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Tan D, Chan JY, Wudhikarn K, Wong RSM, Poon L, Norasetthada L, Huang TC, Tse E. Unmet Needs in the First-Line Treatment of Diffuse Large B-cell Lymphoma: Expert Recommendations From the Asia-Pacific Region With a Focus on the Challenging Subtypes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e320-e328. [PMID: 38853026 DOI: 10.1016/j.clml.2024.05.013] [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: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for around 30-60% of all cases. The management of DLBCL in Asia has several unmet needs due to the diversity of the population, the heterogeneity of local clinical guidelines for DLBCL and the wide disparity in resources and healthcare systems across different regions. Rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) is widely recognized as the standard first-line treatment for DLBCL; however, alternative regimens are required to improve patient outcomes in challenging subtypes, such as patients with high International Prognostic Index scores, old/frail patients, and patients with double-hit and double-expressor DLBCL or concurrent central nervous system disease. This review article draws from the expertise of practicing hematologists/oncologists in the region, with the aim of integrating data from current scientific evidence to address the unmet needs and unique socioeconomic challenges faced by challenging high risk patient groups in the Asia-Pacific region.
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Affiliation(s)
- Daryl Tan
- Clinic for Lymphoma, Myeloma and Blood Disorders, Mount Elizabeth Novena Hospital, Singapore.
| | | | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Raymond Siu Ming Wong
- Sir Y.K. Pao Centre for Cancer & Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Limei Poon
- Department of Hematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Lalita Norasetthada
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tai-Chung Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Eric Tse
- Department of Medicine, University of Hong Kong, Hong Kong
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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.
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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
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Rinaldi I, Muthalib A, Gondhowiardjo S, Setiawan T, Gunawan A, Susanto N, Magdalena L, Winston K, Disamantiji A, Wirawan B. Relapsed isolated CNS lymphoma treated with radiotherapy and intrathecal methotrexate followed by high-dose intravenous methotrexate, rituximab, and temozolomide: A case report. Clin Case Rep 2024; 12:e8409. [PMID: 38435502 PMCID: PMC10907348 DOI: 10.1002/ccr3.8409] [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: 07/28/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024] Open
Abstract
Key Clinical Message Optimized treatments for relapsed isolated CNS lymphoma (RI-SCNSL) remains under investigation. Temozolomide combination-based therapy, which is often used in glioblastoma may be used as potential treatment in RI-SCNSL. Abstract One of the most common types of non-Hodgkin lymphoma (NHL) is diffuse large B-cell lymphoma (DLBCL). Despite advances in treatment, relapsed isolated CNS lymphoma (RI-SCNSL) from DLBCL remains an issue. The optimal approach in RI-SCNSL remains an area of active investigation as currently there is no high level of evidence for the treatments due to lack of randomized studies. In this case report, we present a DLBCL patient with CNS recurrence treated radiotherapy and intrathecal methotrexate (MTX) followed by intravenous high-dose MTX, rituximab, and temozolomide. To the best of our knowledge, this is the first case report describing RI-SCNSL treated with the regiments above which also include temozolomide which is used for glioblastoma.
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Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
- Department of Internal MedicineGading Pluit HospitalJakartaIndonesia
| | - Abdul Muthalib
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
- Department of Internal MedicineGading Pluit HospitalJakartaIndonesia
| | | | - Tjondro Setiawan
- Department of Internal MedicineGading Pluit HospitalJakartaIndonesia
| | - Andhika Gunawan
- Department of Nuclear MedicineGading Pluit HospitalJakartaIndonesia
| | - Nelly Susanto
- Department of RadiologyGading Pluit HospitalJakartaIndonesia
| | | | - Kevin Winston
- Hospital MedicineBhakti Medicare HospitalCicurugIndonesia
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Chua BJG, Low CE, Yau CE, Tan YH, Chiang J, Chang EWY, Chan JY, Poon EYL, Somasundaram N, Rashid MFBH, Tao M, Lim ST, Yang VS. Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma. Exp Hematol Oncol 2024; 13:1. [PMID: 38173015 PMCID: PMC10765685 DOI: 10.1186/s40164-023-00467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
The use of central nervous system (CNS) prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. Although uncommon, CNS relapses are invariably fatal in this otherwise curable disease. Accurate identification of patients at risk and the optimal approach to CNS prophylaxis therefore remains an area of unmet need. The existing literature, largely retrospective in nature, provides mixed conclusions regarding the efficacy of CNS prophylaxis. The utility of CNS prophylaxis has itself been challenged. In this review, we dissect the issues which render the value of CNS prophylaxis uncertain. We first compare international clinical guidelines for CNS prophylaxis. We then interrogate the factors that should be used to identify high-risk patients accurately. We also explore how clinical patterns of CNS relapse have changed in the pre-rituximab and rituximab era. We then discuss the efficacy of CNS-directed approaches, intensification of systemic treatment and other novel approaches in CNS prophylaxis. Improved diagnostics for early detection of CNS relapses and newer therapeutics for CNS prophylaxis are areas of active investigation. In an area where prospective, randomized studies are impracticable and lacking, guidance for the use of CNS prophylaxis will depend on rigorous statistical review of retrospective data.
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Affiliation(s)
- Bernard Ji Guang Chua
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Mohamed Farid Bin Harunal Rashid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore.
- Translational Precision Oncology Lab, Institute of Molecular and Cell Biology (IMCB), 61 Biopolis Dr Proteos, Singapore, 138673, A*STAR, Singapore.
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Habringer S, Demel UM, Fietz AK, Lammer F, Schroers R, Hofer S, Bairey O, Braess J, Meier-Stiegen AS, Stuhlmann R, Schmidt-Hieber M, Hoffmann J, Zinngrebe B, Kaiser U, Reimer P, Möhle R, Fix P, Höffkes HG, Langenkamp U, Büschenfelde CMZ, Hopfer O, Stoltefuß A, La Rosée P, Blasberg H, Jordan K, Kaun S, Meurer A, Unteroberdörster M, von Brünneck AC, Capper D, Heppner FL, Chapuy B, Janz M, Schwartz S, Konietschke F, Vajkoczy P, Korfel A, Keller U. A prospective observational study of real-world treatment and outcome in secondary CNS lymphoma. Eur J Cancer 2024; 196:113436. [PMID: 38008033 DOI: 10.1016/j.ejca.2023.113436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Secondary central nervous system lymphoma (SCNSL) confers a dismal prognosis and treatment advances are constrained by the lack of prospective studies and real-world treatment evidence. METHODS Patients with SCNSL of all entities were included at first diagnosis and patient characteristics, treatment data, and outcomes were prospectively collected in the Secondary CNS Lymphoma Registry (SCNSL-R) (NCT05114330). FINDINGS 279 patients from 47 institutions were enrolled from 2011 to 2022 and 243 patients (median age: 66 years; range: 23-86) were available for analysis. Of those, 49 (20 %) patients presented with synchronous (cohort I) and 194 (80 %) with metachronous SCNSL (cohort II). The predominant histology was diffuse large B-cell lymphoma (DLBCL, 68 %). Median overall survival (OS) from diagnosis of CNS involvement was 17·2 months (95 % CI 12-27·5), with longer OS in cohort I (60·6 months, 95 % CI 45·5-not estimable (NE)) than cohort II (11·4 months, 95 % CI 7·8-17·7, log-rank test p < 0.0001). Predominant induction regimens included R-CHOP/high-dose MTX (cohort I) and high-dose MTX/cytarabine (cohort II). Rituximab was used in 166 (68 %) of B-cell lymphoma. Undergoing consolidating high-dose therapy and autologous hematopoietic stem cell transplantation (HDT-ASCT) in partial response (PR) or better was associated with longer OS (HR adjusted 0·47 (95 % CI 0·25-0·89), p = 0·0197). INTERPRETATION This study is the largest prospective cohort of SCNSL patients providing a comprehensive overview of an international real-world treatment landscape and outcomes. Prognosis was better in patients with SCNSL involvement at initial diagnosis (cohort I) and consolidating HDT-ASCT was associated with favorable outcome in patients with PR or better.
