1
|
Tang C, Jiang P, Tang J, Liao J, Zeng Q. Diffuse large B-cell lymphoma with contemporary involvement of central and peripheral nervous system: A case report and literature review. Heliyon 2024; 10:e28552. [PMID: 38560176 PMCID: PMC10981111 DOI: 10.1016/j.heliyon.2024.e28552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Simultaneous involvement of the peripheral nervous system (PNS) and central nervous system (CNS) during the same period in diffuse large B-cell lymphoma (DLBCL) is rarely documented. In this particular case, the diagnosis of diffuse large B-cell lymphoma was pathologically confirmed, with invasion into the basal ganglia, diencephalon, and several peripheral nerves. The initial clinical manifestations were dyspnoea and hyperventilation. Case presentation The patient presented to the hospital with fatigue, dyspnoea, and limb pain for over 7 months, accompanied by progressive breathlessness and unconsciousness in the last 6 days. Initial treatment with glucocorticoids for Guillain-Barre syndrome (GBS) proved ineffective in controlling the severe shortness of breath and hyperventilation, necessitating the use of ventilator-assisted ventilation. 18-Fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) showed that the basal ganglia, brainstem, and multiple peripheral nerves were thickened and metabolically active. There were atypical cells in the cerebrospinal fluid; the pathology indicated invasive B-cell lymphoma, demonstrating a propensity toward diffuse large B-cell lymphoma (DLBCL). After receiving chemotherapy, the patient regained consciousness and was successfully weaned off ventilator assistance but died of severe pneumonia. Discussion The early clinical manifestations of DLBCL lack specificity, and multifocal DLBCL complicates the diagnostic process. When a single primary disease cannot explain multiple symptoms, the possibility of DLBCL should be considered, and nervous system invasion should be considered when nervous system symptoms are present. Once nervous system involvement occurs in DLBCL, whether the central or peripheral nervous system, it indicates a poor prognosis.
Collapse
Affiliation(s)
- Chuwen Tang
- Department of Emergency Medicine, Luohu District People's Hospital, Shenzhen, 518001, China
| | - Peng Jiang
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinhui Tang
- GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 510182, China
| | - Jinli Liao
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qingli Zeng
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| |
Collapse
|
2
|
Jeong SY, Yoon SE, Cho D, Kang ES, Cho J, Kim WS, Kim SJ. Real-world experiences of CNS-directed chemotherapy followed by autologous stem cell transplantation for secondary CNS involvement in relapsed or refractory diffuse large B-cell lymphoma. Front Oncol 2023; 12:1071281. [PMID: 36741719 PMCID: PMC9894717 DOI: 10.3389/fonc.2022.1071281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Secondary central nervous system (CNS) involvement is a rare but fatal event in patients with diffuse large B cell lymphoma (DLBCL). Some studies have suggested autologous stem cell transplantation (ASCT) for patients responding to salvage therapies, although its role is not clear. Methods We analyzed DLBCL patients with secondary CNS involvement who received salvage therapies with curative intent and who underwent high-dose chemotherapy followed by ASCT. We analyzed the post-ASCT outcome in terms of CNS and/or systemic relapse and overall survival (OS) according to type of secondary CNS involvement and salvage treatment. Results A total of 43 patients who achieved complete or partial response after salvage treatments, mainly high-dose methotrexate (MTX)-containing chemotherapy, was treated with busulphan-thiotepa followed by ASCT between 2009 to 2019. Fifteen patients experienced grade III/IV febrile neutropenia, but all adverse events were manageable. At the median follow-up of 14.7 months after ASCT, 17 patients did not relapse, however, 26 patients had relapsed, comprising isolated CNS relapse (n = 12), systemic relapse (n = 12), and both (n = 2). Patients with systemic relapse had significantly shorter OS than those with isolated CNS relapse (42.7 vs, 11.1 months, p = 0.002). Of the 26 patients who relapsed after ASCT, six patients were rescued by subsequent salvage treatments. Finally, 21 patients were alive at the time of analysis. Discussion In conclusion, consolidative ASCT might be beneficial for secondary CNS involvement in relapsed or refractory DLBCL patients if they responded to CNS-directed salvage chemotherapy and were eligible for transplantation.
