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Bromberg JEC, Issa S, van der Holt B, van der Meulen M, Dirven L, Minnema MC, Seute T, Durian M, Cull G, van der Poel MWM, Stevens WBC, Zijlstra JM, Brandsma D, Nijland M, Mason KD, Beeker A, Abrahamse-Testroote MCJ, van den Bent MJ, de Jong D, Doorduijn JK. Survival, neurocognitive function, and health-related quality of life outcomes after rituximab-methotrexate, BCNU, teniposide, and prednisolone for primary CNS lymphoma: Final results of the HOVON 105/ALLG NHL 24 study. Neuro Oncol 2024; 26:724-734. [PMID: 38037691 PMCID: PMC10995504 DOI: 10.1093/neuonc/noad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Studies on the efficacy of rituximab in primary CNS lymphoma (PCNSL) reported conflicting results. Our international randomized phase 3 study showed that the addition of rituximab to high-dose methotrexate, BCNU, teniposide, and prednisolone (MBVP) in PCNSL was not efficacious in the short term. Here we present long-term results after a median follow-up of 82.3 months. METHODS One hundred and ninety-nine eligible newly diagnosed, nonimmunocompromised patients with PCNSL aged 18-70 years with WHO performance status 0-3 was randomized between treatment with MBVP chemotherapy with or without rituximab, followed by high-dose cytarabine consolidation in responding patients, and reduced-dose WBRT in patients aged ≤ 60 years. Event-free survival was the primary endpoint. Overall survival rate, neurocognitive functioning (NCF), and health-related quality of life (HRQoL) were additionally assessed, with the IPCG test battery, EORTC QLQ-C30 and QLQ-BN20 questionnaires, respectively. RESULTS For event-free survival, the hazard ratio was 0.85, 95% CI 0.61-1.18, P = .33. Overall survival rate at 5 years for MBVP and R-MBVP was 49% (39-59) and 53% (43-63) respectively. In total, 64 patients died in the MBVP arm and 55 in the R-MBVP arm, of which 69% were due to PCNSL. At the group level, all domains of NCF and HRQoL improved to a clinically relevant extent after treatment initiation, and remained stable thereafter up to 60 months of follow-up, except for motor speed which deteriorated between 24 and 60 months. Although fatigue improved initially, high levels persisted in the long term. CONCLUSIONS Long-term follow-up confirms the lack of added value of rituximab in addition to MBVP and HD-cytarabine for PCNSL.
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Affiliation(s)
- Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Bronno van der Holt
- HOVON Foundation, Rotterdam, The Netherlands
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center, Utrecht, The Netherlands
| | - Marc Durian
- Department of Hematology, ETZ Hospital, Tilburg, The Netherlands
| | - Gavin Cull
- Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Department of Hematology, University of Western Australia, Crawley, Western Australia, Australia
| | - Marjolein W M van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josee M Zijlstra
- Department of Hematology, Amsterdam UMC, VUMC, Amsterdam, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Nijland
- Department of Hematology, UMCG, Groningen, The Netherlands
| | - Kylie D Mason
- Department of Hematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Aart Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology and HOVON Pathology, Facility and Biobank, Amsterdam UMC, VUMC, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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van der Meulen M, Ramos RC, Voisin MR, Patil V, Wei Q, Singh O, Climans SA, Kalidindi N, Or R, Aldape K, Diamandis P, Munoz DG, Zadeh G, Mason WP. Differences in methylation profiles between long-term survivors and short-term survivors of IDH-wild-type glioblastoma. Neurooncol Adv 2024; 6:vdae001. [PMID: 38312227 PMCID: PMC10838123 DOI: 10.1093/noajnl/vdae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Patients with glioblastoma (GBM) have a median overall survival (OS) of approximately 16 months. However, approximately 5% of patients survive >5 years. This study examines the differences in methylation profiles between long-term survivors (>5 years, LTS) and short-term survivors (<1 year, STS) with isocitrate dehydrogenase (IDH)-wild-type GBMs. Methods In a multicenter retrospective analysis, we identified 25 LTS with a histologically confirmed GBM. They were age- and sex-matched to an STS. The methylation profiles of all 50 samples were analyzed with EPIC 850k, classified according to the DKFZ methylation classifier, and the methylation profiles of LTS versus STS were compared. Results After methylation profiling, 16/25 LTS and 23/25 STS were confirmed to be IDH-wild-type GBMs, all with +7/-10 signature. LTS had significantly increased O6-methylguanine methyltransferase (MGMT) promoter methylation and higher prevalence of FGFR3-TACC3 fusion (P = .03). STS were more likely to exhibit CDKN2A/B loss (P = .01) and higher frequency of NF1 (P = .02) mutation. There were no significant CpGs identified between LTS versus STS at an adjusted P-value of .05. Unadjusted analyses identified key pathways involved in both LTS and STS. The most common pathways were the Hippo signaling pathway and the Wnt pathway in LTS, and GPCR ligand binding and cell-cell signaling in STS. Conclusions A small group of patients with IDH-wild-type GBM survive more than 5 years. While there are few differences in the global methylation profiles of LTS compared to STS, our study highlights potential pathways involved in GBMs with a good or poor prognosis.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Medicine, Divisions of Neurology and Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ronald C Ramos
