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Bhansali RS, Ellin F, Relander T, Cao M, Li W, Long Q, Ganesan N, Stuver R, Horwitz SM, Wudhikarn K, Hwang SR, Bennani NN, Chavez J, Sokol L, Saeed H, Duan F, Porcu P, Pullarkat P, Mehta-Shah N, Zain JM, Ruiz M, Brammer JE, Prakash R, Iyer SP, Olszewski AJ, Major A, Riedell PA, Smith SM, Goldin C, Haverkos B, Hu B, Zhuang TZ, Allen PB, Toama W, Janakiram M, Brooks TR, Jagadeesh D, Hariharan N, Goodman AM, Hartman G, Ghione P, Fayyaz F, Rhodes JM, Chong EA, Gerson JN, Landsburg DJ, Nasta SD, Schuster SJ, Svoboda J, Jerkeman M, Barta SK. The CNS relapse in T-cell lymphoma index predicts CNS relapse in patients with T- and NK-cell lymphomas. Blood Adv 2024; 8:3507-3518. [PMID: 38739715 PMCID: PMC11261035 DOI: 10.1182/bloodadvances.2024012800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
ABSTRACT Little is known about risk factors for central nervous system (CNS) relapse in mature T-cell and natural killer cell neoplasms (MTNKNs). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at the highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKNs, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse-enriched training set. Using a complete case analysis (n = 182), including 91 with CNS relapse, we applied a least absolute shrinkage and selection operator Cox regression model to select weighted clinicopathologic variables for the CITI score, which we validated in an external cohort from the Swedish Lymphoma Registry (n = 566). CNS relapse was most frequently observed in patients with peripheral T-cell lymphoma, not otherwise specified (25%). Median time to CNS relapse and median overall survival after CNS relapse were 8.0 and 4.7 months, respectively. We calculated unique CITI risk scores for individual training set patients and stratified them into risk terciles. Validation set patients with low-risk (n = 158) and high-risk (n = 188) CITI scores had a 10-year cumulative risk of CNS relapse of 2.2% and 13.4%, respectively (hazard ratio, 5.24; 95% confidence interval, 1.50-18.26; P = .018). We developed an open-access web-based CITI calculator (https://redcap.link/citicalc) to provide an easy tool for clinical practice. The CITI score is a validated model to predict patients with MTNKN at the highest risk of developing CNS relapse.
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Affiliation(s)
- Rahul S. Bhansali
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Fredrik Ellin
- Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden
| | - Thomas Relander
- Department of Clinical Sciences Lund, Section for Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Miao Cao
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Wenrui Li
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Qi Long
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Nivetha Ganesan
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kitsada Wudhikarn
- Division of Hematology, Mayo Clinic, Rochester, MN
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Julio Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Hayder Saeed
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Frank Duan
- Department of Medicine, Christiana Care, Newark, DE
| | - Pierluigi Porcu
- Division of Hematologic Malignancies, Thomas Jefferson University, Philadelphia, PA
| | | | - Neha Mehta-Shah
- Division of Hematology/Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jasmine M. Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Miguel Ruiz
- Divison of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH
| | - Jonathan E. Brammer
- Divison of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH
| | - Rishab Prakash
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Swaminathan P. Iyer
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ajay Major
- Division of Hematology, University of Colorado Cancer Center, Aurora, CO
| | - Peter A. Riedell
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Sonali M. Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Caroline Goldin
- Department of Hematology and Oncology, Ochsner MD Anderson Cancer Center, Jefferson, LA
| | - Bradley Haverkos
- Division of Hematology, University of Colorado Cancer Center, Aurora, CO
| | - Bei Hu
- Department of Hematologic Oncology, Atrium Health, Levine Cancer Institute, Wake Forest School of Medicine, Charlotte, NC
| | - Tony Z. Zhuang
- Winship Cancer Institute at Emory University, Decatur, GA
| | | | - Wael Toama
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Murali Janakiram
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Taylor R. Brooks
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Nisha Hariharan
- Division of Blood and Bone Marrow Transplantation, University of California San Diego Moores Cancer Center, San Diego, CA
| | - Aaron M. Goodman
- Division of Blood and Bone Marrow Transplantation, University of California San Diego Moores Cancer Center, San Diego, CA