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Affiliation(s)
- Stefan Habringer
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité (BIH), Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany
| | - Uta M Demel
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin, Berlin, Germany
| | - Felicitas Lammer
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roland Schroers
- Department of Medicine, Hematology and Oncology, Ruhr University Bochum, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Silvia Hofer
- Division Medical Oncology Cantonal Hospital Luzern, Luzern, Switzerland; Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Osnat Bairey
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Anna Sofia Meier-Stiegen
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Reingard Stuhlmann
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Martin Schmidt-Hieber
- Department of Hematology and Oncology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Johannes Hoffmann
- Pius-Hospital, University Medicine Oldenburg, Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Oldenburg, Germany
| | - Bettina Zinngrebe
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Ulrich Kaiser
- Medizinische Klinik II, St Bernward Krankenhaus, Hildesheim, Germany
| | - Peter Reimer
- Department of Hematology, Medical Oncology and Stem Cell Transplantation, Kliniken Essen-Mitte, Essen, Germany
| | - Robert Möhle
- Department of Internal Medicine II, Medical University Hospital, Tübingen, Germany
| | - Peter Fix
- Onkologische Praxis Dr. med. Peter Fix, Jena, Germany
| | | | - Ulrich Langenkamp
- Department of Internal Medicine, Medical Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, University of Rostock, 18057 Rostock, Germany
| | | | - Olaf Hopfer
- Department of Medicine I, Hospital Frankfurt (Oder), Frankfurt (Oder), Germany
| | - Andrea Stoltefuß
- Department of Hematology, Oncology and Palliative Care, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Paul La Rosée
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany; Klinik für Innere Medizin II, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | - Henning Blasberg
- Hospital of Internal Medicine II, Hematology and Oncology, St. Georg Hospital Leipzig, Leipzig, Germany
| | - Karin Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Stephan Kaun
- Hematology/Oncology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Anna Meurer
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Meike Unteroberdörster
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ann-Christin von Brünneck
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Cluster of Excellence, NeuroCure, Berlin, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Cluster of Excellence, NeuroCure, Berlin, Germany
| | - Björn Chapuy
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Janz
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan Schwartz
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany
| | - Frank Konietschke
- Institute of Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Agnieszka Korfel
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany.
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Shichijo T, Tatetsu H, Nosaka K, Higuchi Y, Kikukawa Y, Inoue Y, Toyoda K, Yasunaga J, Matsuoka M. Predictive impact of soluble interleukin-2 receptor and number of extranodal sites for identification of patients at very high risk of CNS relapse in diffuse large B-cell lymphoma. EJHAEM 2022; 3:385-393. [PMID: 35846027 PMCID: PMC9175809 DOI: 10.1002/jha2.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
Abstract
There remains an unmet clinical need to identify which patients with diffuse large B-cell lymphoma (DLBCL) would benefit from central nervous system (CNS) prophylaxis, due to the low positive predictive value (PPV; 10%-15%) of the currently available predictive models. To stratify patients at high risk of developing CNS relapse, we retrospectively analyzed 182 patients with DLBCL initially treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), or a R-CHOP-like regimen. Among them, 17 patients relapsed with CNS involvement, and the 2-year rate of CNS relapse was 7.9%. Upon carrying out multivariate analysis, ≥3 extranodal sites and elevated soluble interleukin-2 receptor (sIL-2R) levels at diagnosis were identified as independent risk factors for CNS relapse. The 2-year and 3.5-year rates of CNS relapse were 57.1% and 78.6%, respectively, in patients with both elevated sIL-2R and ≥3 extranodal sites. Furthermore, combined use of these risk factors of both elevated sIL-2R and ≥3 extranodal sites resulted in a high PPV (71.4%), negative predictive value (93.1%), and overall accuracy (92.3%) for undergoing CNS relapse. In conclusion, we propose a simple and valuable tool to predict patients with DLBCL at very high risk of CNS relapse.
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Affiliation(s)
- Takafumi Shichijo
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Hiro Tatetsu
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Kisato Nosaka
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Yusuke Higuchi
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Yoshitaka Kikukawa
- Department of Hematology and OncologyKumamoto City HospitalKumamotoJapan
| | - Yoshitaka Inoue
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Kosuke Toyoda
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Jun‐ichirou Yasunaga
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
| | - Masao Matsuoka
- Department of Hematology, Rheumatology and Infectious DiseasesKumamoto University HospitalKumamotoJapan
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Intelligent Diagnosis and Analysis of Brain Lymphoma Based on DSC Imaging Features. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4981620. [PMID: 35251152 PMCID: PMC8894066 DOI: 10.1155/2022/4981620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
Currently, DSC has been extensively studied in the diagnosis, differential diagnosis, and prognosis evaluation of brain lymphoma, but it has not obtained a uniform standard. By combining DSC imaging features, this study investigated the imaging features and diagnostic value of several types of tumors such as primary brain lymphoma. At the same time, this study obtained data from brain lymphoma patients by data collection and set up different groups to conduct experimental studies to explore the correlation between IVIMMRI perfusion parameters and DSC perfusion parameters in brain lymphoma. Through experimental research, it can be seen that the combination of two perfusion imaging techniques can more fully reflect the blood flow properties of the lesion, which is beneficial to determine the nature of the lesion.
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8
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Bennett R, Ruskova A, Petrasich M, Theakston E. Value of cerebrospinal fluid white cell count and protein level in predicting leptomeningeal involvement by systemic aggressive B-cell lymphoma. Int J Lab Hematol 2022; 44:490-496. [PMID: 35166454 DOI: 10.1111/ijlh.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Diagnostic cerebrospinal fluid (CSF) analysis for patients with newly diagnosed aggressive B-cell lymphoma at risk of secondary central nervous system involvement typically includes multiparametric flow cytometry (MFC), cytology (CC), white cell count (WCC) and total protein. The strength of relationships between MFC results and the remaining variables has been disputed in small studies. We explored these relationships in a large homogeneous cohort of patient samples, aiming to establish the relationship between WCC and protein level and MFC results. METHODS Adult patients with aggressive B-cell lymphoma at risk of CNS involvement who underwent staging CSF analysis by MFC were identified retrospectively from institutional electronic records between October 2011 and December 2020. RESULTS Three hundred and seventy eight samples, including 45 (11.9%) MFC+ samples, were analysed. The relative sensitivity of CC for MFC positivity was 0.38, with PPV of 0.68. Significantly higher median WCC (p < .001) and protein levels (p = .011) were seen in MFC+ vs. MFC- samples. MFC + CC+ (vs. MFC + CC- samples) demonstrated higher median neoplastic events and neoplastic cell concentration. WCC ≥36 × 106 /L and protein ≥1.12 g/L cut-off values demonstrated the highest PPVs for MFC positivity (0.67 and 0.88, respectively). CONCLUSIONS Statistically significant associations exist between elevated WCC and protein and MFC positivity, and selected WCC and protein cut-off values have PPVs comparable to that of cytological assessment. Whilst routine WCC and protein analysis may be unnecessary, WCC/protein values above these levels could be regarded as reasonable evidence of CSF involvement in the appropriate setting.