Collapse
Affiliation(s)
- Sun Young Jeong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duck Cho
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Suk Kang
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea,*Correspondence: Seok Jin Kim,
| |
Collapse
|
3
|
Sahin U, Gokmen A, Soydan E, Urlu SM, Merter M, Gokgoz Z, Arslan O, Ozcan M. Outcomes of Autologous Stem Cell Transplantation as a Consolidative Strategy for the Treatment of Primary and Isolated Secondary Central Nervous System Diffuse Large B Cell Lymphomas. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e1-e13. [PMID: 36344419 DOI: 10.1016/j.clml.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/17/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Standard consolidation for primary diffuse large B cell lymphoma (DLBCL) of the central nervous system (CNS) (PCNSL) is not established. This single center, retrospective observational study aims to define the outcomes of consolidative high dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) in patients with PCNSL and isolated secondary CNS DLBCL (SCNSL) and evaluate the prognostic factors. PATIENTS AND METHODS All consecutive patients performed an HDC/ASCT for PCNSL or isolated SCNSLs between October 2012 and February 2022 were identified. Primary endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS Among 35 patients included, 28 had PCNSL and 7 had isolated SCNSL. Median age was 51 (16-78). Males constituted 48.6%. Median follow-up after HDC/ASCT was 42.0 months. MATRIX (51.4%) and TEAM (80.0%) were the most frequent regimens of induction and conditioning, respectively. OS and PFS 1- and 2-year after HDC/ASCT were 68.0%, 57.0%, 58.0%, 48.0%, respectively. Increasing age, poor performance and comorbidities were associated with lower OS and PFS and higher non-relapse mortality (NRM). Complete response (CR) 1 at HDC/ACST was independently associated with higher OS and PFS [hazard ratio (HR): 4.67 and 6.99, respectively]. CONCLUSION In patients < 60 years consolidative HDC/ASCT yields promising OS and PFS. Patients ≥ 60 years may less likely benefit from consolidative HDC/ASCT and should be studied further in trials of novel agents, lower doses of consolidative radiotherapy and dose-adjusted conditioning regimens. Not only age, but also comorbidities, clinical performance and response to induction correlate with outcomes. Patients with isolated SCNSL may achieve similar outcomes.
Collapse
Affiliation(s)
- Ugur Sahin
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ayla Gokmen
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ender Soydan
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Selin M Urlu
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Mustafa Merter
- Department of Hematology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Zafer Gokgoz
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Onder Arslan
- Department of Hematology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Muhit Ozcan
- Department of Hematology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| |
Collapse
|
4
|
Xue F, Zheng P, Liu R, Feng S, Guo Y, Shi H, Liu H, Deng B, Xu T, Ke X, Hu K. The Autologous Hematopoietic Stem Cells Transplantation Combination-Based Chimeric Antigen Receptor T-Cell Therapy Improves Outcomes of Relapsed/Refractory Central Nervous System B-Cell Lymphoma. JOURNAL OF ONCOLOGY 2022; 2022:2900310. [PMID: 36483984 PMCID: PMC9726247 DOI: 10.1155/2022/2900310] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The objective is to explore the effectiveness and safety of CAR T-cell therapy in advanced relapsed/refractory central nervous system B-cell lymphoma and compare the impact of autologous stem cell transplantation (ASCT) plus CAR T-cell therapy versus sequential CART therapy on the survival of patients. METHODS The retrospective analysis was based on the data of 17 patients with advanced relapsed/refractory central nervous system B-cell lymphoma. Bridging chemotherapy was applied before CAR T-cell infusion to further reduce the tumor burden. For patients with autologous hematopoietic stem cell successful collection, CD19/20/22CAR T-cell immunotherapy following ASCT was performed with the thiotepa-containing conditioning regimen, while sequential CD19/CD20/CD22CAR T-cell therapy was applied. For lymphodepletion, patients received bendamustine or fludarabine monotherapy or fludarabine combined with cyclophosphamide pre-CART-cell infusion. RESULTS Out of the 17 patients, 8 completed ASCT plus CART cell therapy, while 9 patients completed CART cell alone therapy. In efficacy assessment at 3 months after infusion, the objective response rate (ORR) was 12/17 (71%) and the complete response rate (CRR) was 11/17 (65%). The CRR of the ASCT group and non-ASCT was 100% and 44.4%, respectively (P < 0.01). The median progression-free survival was 16.3 (2.6-24.5) months, and the median overall survival was 19.3 (6-24.5) months. Patients who underwent ASCT plus CART cell therapy had significantly longer PFS (P < 0.01) and OS (P < 0.01). Grade 3 or higher immune effector cell-associated neurologic toxicity syndrome (≥grade 3 ICANS) and cytokine release syndrome (≥grade 3 CRS) events occurred in 29% and 41% of the patients, respectively. No treatment-related death occurred. CONCLUSION The CAR T-cell therapy could augment its efficacy in the treatment of advanced relapsed/refractory CNS B-cell lymphoma, while ASCT in combination with CART can induce durable responses and OS with a manageable side effect.