| | - Gabrielle Hartman
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Paola Ghione
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fatima Fayyaz
- Division of Hematology/Oncology, Northwell Health Cancer Institute, New Hyde Park, NY
| | - Joanna M. Rhodes
- Division of Hematology/Oncology, Northwell Health Cancer Institute, New Hyde Park, NY
| | - Elise A. Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James N. Gerson
- Division of Hematology/Oncology, University of Vermont Cancer Center, Burlington, VT
| | - Daniel J. Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Sunita D. Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Mats Jerkeman
- Department of Clinical Sciences Lund, Section for Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Stefan K. Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Ma H, Marchi E, O'Connor OA, Lue JK. Mature T-cell and NK-cell lymphoma involvement of the central nervous system: a single center experience. Leuk Lymphoma 2023; 64:1964-1970. [PMID: 37565580 DOI: 10.1080/10428194.2023.2245513] [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: 03/27/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Mature T-cell and NK-cell lymphomas (MTNKL) are rare and heterogeneous lymphoproliferative disorders with poor clinical outcomes despite novel therapeutic advances. Although infrequent, central nervous system (CNS) involvement by MTNKL is associated with poor outcomes with a median overall survival (OS) of <12 months based on retrospective studies. We performed a retrospective analysis of patients who developed CNS involvement of MTNKL diagnosed at a single center from 1999 through 2020. Twenty-five patients were identified. Characteristics such as a diagnosis of adult T-cell leukemia/lymphoma, extranodal involvement, and poor performance status were associated with a higher risk of CNS involvement (p < 0.01). The median OS after diagnosis with CNS involvement was approximately 1 month (0.03-103.97 months). Patients exposed to novel therapeutics and/or clinical trial enrollment tolerated treatment without safety concerns and appeared to derive reasonable therapeutic benefit. Despite advances in the field, new therapeutic approaches are needed for patients with MTNKL with CNS involvement.
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Affiliation(s)
- Helen Ma
- Section of Hematology/Oncology, Department of Medicine, VA Long Beach Healthcare System, Long Beach, CA, USA
- Division of Hematology-Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Enrica Marchi
- Program for T-Cell Lymphoma Research, Division of Hematology-Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Owen A O'Connor
- Program for T-Cell Lymphoma Research, Division of Hematology-Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Jennifer K Lue
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Taranto EP, Barta SK, Bhansali RS. Central Nervous System Relapse in T and NK cell Lymphomas. Curr Hematol Malig Rep 2023; 18:243-251. [PMID: 37620711 DOI: 10.1007/s11899-023-00710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW T and NK cell lymphomas are relatively rare and heterogeneous forms of non-Hodgkin lymphoma that are associated with high rates of mortality. Central nervous system relapse carries significant morbidity, though management is largely extrapolated from literature in B cell neoplasms. As such, outcomes for central nervous system involvement in T/NK cell lymphomas are dismal with no standard of care. In this review, we discuss the epidemiology of central nervous system relapse in T/NK cell lymphomas and critically analyze available literature regarding prophylaxis and treatment. RECENT FINDINGS Retrospective studies of central nervous system involvement in T/NK cell lymphomas have been limited by small sample sizes and heterogeneity of subtypes, though sites of extranodal involvement and disease subtypes are consistently reported as risk factors. Compelling evidence for the use of central nervous system-directed prophylactic therapy has not yet been established, though recent reports of central nervous system activity with novel agents may suggest promising therapeutic options. The overall rarity of T and NK cell lymphomas has precluded adequate study of prophylaxis and treatment of central nervous system relapse. Collaborative efforts are needed to better define strategies to address CNS disease in T/NK cell lymphomas. These should involve the use of targeted agents, which may hold an advantage over traditional cytotoxic drugs.
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Affiliation(s)
- Eleanor P Taranto
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Stefan K Barta
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rahul S Bhansali
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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