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Affiliation(s)
- Rory Bennett
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Anna Ruskova
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Michelle Petrasich
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
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Orellana-Noia VM, Reed DR, McCook AA, Sen JM, Barlow CM, Malecek MK, Watkins M, Kahl BS, Spinner MA, Advani R, Voorhees TJ, Snow A, Grover NS, Ayers A, Romancik J, Liu Y, Huntington SF, Chavez JC, Saeed H, Lazaryan A, Raghunathan V, Spurgeon SE, Ollila TA, Del Prete C, Olszewski A, Ayers EC, Landsburg DJ, Echalier B, Lee J, Kamdar M, Caimi PF, Fu T, Liu J, David KA, Alharthy H, Law J, Karmali R, Shah H, Stephens DM, Major A, Rojek AE, Smith SM, Yellala A, Kallam A, Nakhoda S, Khan N, Sohail MA, Hill BT, Barrett-Campbell O, Lansigan F, Switchenko J, Cohen J, Portell CA. Single-route CNS prophylaxis for aggressive non-Hodgkin lymphomas: real-world outcomes from 21 US academic institutions. Blood 2022; 139:413-423. [PMID: 34570876 PMCID: PMC8777199 DOI: 10.1182/blood.2021012888] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/05/2021] [Indexed: 01/22/2023] Open
Abstract
Prophylaxis is commonly used to prevent central nervous sy stem (CNS) relapse in diffuse large B-cell lymphoma (DLBCL), with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013 and 2019. Prophylaxis was administered intrathecally(IT) in 894 (77%) and using systemic high-dose methotrexate (HD-MTX) in 236 (20%); 32 patients (3%) switched route due to toxicity and were assessed separately. By CNS-International Prognostic Index (IPI), 18% were considered low-risk, 51% moderate, and 30% high. Double-hit lymphoma (DHL) was confirmed in 243 of 866 evaluable patients (21%). Sixty-four patients (5.7%) had CNS relapse after median 7.1 months from diagnosis, including 15 of 64 (23%) within the first 6 months. There was no significant difference in CNS relapse between IT and HD-MTX recipients (5.4% vs 6.8%, P = .4), including after propensity score matching to account for differences between respective recipient groups. Weighting by CNS-IPI, expected vs observed CNS relapse rates were nearly identical (5.8% vs 5.7%). Testicular involvement was associated with high risk of CNS relapse (11.3%) despite most having lower CNS-IPI scores. DHL did not significantly predict for CNS relapse after single-route prophylaxis, including with adjustment for treatment regimen and other factors. This large study of CNS prophylaxis recipients with DLBCL found no significant difference in CNS relapse rates between routes of administration. Relapse rates among high-risk subgroups remain elevated, and reconsideration of prophylaxis strategies in DLBCL is of critical need.
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Affiliation(s)
- Victor Manuel Orellana-Noia
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Daniel R Reed
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Winston-Salem, NC
| | - Ashley Alesia McCook
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | | | - Christian M Barlow
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Mary-Kate Malecek
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Marcus Watkins
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michael A Spinner
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Ranjana Advani
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Hematology, Ohio State University, Columbus, OH
| | - Anson Snow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Natalie Sophia Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amy Ayers
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Jason Romancik
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Yuxin Liu
- Division of Hematology, Yale University, New Haven, CT
| | | | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Hayder Saeed
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Vikram Raghunathan
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Stephen E Spurgeon
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
| | - Thomas A Ollila
- Division of Hematology/Oncology, Brown University, Providence, RI
| | | | - Adam Olszewski
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Emily C Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jun Lee
- Division of Hematology, University of Colorado, Denver, CO
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO
| | - Paolo F Caimi
- Adult Hematologic Malignancies and Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Timothy Fu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Jieqi Liu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Kevin A David
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Hanan Alharthy
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Jennie Law
- Division of Hematology and Oncology, University of Maryland Greenbaum Comprehensive Cancer Center, Baltimore, MD
| | - Reem Karmali
- Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Harsh Shah
- University of Utah/Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ajay Major
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Amulya Yellala
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Avyakta Kallam
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA; and
| | - Mohammad Ahsan Sohail
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Frederick Lansigan
- Division of Hematology and Oncology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Jeffrey Switchenko
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | - Jonathon Cohen
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Craig A Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
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Ma'koseh M, Tamimi F, Abufara A, Abusalem L, Salama O, Saleh Y, Khader R, Faiyoumi BA, Al-Rwashdeh M, Halahleh K. Impact of Central Nervous System International Prognostic Index on the Treatment of Diffuse Large B Cell Lymphoma. Cureus 2021; 13:e16802. [PMID: 34513408 PMCID: PMC8407468 DOI: 10.7759/cureus.16802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/07/2022] Open
Abstract
Background The central nervous system international prognostic index (CNS-IPI) is being used widely for the identification of patients with diffuse large B cell lymphoma (DLBCL) with a high risk of central nervous system (CNS) relapse. The aim of our study is to confirm the value of the CNS-IPI in predicting CNS relapse in our young study population and to evaluate its impact on the selection of patients for CNS prophylaxis. Methods We retrospectively reviewed patients diagnosed with DLBCL who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) regimen from January 2010 till December 2018. Correlation between CNS-IPI and cumulative incidence of CNS relapse and time to CNS relapse was examined through Kaplan-Meier plots. Median time to CNS relapse and median overall survival after CNS relapse were also estimated using the Kaplan-Meier plots. Results A total of 354 patients were included. The median age was 46 years. Overall, 5% of the patients developed CNS relapse. Median survival after CNS relapse was seven months. Two-year CNS relapse rates according to CNS-IPI were 0.7%, 5.1%, and 26% for low, intermediate, and high-risk, groups respectively. On multivariate analysis, poor performance status (p=0.045), involvement of two or more extranodal sites (p= 0.021), involvement of bone marrow (p= 0.029), and renal or adrenal glands (p= 0.006) significantly correlated with CNS relapse. Considering the CNS-IPI and high-risk anatomical sites (breast, uterus, testis, and epidural space), 26% of our patients with DLBCL would have needed prophylaxis. Conclusion Although CNS-IPI helps in better selection of DLBCL patients for CNS prophylaxis, it can possibly increase the number of patients exposed to unnecessary prophylaxis. More investigational biomarkers are needed to better refining high-risk patients.