Collapse
Affiliation(s)
- Fei Xue
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Peihao Zheng
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Rui Liu
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Shaomei Feng
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Yuelu Guo
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Hui Shi
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Haidi Liu
- Cytology Laboratory, Beijing Boren Hospital, Beijing, China
| | - Biping Deng
- Cytology Laboratory, Beijing Boren Hospital, Beijing, China
| | - Teng Xu
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Xiaoyan Ke
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| | - Kai Hu
- Department of Adult Lymphoma, Beijing Boren Hospital, Beijing, China
| |
Collapse
|
5
|
Yokoyama K, Oyama J, Tsuchiya J, Karakama J, Tamura K, Inaji M, Tanaka Y, Kobayashi D, Maehara T, Tateishi U. Branch-like enhancement on contrast enhanced MRI is a specific finding of cerebellar lymphoma compared with other pathologies. Sci Rep 2022; 12:3591. [PMID: 35246572 PMCID: PMC8897486 DOI: 10.1038/s41598-022-07581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/18/2022] [Indexed: 11/09/2022] Open
Abstract
Branch-like enhancement (BLE) on contrast-enhanced (CE) magnetic resonance imaging (MRI) was found to be effective in differentiating primary central nervous system lymphoma (PCNSL) from high-grade glioma (HGG) in the cerebellum. However, whether it can be applied to assessments of secondary central nervous system lymphoma (SCNSL), or other cerebellar lesions is unknown. Hence, we retrospectively reviewed cerebellar masses to investigate the use of BLE in differentiating cerebellar lymphoma (CL), both primary and secondary, from other lesions. Two reviewers qualitatively evaluated the presence and degree of BLE on CE-T1 weighted imaging (T1WI). If multiple views were available, we determined the view in which BLE was the most visible. Seventy-five patients with the following pathologies were identified:17 patients with CL, 30 patients with metastasis, 12 patients with hemangioblastoma, 9 patients with HGG, and 7 patients with others. Twelve patients presented with PCNSL and five with SCNSL. Of 17 patients with CL, 15 (88%) had BLE, whereas three (5%) out of 58 patients in the non-CL group showed BLE. In patients who underwent three-dimensional-CE-T1WI, BLE was the most visible on the sagittal image. In conclusion, BLE is a highly specific finding for CL and the sagittal image is important in evaluating this finding.
Collapse
Affiliation(s)
- Kota Yokoyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Jun Karakama
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoru Tamura
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Kobayashi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| |
Collapse
|
6
|
Abstract
Management of secondary central nervous system (SCNS) involvement in relapsed or refractory aggressive B-cell lymphomas remains an area of unmet medical need. We report a single-center retrospective analysis of 7 adult patients with SCNS lymphoma (SCNSL) who underwent chimeric antigen receptor (CAR) T-cell therapy for their refractory disease, and we describe the safety of whole brain radiation therapy (WBRT) as a bridging therapy. Six patients (85.7%) achieved a complete response at day 28, and 1 patient had progressive disease. The median progression-free survival was 83 days (range, 28-219 days), and median overall survival was 129 days (range, 32-219 days). Three patients died as a result of disease progression. Of the 5 patients who received WBRT as bridging therapy, 3 had no immune effector cell–associated neurotoxicity syndrome (ICANS), but 2 patients had grade 1 or grade 3 ICANS. No grade 4 ICANS was reported in this subset of patients. We conclude that SCNSL should not preclude patients from receiving CAR T-cell therapy as a treatment option because of concerns regarding ICANS, and bridging with WBRT is not associated with increased ICANS. SCNSL should not preclude patients from receiving CAR T-cell therapy because of concerns regarding ICANS. WBRT is not associated with increased ICANS when used as a bridge to CAR T-cell therapy with a short median interval in SCNSL.
Collapse
|
7
|
Levins KJ, Khan M, Drago T, Roman E, Suiter C, Nasa A, Roddy DW, Murphy P. Blame it on the pump. Clin Case Rep 2021; 9:e04195. [PMID: 34136231 PMCID: PMC8190513 DOI: 10.1002/ccr3.4195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022] Open
Abstract
Although intrathecal pumps may lead to spinal symptoms that are likely related to the pump itself, the case presented herein underscores the importance of casting a broad differential diagnosis at the time of initial presentation.
