ATLL) (7.4%), and transformed mycosis fungoides (8.7%). Seventeen patients had CNS disease (7%). Fifteen had CNS involvement with PTCL and two had diffuse large B-cell lymphoma and glioblastoma. Median time to CNS involvement was 3.44 months (0.16-103.1). CNS prophylaxis was given to 24 patients (primarily intrathecal methotrexate). Rates of CNS involvement were not different in patients who received prophylaxis. Univariate analysis identified stage III-IV, bone marrow involvement, >1 extranodal site and ATLL as risk factors for CNS disease. On multivariate analysis, >1 extranodal site and international prognostic index (IPI) ≥ 3 were predictive for CNS involvement. The median survival of patients with CNS involvement was 2.63 months (0.10-75). Conclusions Despite high relapse rates, PTCL, except ATLL, carries a low risk of CNS involvement. Prognosis with CNS involvement is poor and risk factors include: >1 extra nodal site and IPI ≥3.
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Affiliation(s)
- Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neha Mehta
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Jocelyn C Migliacci
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Andrew Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Matthew Lunning
- Medical Oncology Service, Department of Medicine, University of Nebraska, Omaha, Nebraska, USA
| | - Craig Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Paul Hamlin
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Steven Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
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Maciocia P, Badat M, Cheesman S, D'Sa S, Joshi R, Lambert J, Mohamedbhai S, Pule M, Linch D, Ardeshna K. Treatment of diffuse large B-cell lymphoma with secondary central nervous system involvement: encouraging efficacy using CNS-penetrating R-IDARAM chemotherapy. Br J Haematol 2016; 172:545-53. [PMID: 26684148 DOI: 10.1111/bjh.13867] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022]
Abstract
Diffuse large B-cell lymphoma with secondary involvement of the central nervous system (SCNS-DLBCL) is a rare condition carrying a poor prognosis. No optimal therapeutic regimen has been identified. We retrospectively analysed 23 patients with SCNS-DLBCL treated with R-IDARAM (rituximab 375 mg/m(2) IV day 1; methotrexate 12·5 mg by intrathecal injection day 1; idarubicin 10 mg/m(2) /day IV days 1 and 2; dexamethasone 100 mg/day IV infusion over 12 h days 1-3; cytosine arabinoside 1000 mg/m(2) /day IV over 1 h days 1 and 2; and methotrexate 2000 mg/m(2) IV over 2 h day 3. Ten out of 23 (44%) patients had CNS involvement at initial presentation ('new disease'), 10/23 (44%) had relapsed disease and 3/23 (13%) had primary refractory disease. 14/23 (61%) of patients responded - 6 (26%) complete response, 8 (35%) partial response. Grade 3-4 haematological toxicity was seen in all cycles, with no grade 3-4 or long-term neurological toxicity. Median follow-up for surviving patients was 49 months. At 2 years, estimated progression-free survival (PFS) was 39% and overall survival (OS) was 52%. Encouraging outcomes were reported in patients with new disease, with 5-year estimated PFS of 50% and OS 75%. R-IDARAM is a well-tolerated regimen with encouraging efficacy in patients with SCNS-DLBCL, although patients with relapsed or refractory disease continue to fare poorly.
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Affiliation(s)
- Paul Maciocia
- Cancer Institute, Department of Haematology, University College London, London, UK
| | - Mohsin Badat
- Department of Haematology, Royal London Hospital, London, UK
| | - Simon Cheesman
- Department of Pharmacy, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Rahul Joshi
- Department of Haematology, University College London Hospital, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London Hospital, London, UK
| | - Sajir Mohamedbhai
- Cancer Institute, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospital, London, UK
| | - Martin Pule
- Cancer Institute, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospital, London, UK
| | - David Linch
- Cancer Institute, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospital, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospital, London, UK
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47
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Recaída en el sistema nervioso central en el linfoma B difuso de célula grande: factores de riesgo. Med Clin (Barc) 2016; 146:74-80. [DOI: 10.1016/j.medcli.2014.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 11/27/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
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48
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Ferreri AJ, Donadoni G, Cabras MG, Patti C, Mian M, Zambello R, Tarella C, Di Nicola M, D'Arco AM, Doa G, Bruno-Ventre M, Assanelli A, Foppoli M, Citterio G, Fanni A, Mulè A, Caligaris-Cappio F, Ciceri F. High Doses of Antimetabolites Followed by High-Dose Sequential Chemoimmunotherapy and Autologous Stem-Cell Transplantation in Patients With Systemic B-Cell Lymphoma and Secondary CNS Involvement: Final Results of a Multicenter Phase II Trial. J Clin Oncol 2015; 33:3903-10. [DOI: 10.1200/jco.2015.61.1236] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Treatment of secondary CNS dissemination in patients with aggressive lymphomas remains an important, unmet clinical need. Herein, we report the final results of a multicenter phase II trial addressing a new treatment for secondary CNS lymphoma based on encouraging experiences with high doses of antimetabolites in primary CNS lymphoma and with rituximab plus high-dose sequential chemoimmunotherapy (R-HDS) in relapsed aggressive lymphoma. Patients and Methods HIV-negative patients with aggressive B-cell lymphoma and secondary CNS involvement