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Affiliation(s)
| | - Faris Tamimi
- Medical Oncology, King Hussein Cancer Center, Amman, JOR
| | - Alaa Abufara
- Medical Oncology, King Hussein Cancer Center, Amman, JOR
| | - Lana Abusalem
- Medical Oncology, King Hussein Cancer Center, Amman, JOR
| | - Osama Salama
- Medical Oncology, King Hussein Cancer Center, Amman, JOR
| | - Yacob Saleh
- Medical Oncology, King Hussein Cancer Center, Amman, JOR
| | - Rnad Khader
- Medical Oncology, King Hussein Cancer Center, Amman, JOR
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11
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Brown DA, Goyal A, Richter KR, Haglin JM, Himes BT, Lu VM, Snyder K, Hughes J, Decker PA, Opoku-Darko M, Link MJ, Burns TC, Parney IF. Clinical utility of brain biopsy for presumed CNS relapse of systemic lymphoma. J Neurosurg 2021; 136:30-39. [PMID: 34214988 DOI: 10.3171/2020.12.jns202517] [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] [Received: 06/27/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine the frequency with which brain biopsy for presumed CNS relapse of systemic hematological malignancies yields new, actionable diagnostic information. Hematological malignancies represent a disparate group of genetic and histopathological disorders. Proclivity for brain involvement is dependent on the unique entity and may occur synchronously or metasynchronously with the systemic lesion. Diffuse large B-cell lymphomas (DLBCLs) have a high propensity for brain involvement. Patients in remission from systemic DLBCL may present with a lesion suspicious for brain relapse. These patients often undergo brain biopsy. The authors' a priori hypothesis was that brain biopsy in patients with a history of systemic DLBCL and a new brain MRI lesion would have lower diagnostic utility compared with patients with non-DLBCL systemic malignancies. METHODS The authors performed a retrospective review of patients who underwent brain biopsy between 2000 and 2019. Inclusion criteria were patients ≥ 18 years of age with a prior systemic hematological malignancy in remission presenting with a new brain MRI lesion concerning for CNS relapse. Patients with a history of any CNS neoplasms, demyelinating disorders, or active systemic disease were excluded. The main outcome was the proportion of patients with a distinct histopathological brain diagnosis compared with the systemic malignancy. The authors secondarily assessed overall survival, procedure-related morbidity, and 30-day mortality. RESULTS Sixty patients met inclusion criteria (40 males and 20 females); the median age at brain biopsy was 67 years (range 23-88 years). The median follow-up was 8.5 months (range 0.1-231 months). Thirty-nine (65.0%) patients had DLBCL and 21 (35%) had non-DLBCL malignancies. Thirty-five of 36 (97.2%) patients with prior systemic DLBCL and a diagnostic biopsy had histopathological confirmation of the original systemic disease versus 0 of 21 patients with non-DLBCL systemic malignancies (p < 0.001). Morbidity and 30-day mortality were 8.3% and 10.0%, respectively; 2 of 6 30-day mortalities were directly attributable to the biopsy. The median overall survival following brain biopsy was 10.8 months. CONCLUSIONS Patients with a history of systemic DLBCL and presumed CNS relapse gained minimal clinical benefit from brain biopsy but were at high risk of morbidity and mortality. In patients with a history of non-DLBCL systemic malignancies, brain biopsy remained critical given the high likelihood for discovery of distinct diagnostic entities. It was determined that patients with a prior systemic DLBCL and presumed brain relapse should likely receive empirical therapy obviating treatment delay and the risks of brain biopsy.
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Affiliation(s)
| | | | - Kent R Richter
- 2Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona; and
| | - Jack M Haglin
- 2Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona; and
| | | | | | | | - Joshua Hughes
- 3Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee
| | - Paul A Decker
- 4Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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12
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He M, Zhang W, Wang J, Gao L, Jiao L, Wang L, Zheng J, Cai Z, Yang J. Aggregative Perivascular Tumor Cell Growth Pattern of Primary Central Nervous System Lymphomas Is Associated with Hypoxia-Related Endoplasmic Reticulum Stress. J Cancer 2021; 12:3841-3852. [PMID: 34093792 PMCID: PMC8176238 DOI: 10.7150/jca.54952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSLs) often present a unique histopathological feature of aggregative perivascular tumor cells (APVT). Our previous studies showed that patients of PCNSL with APVTs exhibited poor long-term outcomes and increased expression of the endoplasmic reticulum stress (ERS) factor X-box-binding protein (XBP1). However, very little is known about molecular mechanism of the APVT formation in PCNSLs. The aim of this study is to determine if hypoxia-induced ERS is related to the APVT formation in PCNSLs. In this study, cell culture was used to observe the interplay between diffuse large B cell lymphoma (DLBCL) tumor cells and human brain microvascular endothelial cells (HBMECs) in different oxygen conditions. The expression of XBP1, CXCR and CD44 was manipulated by molecular cloning and siRNA technology. Mouse in vivo experiments and clinical studies were conducted to confirm our hypothesis. Our results showed that activated B-cell type-DLBCL cells easily migrated and invaded, and expressed high levels of XBP1 and stromal molecules CXCR4 and CD44 during hypoxia-induced ERS and dithiothreitol unfolded protein response (UPR). The gene upregulation (using overexpression vector) and downregulation (siRNA gene knock-out) in cultured cells and in mouse models further confirmed a close relation of the expression of XBP1, CXCR4, and CD44 with APVT formation, which is coincided with our clinical observation that increased expression of XBP1, CXCR4, and CD44 in the APVT cells in PCNSLs were associated with poor clinical outcomes. The results suggest that hypoxia-induced ERS and UPR might be associated with APVTs formation in PCNSL and its poor clinical outcomes. The results will help us better understand the progression of PCNSL with APVTs feature in daily pathological work and could be valuable for future target treatment of PCNSLs.
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Affiliation(s)
- Miaoxia He
- Department of pathology, Changhai Hospital, Shanghai 200433, China
| | - Weiwei Zhang
- Department of Experimental Diagnose, Changhai Hospital, Shanghai 200433, China
| | - Jianjun Wang
- Department of pathology, Changhai Hospital, Shanghai 200433, China
| | - Lei Gao
- Department of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Lijuan Jiao
- Department of pathology, Changhai Hospital, Shanghai 200433, China
| | - Laixing Wang
- Department of Neurosurgery, Changhai Hospital, Shanghai 200433, China
| | - Jianmin Zheng
- Department of pathology, Changhai Hospital, Shanghai 200433, China
| | - Zailong Cai
- Department of Biochemistry and Molecular Biology, Second Military Medical University, Shanghai, 200433 China
| | - Jianmin Yang
- Department of Hematology, Changhai Hospital, Shanghai 200433, China
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13
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Mao Y, Jiang M, Zhao F, Long L. Intelligent diagnosis and analysis of brain lymphoma based on imaging features. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-189808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, DSC has been extensively studied in the diagnosis, differential diagnosis and prognosis evaluation of brain lymphoma, but it has not obtained a uniform standard. By combining DSC imaging features, this study investigated the imaging features and diagnostic value of several types of tumors such as primary brain lymphoma. At the same time, this study obtained data from brain lymphoma patients by data collection and set up different groups to conduct experimental studies to explore the correlation between IVIM-MRI perfusion parameters and DSC perfusion parameters in brain lymphoma. Through experimental research, it can be seen that the combination of two perfusion imaging techniques can more fully reflect the blood flow properties of the lesion, which is beneficial to determine the nature of the lesion.
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Affiliation(s)
- Yipu Mao
- Department of Radiology, Nanning First People’s Hospital, Nanning, Guangxi, China
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Fanyu Zhao
- Department of Radiology, Guangxi Zhuang Autonomous Region Ethnic Hospital, Nanning, Guangxi, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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14
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Sundriyal D, Arya L, Srivastava R, Walia M, Sehrawat A. Leptomeningeal relapse in primary cutaneous DLBCL: Implications for a prophylactic CNS therapy. Cancer Rep (Hoboken) 2021; 4:e1295. [PMID: 33026176 PMCID: PMC7941546 DOI: 10.1002/cnr2.1295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Isolated leptomeningeal relapse in a case of cutaneous lymphoma is an uncommon event more so in a case of primary cutaneous diffuse large B-cell lymphoma (PCDLBCL). This phenomenon is of great significance as the subsequent prognosis becomes poor and the prophylactic central nervous system (CNS) therapy if administered, can reduce the chances of relapse, however, the survival benefit remains uncertain. The role of prophylactic CNS therapy is not well defined in the case of PCDLBCL. CASE We report a case of PCDLBCL leg type with a low CNS International Prognostic Index (CNS-IPI) risk, who developed isolated leptomeningeal relapse in the form of bilateral facial nerve palsy. He was managed by 2nd line chemotherapy and CNS directed therapy and achieved complete remission. CONCLUSION PCDLBCL leg type is an aggressive malignancy. Molecular/genomic mechanism likely responsible for CNS dissemination should be identified by prospective multi-centric studies that can better define the subsets of patients eligible for prophylactic therapy in the absence of a high CNS-IPI risk.