Collapse
Affiliation(s)
- Kirk John Levins
- Department of Anaesthesia, Intensive Care and Pain MedicineSt. Vincent’s University HospitalDublin 4Ireland
| | - Mohamed Khan
- Department of HaematologyUniversity Hospital LimerickDooradoyleIreland
| | - Thomas Drago
- Trinity College Institute of NeuroscienceTrinity College DublinDublin 2Ireland
| | | | - Cillian Suiter
- Department of Anaesthesia, Intensive Care and Pain MedicineSt. Vincent’s University HospitalDublin 4Ireland
| | - Anurag Nasa
- Trinity College Institute of NeuroscienceTrinity College DublinDublin 2Ireland
| | | | - Paul Murphy
- Department of Anaesthesia, Intensive Care and Pain MedicineSt. Vincent’s University HospitalDublin 4Ireland
| |
Collapse
|
8
|
Wang X, Huynh C, Urak R, Weng L, Walter M, Lim L, Vyas V, Chang WC, Aguilar B, Brito A, Sarkissian A, Bandara NA, Yang L, Wang J, Wu X, Zhang J, Priceman SJ, Qin H, Kwak LW, Budde LE, Thomas SH, Clark MC, Popplewell L, Siddiqi T, Brown CE, Forman SJ. The Cerebroventricular Environment Modifies CAR T Cells for Potent Activity against Both Central Nervous System and Systemic Lymphoma. Cancer Immunol Res 2020; 9:75-88. [PMID: 33093217 DOI: 10.1158/2326-6066.cir-20-0236] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/24/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
Lymphomas with central nervous system (CNS) involvement confer a worse prognosis than those without CNS involvement, and patients currently have limited treatment options. T cells genetically engineered with CD19-targeted chimeric antigen receptors (CAR) are effective against B-cell malignancies and show tremendous potential in the treatment of systemic lymphoma. We aimed to leverage this strategy toward a more effective therapy for patients with lymphoma with CNS disease. NOD-scid IL2Rgammanull (NSG) mice with CNS and/or systemic lymphoma were treated with CD19-CAR T cells via intracerebroventricular (ICV) or intravenous (IV) injection. CAR T cells isolated after treatment were rigorously examined for phenotype, gene expression, and function. We observed that CAR T cells infused ICV, but not IV, completely and durably eradicated both CNS and systemic lymphoma. CAR T cells delivered ICV migrated efficiently to the periphery, homed to systemic tumors, and expanded in vivo, leading to complete elimination of disease and resistance to tumor rechallenge. Mechanistic studies indicated that ICV-delivered CAR T cells are conditioned by exposure to cerebrospinal fluid in the ICV environment for superior antilymphoma activity and memory function compared with IV-delivered CAR T cells. Further analysis suggested that manipulating cellular metabolism or preactivating therapeutic CAR T cells with antigen ex vivo may improve the efficacy of CAR T cells in vivo Our demonstration that ICV-delivered CD19-CAR T cells had activity against CNS and systemic lymphoma could offer a valuable new strategy for treatment of B-cell malignancies with CNS involvement.
Collapse
Affiliation(s)
- Xiuli Wang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Christian Huynh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ryan Urak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Lihong Weng
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Miriam Walter
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Laura Lim
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Vibhuti Vyas
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Wen-Chung Chang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Brenda Aguilar
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Alfonso Brito
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Aniee Sarkissian
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - N Achini Bandara
- Clinical and Translational Project Development Core, City of Hope, Duarte, California
| | - Lu Yang
- Department of Molecular and Cellular Biology, Beckman Research Institute, City of Hope, Duarte, California
| | - Jinhui Wang
- Integrative Genomics Core, Beckman Research Institute, City of Hope, Duarte, California
| | - Xiwei Wu
- Integrative Genomics Core, Beckman Research Institute, City of Hope, Duarte, California
| | - Jianying Zhang
- The Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - Saul J Priceman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Hong Qin
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope, Duarte, California
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope, Duarte, California
| | - Lihua E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sandra H Thomas
- Clinical and Translational Project Development Core, City of Hope, Duarte, California
| | - Mary C Clark
- Clinical and Translational Project Development Core, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Christine E Brown
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Azriel A, Towner JE, Gaillard F, Box G, Rogers T, Morokoff A. Solitary intraventricular Hodgkin lymphoma post-transplant lymphoproliferative disease (HL-PTLD): Case report. J Clin Neurosci 2019; 69:269-272. [PMID: 31451379 DOI: 10.1016/j.jocn.2019.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
Lymphomas affecting the central nervous system (CNS), both primarily and secondarily, are uncommon malignancies. Immunosuppressed states, including iatrogenic immunosuppression following organ transplantation, are the most significant risk factors for developing primary CNS lymphoma (PCNSL). Post-transplant lymphoproliferative disease (PTLD) is a well described complication following bone marrow or solid organ transplantation. PTLD is usually a systemic disease with occasional CNS involvement. The incidence of CNS involvement in PTLD is low, and the majority of these cases tend to be PCNSL. Hodgkin lymphoma PTLD (HL-PTLD) constitutes only a very small percentage of PTLD. We report a rare case of a primary intraventricular CNS classical HL-PTLD in a male patient, 18 years following renal transplantation. The location allowed for safe neurosurgical intervention which resolved the symptom of elevated intracranial pressure and allowed for induction of a Rituximab-based chemotherapy regimen. Both the ventricular location of the PTLD and Hodgkin Lymphoma PTLD are themselves individually quite rare and have not previously been reported together. The unique location allowed safe neurosurgical intervention which quickly resolved the symptom of elevated intracranial pressure and allowed for induction of a Rituximab-based chemotherapy regimen.