- Department of Medicine, Divisions of Neurology and Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mathew R Voisin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vikas Patil
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Qingxia Wei
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Olivia Singh
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Seth A Climans
- Department of Medicine, Divisions of Neurology and Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Navya Kalidindi
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rosemarylin Or
- Department of Neurology, The Medical City, Pasig, Philippines
| | - Ken Aldape
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David G Munoz
- Department of Laboratory Medicine, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Warren P Mason
- Department of Medicine, Divisions of Neurology and Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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de Koning ME, Hof JJ, Jansen C, Doorduijn JK, Bromberg JEC, van der Meulen M. Primary central nervous system lymphoma. J Neurol 2023:10.1007/s00415-023-12143-w. [PMID: 38112784 DOI: 10.1007/s00415-023-12143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma (NHL) manifesting in the brain, spinal cord, cerebrospinal fluid and/or eyes, in the absence of systemic manifestations. With an increasing incidence and a 30% 5-year overall survival if promptly treated, timely diagnosis and subsequent treatment is paramount. The typical MRI appearance for PCNSL is a solitary or multiple T2-hypointense, homogeneous gadolinium-enhancing lesion with restricted diffusion. Dexamethasone treatment might compromise and delay the diagnosis. Hallmark of treatment is induction with intravenous high-dose methotrexate consisting polychemotherapy followed by consolidation treatment. Consolidation treatment consists of either whole brain radiotherapy (WBRT) or autologous stem cell transplantation (ASCT). Given the (cognitive) side effects of WBRT, ASCT is increasingly being used as the first choice of treatment.
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Affiliation(s)
- Myrthe E de Koning
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Jurrit J Hof
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Casper Jansen
- Laboratory of Pathology Eastern Netherlands, Hengelo, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van der Meulen M, Chahal M, Mason WP. The Value of Etoposide for Recurrent Glioma. Can J Neurol Sci 2023:1-4. [PMID: 37641946 DOI: 10.1017/cjn.2023.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND For multiply recurrent glioma, options are few and choices are very limited. Etoposide in combination with carboplatin and/or bevacizumab has been evaluated in recurrent glioma with modest efficacy. This retrospective study describes the efficacy of etoposide monotherapy in adults with multiply recurrent diffuse glioma. METHODS In this single center retrospective series, all adult patients with radiographically proven multiply recurrent diffuse glioma (WHO grade 2-4) treated with etoposide between 2016 and 2020 were evaluated. Progression-free survival (PFS) and overall survival (OS) after initiating etoposide were calculated for the total group and for different histologic tumor types. In addition, treatment-related toxicity was recorded. RESULTS Totally, 48 patients with a median age 43 years-old (range 24-78) were included. Etoposide was given as 3rd line of treatment in 18 patients (37.5%) and as 4th or 5th line of treatment in 30 patients (62.5%). The majority were diagnosed with a glioblastoma, WHO grade 4 (27, 56.3%). The median PFS was 8.6 weeks (95% confidence interval [CI]: 8.3-8.9). The median OS of the total population was 4.0 months (95% CI: 2.4-5.6). Patients with an oligodendroglioma had the best OS (median 13 months), compared to astrocytoma and glioblastoma, but the difference was not statistically significant (p = 0.15). Etoposide was stopped due to progression in the majority of the patients (81.3%). Only 1 patient had a grade 3 toxicity. CONCLUSION Etoposide is a well-tolerated chemotherapy in heavily pretreated patients with multiply recurrent glioma and could be considered when other options are not available. OS was 4 months after initiating etoposide.