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshIndia
| | - Lima Arya
- Department of Medical OncologyMax Superspeciality HospitalNew DelhiIndia
| | - Ruchi Srivastava
- Department of PathologyMax Superspeciality HospitalNew DelhiIndia
| | - Meenu Walia
- Department of Medical OncologyMax Superspeciality HospitalNew DelhiIndia
| | - Amit Sehrawat
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshIndia
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15
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Sundriyal D, Arya L, Srivastava R, Walia M, Sehrawat A. Leptomeningeal relapse in primary cutaneous
DLBCL
: Implications for a prophylactic
CNS
therapy. Cancer Rep (Hoboken) 2021. [DOI: https:/doi.org/10.1002/cnr2.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
| | - Lima Arya
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Ruchi Srivastava
- Department of Pathology Max Superspeciality Hospital New Delhi India
| | - Meenu Walia
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
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16
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Sundriyal D, Arya L, Srivastava R, Walia M, Sehrawat A. Leptomeningeal relapse in primary cutaneous
DLBCL
: Implications for a prophylactic
CNS
therapy. Cancer Rep (Hoboken) 2020. [DOI: https://doi.org/10.1002/cnr2.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
| | - Lima Arya
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Ruchi Srivastava
- Department of Pathology Max Superspeciality Hospital New Delhi India
| | - Meenu Walia
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
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Abstract
We present a case of secondary central nervous system relapse of lymphoma detected initially on PET/CT without corresponding findings on MRI. A 60-year-old lymphoma patient demonstrated an FDG-avid focus in left cerebellar hemisphere on restaging PET/CT. MRI brain showed no corresponding abnormality, and expectant management ensued. Six months later, she represented with metabolic progression of previously seen FDG-avid focus in left cerebellar hemisphere, now also manifesting as an enhancing mass on MRI. Posttreatment scan for presumed lymphoma relapse showed metabolic response. This case demonstrates the advantage of PET/CT over anatomical imaging to detect metabolic changes before structural changes become apparent.
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18
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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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19
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Alonso-Álvarez S, Alcoceba M, García-Álvarez M, Blanco O, Rodríguez M, Baile M, Caballero JC, Dávila J, Vidriales MB, Esteban C, Arias P, Díaz LG, Tamayo P, Caballero MD, Gutiérrez NC, González M, Martín A. Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-Cell Lymphoma. Cancers (Basel) 2020; 12:cancers12020474. [PMID: 32085520 PMCID: PMC7072385 DOI: 10.3390/cancers12020474] [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: 01/16/2020] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 12/24/2022] Open
Abstract
The biology and clinical impact of bone marrow (BM) infiltration in patients with diffuse large B-cell lymphoma (DLBCL) remains unclear in the rituximab era. We retrospectively analyzed 232 patients diagnosed with DLBCL at our center between 1999 and 2014. Concordant-presence of large cells similar to those of the lymph node biopsy- and discordant-infiltration by small cells forming lymphoid aggregates, lacking cytological atypia-BM infiltration was defined by histological criteria and further characterized by flow cytometry (FCM). Cell of origin (COO) was determined using Hans’ algorithm. For the clonal relationship between tumor and discordant BM, the VDJH rearrangement was analyzed. Survival analyses were restricted to 189 patients treated with rituximab and chemotherapy. Thirty-six (16%) had concordant, and 37 (16%) discordant BM infiltration. FCM described different indolent lymphomas among discordant cases, clonally related with DLBCL in 10/13 available samples. Median follow-up was 58 months. 5-year-progression-free survival (PFS) for non-infiltrated, discordant and concordant groups was 68%, 65% and 30%, respectively (p < 0.001). Combining COO and BM infiltration, patients with discordant BM and non-germinal center B-cell COO also had decreased 5-year-PFS (41.9%). In multivariate analysis, concordant BM had an independent effect on PFS (HR 2.5, p = 0.01). Five-year cumulative incidence of central nervous system (CNS) relapse was 21%, 4% and 1% in concordant, discordant and non-infiltrated groups, respectively (p < 0.001). In conclusion, concordant BM infiltration represents a subset with poor prognosis, whereas the prognostic impact of discordant BM infiltration could be limited to non-CGB cases.
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Affiliation(s)
- Sara Alonso-Álvarez
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Miguel Alcoceba
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - María García-Álvarez
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Oscar Blanco
- Department of Pathology, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, Spain
| | - Marta Rodríguez
- Department of Pathology, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, Spain
| | - Mónica Baile
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Juan Carlos Caballero
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Julio Dávila
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - María Belén Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Carmen Esteban
- Department of General and Gastrointestinal Surgery, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, Spain
| | - Piedad Arias
- Department of Radiology, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, Spain
| | - Luis G. Díaz
- Department of Nuclear Medicine, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, Spain
| | - Pilar Tamayo
- Department of Nuclear Medicine, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, Spain
| | - María Dolores Caballero
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Norma C. Gutiérrez
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Marcos González
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
| | - Alejandro Martín
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, Spain
- Correspondence:
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Central Nervous System Involvement by Small Lymphocytic Lymphoma after a Myxoma-Related Embolic Event. Case Rep Hematol 2019; 2019:1825491. [PMID: 31827948 PMCID: PMC6881765 DOI: 10.1155/2019/1825491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/05/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Involvement of the central nervous system by chronic lymphocytic leukemia/small lymphocytic lymphoma is exceedingly rare, and currently no risk factors have been described. We report the case of a patient with concomitant chronic lymphocytic leukemia/small lymphocytic lymphoma and an embolic cerebrovascular accident related to a cardiac myxoma, who developed parenchymal central nervous system involvement of lymphoma on the ischemic bed. The patient was successfully treated with a high-dose fludarabine-based chemotherapy regimen, achieving a sustained remission. We propose that embolic breakage of the blood-brain barrier may be a major risk factor in producing central nervous system involvement. We also propose that a high-dose fludarabine-based chemotherapy regimen may be adequate to achieve a better CNS penetration and improved outcomes.
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21
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Ma J, Li Q, Shao J, Ma Y, Lin Z, Kang H, Chen B. Central Nervous System Involvement in Patients with Diffuse Large B Cell Lymphoma: Analysis of the Risk Factors and Prognosis from a Single-Center Retrospective Cohort Study. Cancer Manag Res 2019; 11:10175-10185. [PMID: 31819650 PMCID: PMC6896928 DOI: 10.2147/cmar.s225372] [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: 08/01/2019] [Accepted: 11/16/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to identify the risk factors for central nervous system (CNS) involvement in systemic diffuse large B-cell lymphoma (DLBCL) patients and to explore prognostic for DLBCL patients with CNS involvement (relapse or progression). Patients and methods This was a retrospective cohort study in our hospital. Data were collected from all DLBCL patients diagnosed in our institutes from January 2013 to June 2018. Clinical information was collected from medical records. Results The participants included 138 patients with DLBCL. Among them, 38 patients were diagnosed as CNS lymphoma, including 15 patients exhibited CNS involvement while DLBCL was pathologically confirmed, and 23 patients developed CNS lymphoma during or after initial chemotherapy. The median disease-free interval to CNS involvement was 13 months. Multivariate analysis identified elevated serum lactate dehydrogenase (LDH) level [hazard ratio (HR)=4.035; 95% confidence interval (95% CI): 1.147-14.195] was an independent predictor of CNS involvement. The median progression-free survival (PFS) and overall survival (OS) time of DLBCL patients with CNS involved were 12.5 months and 22 months, respectively. Multivariate prognostic analysis showed that eastern cooperative oncology group (ECOG) score>2(P=0.018; HR=7.333; 95% CI: 1.424-42.002), elevated serum LDH level (P=0.046; HR=6.510; 95% CI: 1.035-40.949), deep lesion (P=0.005; HR=10.957; 95% CI: 2.050-58.569), and CNS with systemic involvement (P=0.023; HR=2.730; 95% CI: 1.151-6.479) were independent poor prognostic factors for the patients. The cases with lymphocyte absolute count >0.75×109/L (HR=0.047; 95% CI: 0.003-0.732) had better prognosis. The OS of DLBCL patients with secondary CNS lymphoma was inferior to DLBCL patients without CNS involvement. There was no significant difference between the patients with CNS and extra-CNS involvement. There was no significant difference between the patients with CNS involvement and stage III-IV DLBCL cases without CNS lymphoma. Conclusion In conclusion, elevated serum LDH was independent high-risk factor for secondary CNS lymphoma. For DLBCL patients with CNS involvement, ECOG score>2, elevated serum LDH level, deep lesion, lymphocyte absolute count ≤0.75×109/L and CNS with systemic involvement retained a significant association with outcome.