at diagnosis or relapse, age 18 to 70 years, and Eastern Cooperative Oncology Group performance status ≤ 3 were enrolled and treated with high-doses of methotrexate and cytarabine, followed by R-HDS (cyclophosphamide, cytarabine, and etoposide) supported by autologous stem-cell transplantation (ASCT). Treatment included eight doses of rituximab and four doses of intrathecal liposomal cytarabine. The primary end point was 2-year event-free survival; the planned accrual was 38 patients. Results Thirty-eight patients were enrolled; CNS disease was detected at presentation in 16 patients. Toxicity was usually hematologic and manageable, with grade 4 febrile neutropenia in 3% of delivered courses and grade 4 nonhematologic toxicity in 2% of delivered courses. Four patients died because of toxicity. Autologous stem cells were successfully collected in 24 (89%) of 27 patients (median, 10 × 106/kg); 20 patients underwent ASCT. Complete response was achieved in 24 patients (complete response rate, 63%; 95% CI, 48% to 78%). At a median follow-up of 48 months, 17 patients remained relapse free, with a 2-year event-free survival rate of 50% ± 8%. At 5 years, 16 patients were alive, with a 5-year overall survival rate of 41% ± 8% for the whole series and 68% ± 11% for patients who received transplantation. Systemic (extra-CNS) and/or meningeal disease did not affect outcome. Conclusion The combination of high doses of antimetabolites, R-HDS, and ASCT is feasible and effective in patients age 18 to 70 years old with secondary CNS lymphoma, and we propose it as a new standard therapeutic option.
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Affiliation(s)
- Andrés J.M. Ferreri
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Giovanni Donadoni
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Maria Giuseppina Cabras
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Caterina Patti
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Michael Mian
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Renato Zambello
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Corrado Tarella
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Massimo Di Nicola
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Alfonso M. D'Arco
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Gianluca Doa
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Marta Bruno-Ventre
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Andrea Assanelli
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Marco Foppoli
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Giovanni Citterio
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Alessandro Fanni
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Antonino Mulè
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Federico Caligaris-Cappio
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
| | - Fabio Ciceri
- Andrés J.M. Ferreri, Giovanni Donadoni, Marta Bruno-Ventre, Andrea Assanelli, Marco Foppoli, Giovanni Citterio, Federico Caligaris-Cappio, and Fabio Ciceri, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute; Massimo Di Nicola, Istituto Nazionale dei Tumori, Milano; Maria Giuseppina Cabras and Alessandro Fanni, Hospital Businco, Cagliari; Caterina Patti and Antonino Mulè, Hospital “V. Cervello,” Palermo; Michael Mian, Ospedale di Bolzano, Bolzano; Renato Zambello,
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49
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Lemma SA, Pasanen AK, Haapasaari KM, Sippola A, Sormunen R, Soini Y, Jantunen E, Koivunen P, Salokorpi N, Bloigu R, Turpeenniemi-Hujanen T, Kuittinen O. Similar chemokine receptor profiles in lymphomas with central nervous system involvement - possible biomarkers for patient selection for central nervous system prophylaxis, a retrospective study. Eur J Haematol 2015; 96:492-501. [DOI: 10.1111/ejh.12626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Siria A. Lemma
- Department of Oncology and Radiotherapy; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Anna Kaisa Pasanen
- Department of Oncology and Radiotherapy; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Kirsi-Maria Haapasaari
- Department of Oncology and Radiotherapy; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
- Department of Pathology; Institute of Diagnostics; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Antti Sippola
- Department of Oncology and Radiotherapy; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Raija Sormunen
- Department of Pathology; Institute of Diagnostics; University of Oulu and Oulu University Hospital; Oulu Finland
- Biocenter Oulu; University of Oulu; Oulu Finland
| | - Ylermi Soini
- Department of Clinical Pathology and Forensic Medicine; University of Eastern Finland; Cancer Center of Eastern Finland and Kuopio University Hospital; Kuopio Finland
| | - Esa Jantunen
- Department of Medicine; University of Eastern Finland and Kuopio University Hospital; Kuopio Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Niina Salokorpi
- Department of Neurosurgery; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Risto Bloigu
- Medical Informatics and Statistics Research Group; University of Oulu; Oulu Finland
| | - Taina Turpeenniemi-Hujanen
- Department of Oncology and Radiotherapy; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Outi Kuittinen
- Department of Oncology and Radiotherapy; Institute of Clinical Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
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50
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Roschewski M, Dunleavy K. Secondary diffuse large B-cell lymphoma of the central nervous system: the need for better predictors. Leuk Lymphoma 2015; 56:1583-4. [PMID: 26099732 DOI: 10.3109/10428194.2015.1016936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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