Collapse
Affiliation(s)
- Amit Azriel
- Department of Neurosurgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia.
| | - James E Towner
- Department of Neurosurgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Frank Gaillard
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Australia
| | - Georgia Box
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - TeWhiti Rogers
- Department of Pathology, The Royal Melbourne Hospital, Victoria, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Umino K, Fujiwara SI, Sato K, Minakata D, Nakano H, Yamasaki R, Kawasaki Y, Sugimoto M, Yamamoto C, Hatano K, Okazuka K, Oh I, Ohmine K, Suzuki T, Muroi K, Kanda Y. High-Dose Methotrexate and Cytarabine-Based Multi-Agent Chemotherapy (Modified Bonn Protocol) for Systemic Lymphoma with CNS Involvement. Acta Haematol 2017; 137:93-99. [PMID: 28118621 DOI: 10.1159/000454890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/29/2016] [Indexed: 11/19/2022]
Abstract
The prognosis of patients with systemic lymphoma with central nervous system (CNS) involvement is very poor and there is no established standard therapy. We retrospectively analyzed 18 patients (4 untreated and 14 relapsed) with systemic lymphoma with CNS involvement who received methotrexate and cytarabine-based multiagent chemotherapy (modified Bonn protocol). Complete and partial responses were achieved in 56 and 22% of the patients, respectively. The 1-year overall survival (OS) and progression-free survival (PFS) was 81.0 and 39.2%, respectively. Patients with parenchymal involvement showed a better 1-year PFS than those with either leptomeningeal involvement or both. In a multivariate analysis, poor performance status (PS) was the only independent prognostic factor for the 1-year OS and PFS (HR 10.8, 95% CI 1.09-108, p = 0.042; HR 20.8, 95% CI 2.39-181, p = 0.006, respectively). Grade 4 neutropenia and thrombocytopenia occurred in 17 patients each (94%), but there were no grade 4 nonhematopoietic adverse events. The modified Bonn protocol resulted in relatively favorable response and survival, and provided clinical benefits to patients with good PS, in particular. This study demonstrated that the modified Bonn protocol could be a feasible and encouraging treatment approach for lymphoma with CNS and systemic involvement.
Collapse
Affiliation(s)
- Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Lee MY, Kim HS, Lee JY, Lim SH, Kang ES, Ko YH, Kim SJ, Kim WS. Efficacy and feasibility of autologous stem cell transplantation in patients with diffuse large B‑cell lymphoma with secondary central nervous system involvement. Int J Hematol 2016; 102:678-88. [PMID: 26493833 DOI: 10.1007/s12185-015-1874-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
Secondary central nervous system (CNS) involvement is a fatal complication of diffuse large B-cell lymphoma (DLBCL). We evaluated the efficacy and feasibility of high-dose chemotherapy containing busulfan and thiotepa followed by autologous stem cell transplantation (HDC-ASCT) in DLBCL with secondary CNS involvement. Thirty-one patients with secondary CNS involvement including CNS involvement at diagnosis (n = 9), isolated CNS relapse (n = 14), and CNS involvement with systemic disease progression or relapse (n = 8) were selected and analyzed from our prospective cohorts. Of these, 12 patients, including seven with isolated CNS relapse, successfully completed HDC-ASCT without engraftment failure or transplantation-related mortality. After ASCT, six patients were alive; however, three patients experienced post-transplantation relapse. With a median follow-up of 29 months after secondary CNS involvement, the median overall survival of 31 patients was 9 months (95% CI 5–12 months). The survival outcomes of patients who had undergone HDC-ASCT were significantly better than those of patients who did not (p < 0.01). Accordingly, patients with isolated CNS relapse tended to have a longer survival outcome than other cases. Our results suggest that HDC-ASCT may provide survival benefits in DLBCL patients with secondary CNS involvement, especially in case of isolated CNS relapse.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Yoo KH, Lee JY, Lim SH, Ko YH, Kim SJ, Kim WS. Pilot trial of systemic methotrexate plus R-CHOP regimen with intrathecal methotrexate for simultaneous central nervous system and systemic diffuse large B cell lymphoma. Acta Haematol 2014; 133:179-82. [PMID: 25323539 DOI: 10.1159/000362149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The simultaneous presentation of systemic diffuse large B cell lymphoma (DLBCL) with central nervous system (CNS) disease is not well controlled by either R-CHOP or systemic methotrexate (MTX) alone. METHODS We conducted a pilot trial with 6 patients who were initially diagnosed with systemic DLBCL with CNS involvement. Patients were treated with a systemic MTX plus R-CHOP regimen. RESULTS The overall response rate was 4/6 (66.7%). The CNS response rate and systemic response rate were 4/6 (66.7%) and 5/6 (83.3%), respectively. The median response duration of the 4 patients with complete remission at completion was 25.5 months, and the median survival of all patients was 25.1 months. CNS lesions progressed in all relapsed and refractory patients, while systemic disease progression was observed in 1 patient. No fatal hematologic adverse effects, hepatotoxicity or nephrotoxicity were observed. CONCLUSIONS The dose of systemic MTX (1∼1.5 g/m(2)) or dose intensity (4-week interval in 4 patients) used in this trial was considered insufficient. Therefore, the dose of MTX or interval of each chemotherapy cycle should be modified in future trials to control CNS disease involved with DLBCL.