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Affiliation(s)
- Jingjing Ma
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Qing Li
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Jie Shao
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Yan Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Zhiguang Lin
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Hui Kang
- Department of Hematology, Huashan Hospital North, Fudan University, Shanghai 201907, People's Republic of China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
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22
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Luo H, Yi P, Wang W, Li K, Meng L, Li J, Zeng W, Tang M. Clinicopathological Features, Treatment, and Prognosis in Primary Diffuse Large B Cell Lymphoma of the Breast: A Retrospective Study of 46 Patients. Med Sci Monit 2019; 25:8671-8682. [PMID: 31734687 PMCID: PMC6876064 DOI: 10.12659/msm.917550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Primary lymphoma of the breast is rare, and primary diffuse large B cell lymphoma (DLBCL) of the breast is very rare. This study aimed to identify the clinicopathological characteristics and treatment associated with prognosis in patients with primary DLBCL of the breast. MATERIAL AND METHODS A retrospective study included the clinical and treatment data from 46 women with a histological diagnosis of primary DLBCL. Patients were staged using Ann Arbor staging criteria, overall survival (OS), progression-free survival (PFS), and the international prognostic index (IPI) scores were obtained. Laboratory finding included serum lactate dehydrogenase (LDH), and the immunohistochemistry findings were recorded. RESULTS Patients (n=46), included stage I (n=18), stage II (n=18), stage III (n=3), and stage IV DLBCL (n=9). Treatment included chemotherapy with rituximab (n=16), and radiotherapy (n=12). The median follow-up time was 40.5 months, the 5-year OS rate was 36.2%, and the 5-year PFS rate was 29.1%. Univariate analysis showed that clinical stage, serum LDH, the IPI score, chemotherapy cycles >3, and Bcl-2 and Bcl-6 expression were correlated with the 5-year OS and PFS. Multivariate risk regression analysis showed that the number of chemotherapy cycles (>3) and Bcl-6 expression were independent prognostic factors in primary DLBCL of the breast (P<0.05). CONCLUSIONS A retrospective study of 46 patients with primary DLBCL of the breast showed that >3 cycles of chemotherapy and expression of Bcl-6 resulted in improved OS and PFS. Radiotherapy controlled local tumor recurrence but did not improve the OS and PFS. Rituximab did not improve patient survival.
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Affiliation(s)
- Hanjia Luo
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Pingyong Yi
- Department of Oncology, Shaoyang Kexin Cancer Hospital, Shaoyang, Hunan, China (mainland)
| | - Wei Wang
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Kunlun Li
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Liu Meng
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Jiwei Li
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Weisi Zeng
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Min Tang
- Department of Oncology, Cancer Hospital of Hu'nan Province, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
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23
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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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Armand M, Costopoulos M, Osman J, Tarfi S, Houillier C, Choquet S, Agnelo H, Bonnemye P, Ronez E, Settegrana C, Soussain C, Hoang‐Xuan K, Le Garff‐Tavernier M, Davi F. Optimization of CSF biological investigations for CNS lymphoma diagnosis. Am J Hematol 2019; 94:1123-1131. [PMID: 31328307 DOI: 10.1002/ajh.25578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 01/12/2023]
Abstract
Diagnosis of lymphoma leptomeningeal dissemination is challenging and relies on a wide array of methods. So far, no consensus biological guidelines are available. This increases the chance of intra- and interpractice variations, despite the shared concern to perform the minimum amount of tests while preserving clinically relevant results.We evaluated a training cohort of 371 cerebrospinal fluid (CSF) samples from patients with putative lymphomatous central nervous system (CNS) localization using conventional cytology (CC), flow cytometry (FCM), molecular clonality assesment by PCR and cytokine quantification (CQ). This led us to propose a biological algorithm, which was then verified on a validation cohort of 197 samples. The samples were classified according to the clinical context and the results of each technique were compared. Using all four techniques was not useful for exclusion diagnosis of CNS lymphoma (CNSL), but they proved complementary for cases with suspected CNSL. This was particularly true for CQ in primary CNSL. Overall, diagnosis can be obtained with a two-step approach. The first step comprises CC and FCM, as results are available quickly and FCM is a sensitive method. Both PCR and CQ can be postponed and performed in a second step, depending on the results from the first step and the clinical context.The proposed algorithm missed none of the CNSL samples of the validation cohort. Moreover, applying this algorithm would have spared 30% of PCR tests and 20% of CQ over a one-year period, without compromising clinical management.
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Affiliation(s)
- Marine Armand
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Myrto Costopoulos
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Jennifer Osman
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Sihem Tarfi
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Caroline Houillier
- Department of NeurologyAPHP Pitié‐Salpêtrière, Hospital and Sorbonne Université Paris France
| | - Sylvain Choquet
- Department of HematologyAPHP Pitié‐Salpêtrière, Hospital and Sorbonne Université Paris France
| | - Hervé Agnelo
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Patrick Bonnemye
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Emily Ronez
- Hematology Immunology and Transfusion LaboratoryAPHP Hopital Ambroise Paré Boulogne Billancourt France
| | - Catherine Settegrana
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Carole Soussain
- Department of HematologyHôpital René Huguenin, Institut Curie Saint‐Cloud France
| | - Khê Hoang‐Xuan
- Department of NeurologyAPHP Pitié‐Salpêtrière, Hospital and Sorbonne Université Paris France
| | | | - Frédéric Davi
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
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25
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Perry C, Ben Barouch S, Goldschmidt N, Sarid N, Herishanu Y, Shvidel L, Bairey O, Lavi N, Horowitz N, Avigdor A, Lebel E, Sofer O, Ram R, Avivi I. Characteristics, management and outcome of DLBCL patients, presenting with simultaneous systemic and CNS disease at diagnosis: A retrospective multicenter study. Am J Hematol 2019; 94:992-1001. [PMID: 31211434 DOI: 10.1002/ajh.25558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 02/01/2023]
Abstract
The incidence of systemic diffuse large B cell lymphoma (DLBCL) concurrently involving the central nervous system (CNS) at diagnosis, is very low and data regarding the clinical course of these patients are scarce. We investigated characteristics, efficacy of treatment regimens including consolidative autologous stem cell transplantation and outcome of patients presenting with concomitant systemic and CNS DLBCL. The records of 44 patients, diagnosed between 2004 and 2017, who fulfilled the inclusion criteria, were retrospectively reviewed. CNS involvement was diagnosed as solely parenchymal in 41%, solely leptomeningeal in 43%, and paranchymal with leptomeningeal in 11% of the patients. Induction regimens were anthracycline-based combined with high-dose methotrexate (HD-MTX) in 80% (n = 35) of patients, anthracycline-based combined with intrathecal MTX in 3, cytarabine-based (without antracyclines) in 2, HD-MTX in 1 and palliative in three. Five of 41 patients treated with chemotherapy died of treatment-related toxicity, all due to infections. Nineteen patients had consolidative autologous transplantation. Overall response rate following induction was 80% (complete responses 66% and partial responses 15%). All relapses (n = 11) occurred within less than 2 years. Within a median follow-up of 26.8 months, 3-years projected overall survival (OS) and progression free survival rates for the entire cohort were 56% ± 8.3 and 42% ± 8.9, respectively. In multivariate analysis, RCHOP-HD MTX-based induction [HR = 0.228, (0.054-0.964)], administration of 3.5 g/m2 MTX [HR = 0.735 (0.620-0.871)], and attaining CR following induction [HR = 0.185, (0.051-0.667)] predicted longer OS. RCHOP-HD MTX can provide prolonged remissions in DLBCL patients presenting with concomitant systemic and CNS involvement whereas role of autograft remains uncertain.