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Affiliation(s)
- Matthijs van der Meulen
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Manik Chahal
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, BC, Canada
| | - Warren P Mason
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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van der Meulen M, Ramos R, Voisin M, Patil V, Wei Q, Singh O, Climans S, Kalidindi N, Or R, Diamandis P, Munoz D, Zadeh G, Mason W. PATH-28. DIFFERENCES IN METHYLATION PROFILES BETWEEN LONG-TERM SURVIVORS AND SHORT-TERM SURVIVORS OF IDH WILD-TYPE GLIOBLASTOMA. Neuro Oncol 2022. [PMCID: PMC9660785 DOI: 10.1093/neuonc/noac209.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Patients with glioblastomas (GBM) have an overall survival (OS) of approximately 15 months. However, approximately 5% of patients survive much longer, with an OS of > 5 years. This study examines the differences in methylation profiles between long-term survivors ( > 5 years, LTS) and short-term survivors (< 1 year, STS) with an isocitrate dehydrogenase (IDH) wild-type GBM.
METHODS
In a multicenter retrospective analysis, we identified 25 long-term survivors with a histologically confirmed GBM. These were age and sex-matched to a short-term survivor. The methylation profiles of all 50 samples were analyzed with EPIC 850k, classified according to the DKFZ methylation classifier, and the methylation profiles of all IDH wild-type LTS vs STS were compared.
RESULTS
After methylation profiling, 16/25 LTS and 23/25 STS were confirmed to be IDH wild-type GBMs, all with copy number gains of chromosome 7 and loss of chromosome 10. There were no significant differences between tumour purity or GBM subtype between LTS and STS. LTS had significantly increased MGMT promoter methylation (p = 0.01), and higher FGFR3-TACC3 (p = 0.03), compared to STS. STS had significantly more often a CDKN2A/B loss (p = 0.01) and higher levels of NF1 (p = 0.02), compared to LTS. There were no significant CpGs identified between LTS vs STS at an adjusted p-value of 0.05. Unadjusted analyses identified key pathways and biological processes involved in both LTS and STS. The top pathway in LTS was the Hippo signaling pathway and the Wnt pathway. The top pathway in STS was GPCR ligand binding and cell-cell signaling.
CONCLUSION
A small group of patients with IDH wild-type GBM survive more than 5 years. While there are few differences in the global methylation profiles of long-term survivors compared to short-term survivors, our study highlights potential pathways involved in aggressive and senescent GBMs.