Collapse
MESH Headings
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Methotrexate/administration & dosage
- Methotrexate/adverse effects
- Middle Aged
- Nervous System Diseases/drug therapy
- Nervous System Diseases/mortality
- Nervous System Diseases/pathology
- Pilot Projects
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Rituximab
- Survival Rate
- Time Factors
- Vincristine/administration & dosage
- Vincristine/adverse effects
Collapse
Affiliation(s)
- Kwai Han Yoo
- Division of Hematology and Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
16
|
Tomita N, Takasaki H, Ishiyama Y, Kishimoto K, Ishibashi D, Koyama S, Ishii Y, Takahashi H, Numata A, Watanabe R, Tachibana T, Ohshima R, Hagihara M, Hashimoto C, Takemura S, Taguchi J, Fujimaki K, Sakai R, Motomura S, Ishigatsubo Y. Intrathecal methotrexate prophylaxis and central nervous system relapse in patients with diffuse large B-cell lymphoma following rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone. Leuk Lymphoma 2014; 56:725-9. [PMID: 24913502 DOI: 10.3109/10428194.2014.931953] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study evaluated the efficacy of central nervous system (CNS) prophylaxis using intrathecal methotrexate (IT-MTX) in patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively studied 322 patients who achieved first complete remission (CR) after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The CNS prophylaxis consisted of four doses of IT-MTX (15 mg) with hydrocortisone (25 mg) administered after CR was achieved. Forty patients (12%) received CNS prophylaxis (group A) and 282 patients (88%) did not (group B). Three patients in group A (8%) and eight in group B (3%) experienced isolated CNS relapse during the first CR, although this difference was not statistically significant (p = 0.14). Ten of 11 CNS relapses occurred in the brain parenchyma with (n = 3) or without (n = 7) leptomeningeal involvement, and the remaining patient had exclusive leptomeningeal involvement. In patients with DLBCL attaining CR after R-CHOP, IT-MTX administration was insufficient to prevent CNS relapse.
Collapse
Affiliation(s)
- Naoto Tomita
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Rituximab plus a CHOP-like regimen, central nervous system prophylaxis, and contralateral testicular irradiation for localized primary testicular diffuse large B-cell lymphoma lead to prolonged progression-free survival. Int J Hematol 2014; 100:370-8. [DOI: 10.1007/s12185-014-1646-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/01/2022]
|
18
|
DeRosa P, Cappuzzo JM, Sherman JH. Isolated recurrence of secondary CNS lymphoma: case report and literature review. J Neurol Surg Rep 2014; 75:e154-9. [PMID: 25083377 PMCID: PMC4110153 DOI: 10.1055/s-0034-1378152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/04/2014] [Indexed: 01/20/2023] Open
Abstract
Isolated secondary central nervous system lymphoma (SCNSL) relapse is a rare disease. Consequently, standardized treatment regimens have yet to be developed. We present an interesting case of isolated SCNSL presenting with altered mental status and panhypopituitarism in a patient at low risk of developing the disease. We also review the related literature and discuss newer, more aggressive treatments for primary CNS lymphoma and SCNSL.
Collapse
Affiliation(s)
- Peter DeRosa
- Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, United States
| | - Justin M Cappuzzo
- School of Medical and Health Sciences, The George Washington University, Washington, District of Columbia, United States
| | - Jonathan H Sherman
- Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, United States
| |
Collapse
|
19
|
Najjar YG, Mittal K, Faza NN, Dushkin H, Peereboom DM. Isolated secondary CNS relapse in a case of stage I diffuse large B-cell lymphoma. BMJ Case Rep 2014; 2014:bcr-2013-201442. [PMID: 24798352 DOI: 10.1136/bcr-2013-201442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old woman was admitted to our hospital with a 10-day history of right arm weakness and numbness. The patient's medical history was notable for lobular carcinoma in situ of the right breast in 2008 and stage I diffuse large B-cell lymphoma of the left axilla. The patient had completed treatment with chemotherapy and radiation 2 months prior to presentation. Blood counts, metabolic panel and lumbar puncture were unremarkable. MRI of the brain revealed multiple enhancing masses. The patient was started on dexamethasone, with rapid symptom improvement. A stereotactic brain biopsy revealed CD20 diffuse large B-cell lymphoma. The patient was started on high-dose intravenous methotrexate. She has received 11 cycles and has regained near normal function of the right arm. The patient's most recent brain MRI showed near complete resolution of all previously seen abnormal foci of enhancement.