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Affiliation(s)
- Chava Perry
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | | | - Neta Goldschmidt
- Department of HematologyHadassah Medical Center Jerusalem Israel
| | - Nadav Sarid
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Yair Herishanu
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Lev Shvidel
- Department of HematologyKaplan Medical Centre Rehovot Israel
| | - Osnat Bairey
- Davidoff Cancer Center, Rabin Medical CenterInstitute of Hematology Petah‐Tikva Israel
| | - Noa Lavi
- Department of Hematology and Bone Marrow TransplantationRambam Health Care Campus Haifa Israel
| | - Netanel Horowitz
- Department of Hematology and Bone Marrow TransplantationRambam Health Care Campus Haifa Israel
| | - Avraham Avigdor
- Division of Hematology and Bone Marrow TransplantationChaim Sheba Medical Center Tel Hashomer Israel
| | - Eyal Lebel
- Department of HematologyHadassah Medical Center Jerusalem Israel
| | - Orit Sofer
- Hillel Yaffe Medical CenterInstitute of Hematology Hadera Israel
| | - Ron Ram
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Irit Avivi
- Sourasky Medical CenterInstitute of Hematology Tel‐Aviv Israel
- Sourasky Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
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26
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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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González-Barca E, Coronado M, Martín A, Montalbán C, Montes-Moreno S, Panizo C, Rodríguez G, Sancho JM, López-Hernández A. Spanish Lymphoma Group (GELTAMO) guidelines for the diagnosis, staging, treatment, and follow-up of diffuse large B-cell lymphoma. Oncotarget 2018; 9:32383-32399. [PMID: 30190794 PMCID: PMC6122355 DOI: 10.18632/oncotarget.25892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/23/2018] [Indexed: 01/23/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30% of non-Hodgkin lymphoma (NHL) cases in adult series. DLBCL is characterized by marked clinical and biological heterogeneity, encompassing up to 16 distinct clinicopathological entities. While current treatments are effective in 60% to 70% of patients, those who are resistant to treatment continue to die from this disease. An expert panel performed a systematic review of all data on the diagnosis, prognosis, and treatment of DLBCL published in PubMed, EMBASE and MEDLINE up to December 2017. Recommendations were classified in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework, and the proposed recommendations incorporated into practical algorithms. Initial discussions between experts began in March 2016, and a final consensus was reached in November 2017. The final document was reviewed by all authors in February 2018 and by the Scientific Committee of the Spanish Lymphoma Group GELTAMO.
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Affiliation(s)
- Eva González-Barca
- Department of Hematology, Institut Català d' Oncologia and IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Coronado
- Department of Nuclear Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - Carlos Montalbán
- Department of Hematology, MD Anderson Cancer Center, Madrid, Spain
| | - Santiago Montes-Moreno
- Department of Pathology and Translational Hematopathology Lab, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Carlos Panizo
- Department of Hematology, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Guillermo Rodríguez
- Department of Hematology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Juan Manuel Sancho
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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CNS relapse in patients with DLBCL treated with lenalidomide plus R-CHOP (R2CHOP): analysis from two phase 2 studies. Blood Cancer J 2018; 8:63. [PMID: 29946110 PMCID: PMC6018787 DOI: 10.1038/s41408-018-0097-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is a devastating event occurring in ~ 5% of patients treated with R-CHOP. We hypothesized that adding lenalidomide to R-CHOP (R2CHOP) may decrease the risk of CNS relapse. We analyzed records for patients with DLBCL from two R2CHOP trials. We assessed variables pertinent to the CNS-International Prognostic Index (CNS-IPI) scoring system and classified patients into groups of low, intermediate, and high risk of CNS relapse. The 2-year CNS relapse rate for each risk group was estimated using the Kaplan–Meier method and compared with reported rates in cohorts treated with contemporary chemoimmunotherapy. A total of 136 patients were included. Mean age was 65 and median follow-up was 48.2 months. 10.3, 71.3, and 18.4% of patients were classified into low, intermediate, and high-risk CNS-IPI groups, respectively. Only one of 136 patients developed CNS relapse, corresponding to an incidence of 0.7% and an estimated 2-year CNS relapse rate of 0.9% for the entire R2CHOP cohort. The estimated 2-year CNS relapse rates for the low, intermediate, and high-risk groups were 0, 0, and 5.0%, respectively. Frontline therapy with R2CHOP in patients with DLBCL is associated with a lower-than-expected rate of CNS relapse.
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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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30
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Marinelli JP, Modzeski MC, Lane JI, Van Gompel JJ, Stokken JK, Thanarajasingam G, Carlson ML. Primary Skull Base Lymphoma: Manifestations and Clinical Outcomes of a Great Imitator. Otolaryngol Head Neck Surg 2018; 159:643-649. [PMID: 29734937 DOI: 10.1177/0194599818773994] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Primary skull base lymphoma (PSBL) represents a rare manifestation of extranodal lymphoma. Presenting with nonspecific symptomatology and imaging findings, PSBL often masquerades as more common cranial base pathology and thus can present a diagnostic challenge. The objectives of this study were to characterize the manifestations and clinical outcomes of PSBL. Study Design Case series and chart review. Setting Tertiary referral center. Subjects and Methods Review of 48 patients with PSBL treated between 1994 and 2016. Results The median age at diagnosis was 60 years. Diffuse large B-cell lymphoma comprised the most common subtype (56%). Presenting symptoms included diplopia (52%), trigeminal hypesthesia (38%), headache (29%), facial nerve weakness (25%), B-symptoms (fevers, night sweats, and/or weight loss) (25%), and hearing loss (21%). Discrete lesions commonly mimicked meningioma, schwannoma, and nasopharyngeal carcinoma. Diffuse lesions imitated neurosarcoidosis, granulomatosis with polyangiitis, and carcinomatosis meningitis. Only 26% of all initial clinical evaluations suspected lymphoma. The combination of restricted diffusion on diffusion-weighted imaging, an absence of flow voids or surrounding hyperostosis, bony erosion and/or marrow signal replacement, and heterogeneous contrast enhancement facilitated delineation between PSBL and common skull base pathology. Cerebrospinal fluid (CSF) analysis was diagnostic of lymphoma in 24% of cases. Lymphoma within CSF portended significantly worse overall survival (85% vs 18% at 3-years; P < .001). Conclusion A history significant for multiple cranial nerve palsies, B-symptoms, and imaging findings inconsistent with common skull base pathology should raise suspicion for PSBL. CSF analysis in the setting of PSBL can provide diagnostic and prognostic value for patients.
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Affiliation(s)
- John P Marinelli
- 1 Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mara C Modzeski
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John I Lane
- 3 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,4 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Janalee K Stokken
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew L Carlson
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,4 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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31
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Ludmir EB, Milgrom SA, Pinnix CC, Gunther JR, Westin J, Oki Y, Fayad LE, Medeiros LJ, Dabaja BS, Nastoupil LJ. Primary breast diffuse large B-cell lymphoma: treatment strategies and patterns of failure<sup/>. Leuk Lymphoma 2018; 59:2896-2903. [PMID: 29697005 DOI: 10.1080/10428194.2018.1460825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Treatment strategies and outcomes were assessed in 25 patients with primary breast diffuse large B-cell lymphoma (PB-DLBCL) treated between 1995 and 2016. We specifically investigated the timing of recurrence, and the roles of radiotherapy (RT) and central nervous system prophylaxis (CNS PPX). Fifty-two percent of patients received RT, and 28% received CNS PPX. Fourteen patients (56%) experienced recurrence, with 76% of relapses occurring ≥24 months after diagnosis, in contrast to reports supporting the use of 24-month event-free survival as a surrogate endpoint in the general DLBCL population. Use of RT was associated with a trend toward improved progression-free survival (PFS). Twenty percent of patients experienced CNS relapse, with no clear benefit to CNS PPX. These data emphasize the importance of long-term follow-up for PB-DLBCL patients, suggest a PFS benefit with the addition of RT, and highlight high rates of CNS relapse.
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Affiliation(s)
- Ethan B Ludmir
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sarah A Milgrom
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Chelsea C Pinnix
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jillian R Gunther
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jason Westin
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Yasuhiro Oki
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Luis E Fayad
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - L Jeffrey Medeiros
- c Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Bouthaina S Dabaja
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Loretta J Nastoupil
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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32
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Tawfik B, Brown L, Fuda F, Chen W, Niu S, Sailors J, Sadeghi N. Utility and proposed algorithm of CSF flow cytometry in hematologic malignancies. Ann Hematol 2018; 97:1707-1716. [DOI: 10.1007/s00277-018-3336-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/08/2018] [Indexed: 01/26/2023]
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33
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Goldwirt L, Beccaria K, Ple A, Sauvageon H, Mourah S. Ibrutinib brain distribution: a preclinical study. Cancer Chemother Pharmacol 2018; 81:783-789. [DOI: 10.1007/s00280-018-3546-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/17/2018] [Indexed: 10/18/2022]
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34
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Zhou JJ, Xu JF, Zheng XN, Peng GP. Asymptomatic syringomyelia accompanied with metastatic cerebellar and spinal intramedullary lymphoma: A case report. Medicine (Baltimore) 2017; 96:e8593. [PMID: 29145275 PMCID: PMC5704820 DOI: 10.1097/md.0000000000008593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Asympotamic syringomyelia accompanied with metastatic cerebellar and thoracic spinal intramedullary lymphoma is rare in clinical practice. If the intramedullary lymphoma is large enough, the patient will rapidly develop neurologic signs of spinal injury. The prognosis of this type of complication is always bad. PATIENT CONCERNS Rapid and correct diagnosis and treatment is important for metastatic extranodal lymphoma with B cell of origin. DIAGNOSES Syringomyelia accompanied with metastatic cerebellar and thoracic spinal intramedullary lymphoma. INTERVENTIONS The patient was treated with a combination of systemic chemotherapy and focal radiotherapy and intrathecal therapy. OUTCOMES Resolution of metastatic lymphoma was not continued after conservative medical management and the patient died finally due to multiple organ failure. LESSONS Syringomyelia can develop due to the metastatic thoracic intramedullary lymphoma in patients with diffuse malignant large B cell lymphoma. Early and accurate diagnosis, anti-lymphoma treatment, and timely neurosurgical intervention may delay the development of the disease.
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Affiliation(s)
| | - Jin-Feng Xu
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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35
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Cencini E, Fabbri A, Arrigucci U, Cerase A, Bocchia M. Lenalidomide and Temozolomide Combination in a Very Elderly Patient with CNS Relapse of Diffuse Large B-Cell Lymphoma. Mediterr J Hematol Infect Dis 2017; 9:e2017040. [PMID: 28698783 PMCID: PMC5499499 DOI: 10.4084/mjhid.2017.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/10/2017] [Indexed: 12/27/2022] Open
Abstract
Central nervous system (CNS) relapse is an infrequent but severe complication for DLBCL patients, associated with poor prognosis. Intravenous prophylaxis with high-dose methotrexate has shown promising results but is rarely feasible in elderly and/or nephropathic patients. A 83 years old woman with CNS relapse occurred 6 months after chemoimmunotherapy. The patient was defined ineligible for radiotherapy (RT) and started oral Temozolomide 250mg daily for 5 consecutive days without any improvement after 1st cycle. We administered lenalidomide 25mg daily for 21 days every 28 days together with temozolomide 250mg daily for 5 days every 28 days. The patient experienced a rapid improvement of general and cognitive conditions; Gadolinium-enhanced brain MRI showed a wide reduction of neoplastic tissue. The patients maintained good clinical conditions with mild treatment toxicity until the end of the 6th cycle, when brain MRI showed disease progression and the patient died 1 month later. We suggest lenalidomide could be a feasible option for CNS relapse in elderly DLBCL patients and it could be associated in future studies with other cytotoxic agents such as temozolomide.
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Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- University of Siena, Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Umberto Arrigucci
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Università Senese, “Santa Maria alle Scotte” University and NHS Hospital, Siena, Italy
| | - Alfonso Cerase
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Università Senese, “Santa Maria alle Scotte” University and NHS Hospital, Siena, Italy
| | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- University of Siena, Siena, Italy
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36
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Gardette E, Maraval A, Brunet-Possenti F, Quereux G, Beltraminelli H, Templier I, Hodel J, Scherman E, Durot E, Bagot M, Pham-Ledard A, Grange F, Beylot-Barry M, Ingen-Housz-Oro S. Central nervous system involvement of primary cutaneous diffuse large B-cell lymphoma, leg type: 13 cases. J Eur Acad Dermatol Venereol 2017; 31:e498-e501. [PMID: 28543967 DOI: 10.1111/jdv.14358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E Gardette
- Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - A Maraval
- Neuroradiology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - F Brunet-Possenti
- Dermatology, AP-HP, Bichat Hospital, Paris, France.,French Study Group of Cutaneous Lymphoma, GFELC, Paris, France
| | - G Quereux
- French Study Group of Cutaneous Lymphoma, GFELC, Paris, France.,Dermatology, University Hospital of Nantes, Nantes, France
| | - H Beltraminelli
- French Study Group of Cutaneous Lymphoma, GFELC, Paris, France.,Dermatology, Inselspital, Bern University Hospital, Bern, France
| | - I Templier
- French Study Group of Cutaneous Lymphoma, GFELC, Paris, France.,Dermatology, University Hospital of Grenoble, Grenoble, France
| | - J Hodel
- Neuroradiology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - E Scherman
- Lymphoid Malignancies Unit, AP-HP, Henri Mondor Hospital, Créteil, France
| | - E Durot
- Hematology, University Hospital of Reims, Reims, France
| | - M Bagot
- French Study Group of Cutaneous Lymphoma, GFELC, Paris, France.,Dermatology, AP-HP, Saint-Louis Hospital, Paris, France
| | - A Pham-Ledard
- Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | - F Grange
- French Study Group of Cutaneous Lymphoma, GFELC, Paris, France.,Dermatology, University Hospital of Reims, Reims, France
| | - M Beylot-Barry
- French Study Group of Cutaneous Lymphoma, GFELC, Paris, France.,Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | - S Ingen-Housz-Oro
- Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,French Study Group of Cutaneous Lymphoma, GFELC, Paris, France
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