Collapse
Affiliation(s)
- Yana G Najjar
- Department of Internal Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | |
Collapse
|
20
|
Phase II study of CHOP-GR therapy in diffuse large B-cell lymphoma. Int J Hematol 2012; 96:241-6. [DOI: 10.1007/s12185-012-1119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
|
21
|
Tomita N, Yokoyama M, Yamamoto W, Watanabe R, Shimazu Y, Masaki Y, Tsunoda S, Hashimoto C, Murayama K, Yano T, Okamoto R, Kikuchi A, Tamura K, Sato K, Sunami K, Shibayama H, Takimoto R, Ohshima R, Hatta Y, Moriuchi Y, Kinoshita T, Yamamoto M, Numata A, Ishigatsubo Y, Takeuchi K. Central nervous system event in patients with diffuse large B-cell lymphoma in the rituximab era. Cancer Sci 2011; 103:245-51. [DOI: 10.1111/j.1349-7006.2011.02139.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
22
|
Kawano N, Ochiai H, Yoshida S, Yamashita K, Shide K, Shimoda H, Hidaka T, Kubuki Y, Katayose K, Toyama T, Kawano H, Matsuoka H, Ishizaki J, Maeda K, Satou S, Yano T, Yamaguchi K, Takenaka K, Shimao Y, Oshima K, Ueda A, Shimoda K. Clinical features and treatment outcomes of isolated secondary central nervous system lymphomas in Miyazaki Prefecture. Int J Clin Oncol 2011; 17:336-40. [PMID: 21904968 DOI: 10.1007/s10147-011-0292-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 07/09/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Secondary central nervous system lymphoma (SCNSL) without extra-central nervous system (CNS) involvement is characterized by isolated secondary CNS relapse in malignant lymphoma patients. SCNSL is a rare disease, and no standard treatment has yet been established. PATIENTS AND METHODS To elucidate the clinical characteristics and outcomes of SCNSL, we retrospectively analyzed 12 patients (median age 67 years) in Miyazaki prefecture for the last 5 years. RESULTS The initial histological diagnoses of the patients were diffuse large B-cell lymphoma (DLBCL), mantle-cell lymphoma, and adult T-cell lymphoma in 9, 2, and 1 patient, respectively. We focused on analysis of the 9 SCNSL cases originating from DLBCL. The locations of CNS relapse were the cerebral hemisphere, basal ganglia, and cerebellum in 7, 1, and 1 patient, respectively. Three patients were treated with high-dose methotrexate (HD-MTX) therapy; 4 with whole-brain radiation therapy (WBRTX); and 1 with both HD-MTX and WBRTX. The remaining patients were treated with rituximab. Partial remission was achieved in 6 out of 9 patients (67%); the other 3 patients (33%) did not respond to therapy. Median survival of the 9 patients with CNS relapse was 253 days; 6 of the 9 patients survived for more than 6 months. As of March 2011, 2 HD-MTX group patients but none of the WBRTX group patients were alive. CONCLUSIONS In this retrospective study, 6 of 9 patients with SCNSL originating from DLBCL survived for more than 6 months. Both HD-MTX and WBRTX had clinical benefits in the treatment of SCNSL.
Collapse
Affiliation(s)
- Noriaki Kawano
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Secondary central nervous system (CNS) involvement in patients with diffuse large B-cell lymphoma: a therapeutic dilemma. Ann Hematol 2010; 90:539-46. [DOI: 10.1007/s00277-010-1104-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 10/08/2010] [Indexed: 11/27/2022]
|
24
|
Anthony S. Non-Hodgkin's lymphoma presenting with multiple cranial nerve deficits. ACTA ACUST UNITED AC 2010; 81:510-5. [DOI: 10.1016/j.optm.2010.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/20/2010] [Accepted: 01/29/2010] [Indexed: 11/16/2022]
|
25
|
Yamamoto W, Tomita N, Watanabe R, Hattori Y, Nakajima Y, Hyo R, Hashimoto C, Motomura S, Ishigatsubo Y. Central nervous system involvement in diffuse large B-cell lymphoma. Eur J Haematol 2010; 85:6-10. [PMID: 20236301 DOI: 10.1111/j.1600-0609.2010.01438.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malignant lymphoma with central nervous system (CNS) involvement has an extremely poor prognosis. We retrospectively studied the risk factors for CNS involvement in patients with diffuse large B-cell lymphoma (DLBCL) treated by cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab (R) -CHOP chemotherapy. PATIENTS AND METHODS We studied 375 consecutive patients who were newly diagnosed with DLBCL between 1996 and 2006. Patients with primary CNS involvement and patients who received CNS prophylaxis were excluded. All the patients received CHOP (n = 172) or R-CHOP (n = 203) chemotherapy. The following variables were assessed for their potential to predict CNS involvement: gender, age, serum lactate dehydrogenase (LDH) level, performance status, clinical stage, number of extranodal involvements, International Prognostic Index (IPI), bone marrow involvement, presence of a bulky mass, presence of B symptom, and treatment. RESULTS CNS involvement was observed in 13 cases (3.5%). In univariate analysis, LDH more than normal range, LDH more than twice as normal range, high IPI, bone marrow involvement, and systemic relapse were the predictors for CNS involvement. In multivariate analysis, no risk factors were detected for CNS involvement. The use of rituximab did not have an impact on CNS involvement. CONCLUSIONS The incidence of CNS involvement does not decrease in rituximab-era.
Collapse
Affiliation(s)
- Wataru Yamamoto
- Department of Hematology, Yamato Municipal Hospital, Yamato, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Van Besien K, Gisselbrecht C, Pfreundschuh M, Zucca E. Secondary lymphomas of the central nervous system: risk, prophylaxis and treatment. Leuk Lymphoma 2009; 49 Suppl 1:52-8. [DOI: 10.1080/10428190802311458] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Diffuse large B-cell lymphoma with central nervous system relapse: prognosis and risk factors according to retrospective analysis from a single-center experience. Int J Hematol 2009; 89:577-83. [PMID: 19353238 DOI: 10.1007/s12185-009-0289-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 01/22/2023]
Abstract
The introduction of rituximab for diffuse large B-cell lymphoma (DLBCL) has improved the disease's overall prognosis. However, relapse in the central nervous system (CNS) is still an issue. We investigated the prognosis and risk factors of CNS recurrence in DLBCL. A total of 403 patients who were diagnosed with DLBCL without CNS involvement between January 1996 and April 2007 at our institution were included in the study. Subsequently, 42 experienced CNS relapse. Clinical information was gathered by chart review. The median disease-free interval to CNS relapse was 625 days. The mean survival periods after relapse in the cases with CNS and extra-CNS involvement were 513 and 1,615 days, respectively (P = 0.0004). Multivariate analysis identified age >60 years (P = 0.031), involvement in two or more extranodal sites (P = 0.040), bone marrow involvement (P = 0.036), an elevated serum lactate dehydrogenase (LDH) level (P = 0.016), and treatment without rituximab before CNS relapse (P = 0.027) as independent predictors of CNS relapse. We have shown that cases of DLBCL occurring in advanced age, involving two or more extranodal sites or the bone marrow, or showing an elevation of LDH have a higher risk of CNS relapse. Rituximab may prevent CNS relapse by reducing the recurrence of DLBCL at all sites. An effective CNS prophylaxis strategy should be determined according to the risk assessment of CNS relapse.
Collapse
|
28
|
Di Noto R, Scalia G, Abate G, Gorrese M, Pascariello C, Raia M, Morabito P, Capone F, Pardo CL, Mirabelli P, Mariotti E, Del Vecchio L. Critical role of multidimensional flow cytometry in detecting occult leptomeningeal disease in newly diagnosed aggressive B-cell lymphomas. Leuk Res 2008; 32:1196-9. [DOI: 10.1016/j.leukres.2007.12.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 12/20/2007] [Accepted: 12/20/2007] [Indexed: 11/28/2022]
|
29
|
Herpes simplex encephalitis and subsequent cytomegalovirus encephalitis after chemoradiotherapy for central nervous system lymphoma: a case report and literature review. Int J Hematol 2008; 87:538-541. [DOI: 10.1007/s12185-008-0083-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/07/2008] [Accepted: 03/14/2008] [Indexed: 10/22/2022]
|
30
|
Affiliation(s)
- Nancy D Doolittle
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| |
Collapse
|
31
|
Shimizu I, Ichikawa N, Yotsumoto M, Sumi M, Ueno M, Kobayashi H. Asian variant of intravascular lymphoma: aspects of diagnosis and the role of rituximab. Intern Med 2007; 46:1381-6. [PMID: 17827836 DOI: 10.2169/internalmedicine.46.0066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The Asian variant of intravascular lymphoma (AIVL) is a rare non-Hodgkin's lymphoma, characterized by hemophagocytic syndrome and the absence of neurological abnormality or skin lesions, which are typical features of classical IVL. The purpose of this study was to describe the characteristics and outcomes of AIVL patients. PATIENTS AND METHODS We conducted a retrospective chart review of AIVL patients who were admitted to our institution between January 1999 and December 2006. RESULTS Eight patients met the criteria. All patients presented with typical clinical features, including fever, hepatosplenomegaly, and cytopenia. The median time from onset to diagnosis was 4 weeks (range 2-12). Pathological diagnoses were made by bone marrow biopsy in three patients, transjugular liver biopsy in two patients, splenectomy in two patients, and percutaneous liver biopsy in one patient. All patients were treated with CHOP-like chemotherapy and rituximab was administered in five patients. Six patients achieved complete response, one achieved partial response, and two patients had central nervous system (CNS) relapse. Among the five patients treated with rituximab, four are still alive, with a median follow-up of 28 months. CONCLUSION A CHOP-like regimen with rituximab may be effective for AIVL cases, but, as in classical IVL, CNS prophylaxis should be considered.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asian People
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/secondary
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prednisolone/therapeutic use
- Retrospective Studies
- Rituximab
- Vascular Neoplasms/diagnosis
- Vascular Neoplasms/drug therapy
- Vascular Neoplasms/pathology
- Vincristine/therapeutic use
Collapse
Affiliation(s)
- Ikuo Shimizu
- Department of Hematology, Nagano Red Cross Hospital.
| | | | | | | | | | | |
Collapse
|