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Affiliation(s)
| | | | | | - Vikas Patil
- MacFeeters-Hamilton Center for Neuro-Oncology Research, Princess Margaret Cancer Centre , Toronto , Canada
| | - Qingxia Wei
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre , Toronto , Canada
| | - Olivia Singh
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Toronto , Ontario , Canada
| | | | | | - Rosamarylin Or
- Department of Neurology, The Medical City, Pasig City, Philippines , Pasig City , Philippines
| | | | | | - Gelareh Zadeh
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research , Toronto , Canada
| | - Warren Mason
- The Princess Margaret Cancer Center , Toronto , Canada
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van der Meulen M, Ramos RC, Mason WP, Von Deimling A, Maas SLN. Opinion & Special Article: Glioma Classification: How to Interpret Molecular Markers in a Diffuse Glioma Pathology Report. Neurology 2022; 99:903-908. [PMID: 36240081 DOI: 10.1212/wnl.0000000000201262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/01/2022] [Indexed: 11/15/2022] Open
Abstract
Diffuse infiltrating gliomas are the most common malignant brain tumors in adults. The 2021 World Health Organization classification for CNS tumors (CNS5 WHO) has significantly altered the rules for classification and grading of diffuse gliomas. Clinicians, including neurology residents and neurologists, will have to consider the changes that include the introduction of new tumor types, allotting established tumor types to other groups and substituting previously essential morphological features for additional molecular markers. For example, in the current classification, glioblastoma is defined as isocitrate dehydrogenase (IDH)-wildtype, grade 4. Whereas, a grade 4 IDH-mutated astrocytic glioma is referred to as astrocytoma, IDH-mutated, grade 4. In addition, potential targeted treatments, based on the underlying molecular alterations, have become therapeutic options for diffuse gliomas. For clinicians, it is important to know the rationale for why these options are only available for specific tumors. Owing to the emphasis of molecular markers in the CNS5 WHO classification, interpretation of a pathology report and understanding of its clinical implications can be challenging. This review describes the most important molecular alterations in glioma, summarizes the recent changes in the CNS5 WHO classification for glioma, and presents a stepwise approach for trainees and neurologists to decipher a glioma pathology report. Additional information is summarized in eTable 1 (links.lww.com/WNL/C324).
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Affiliation(s)
- Matthijs van der Meulen
- From the Departments of Neurology and Medical Oncology and Hematology (M.v.d.M., R.C.R., W.P.M.), Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Neurology (M.v.d.M.), Medisch Spectrum Twente, Enschede, the Netherlands; Division of Neurology (R.C.R.), Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Neuropathology (A.V.D.), University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg; Department of Pathology (S.L.N.M.), University Medical Center, Utrecht; and Department of Pathology (S.L.N.M.), Leiden University Medical Center, the Netherlands.
| | - Ronald C Ramos
- From the Departments of Neurology and Medical Oncology and Hematology (M.v.d.M., R.C.R., W.P.M.), Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Neurology (M.v.d.M.), Medisch Spectrum Twente, Enschede, the Netherlands; Division of Neurology (R.C.R.), Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Neuropathology (A.V.D.), University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg; Department of Pathology (S.L.N.M.), University Medical Center, Utrecht; and Department of Pathology (S.L.N.M.), Leiden University Medical Center, the Netherlands
| | - Warren P Mason
- From the Departments of Neurology and Medical Oncology and Hematology (M.v.d.M., R.C.R., W.P.M.), Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Neurology (M.v.d.M.), Medisch Spectrum Twente, Enschede, the Netherlands; Division of Neurology (R.C.R.), Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Neuropathology (A.V.D.), University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg; Department of Pathology (S.L.N.M.), University Medical Center, Utrecht; and Department of Pathology (S.L.N.M.), Leiden University Medical Center, the Netherlands
| | - Andreas Von Deimling
- From the Departments of Neurology and Medical Oncology and Hematology (M.v.d.M., R.C.R., W.P.M.), Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Neurology (M.v.d.M.), Medisch Spectrum Twente, Enschede, the Netherlands; Division of Neurology (R.C.R.), Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Neuropathology (A.V.D.), University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg; Department of Pathology (S.L.N.M.), University Medical Center, Utrecht; and Department of Pathology (S.L.N.M.), Leiden University Medical Center, the Netherlands
| | - Sybren L N Maas
- From the Departments of Neurology and Medical Oncology and Hematology (M.v.d.M., R.C.R., W.P.M.), Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Neurology (M.v.d.M.), Medisch Spectrum Twente, Enschede, the Netherlands; Division of Neurology (R.C.R.), Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Neuropathology (A.V.D.), University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg; Department of Pathology (S.L.N.M.), University Medical Center, Utrecht; and Department of Pathology (S.L.N.M.), Leiden University Medical Center, the Netherlands
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van der Meulen M, Mason WP. First-line chemotherapeutic treatment for oligodendroglioma, WHO grade 3-PCV or temozolomide? Neurooncol Pract 2022; 9:163-164. [PMID: 35601972 PMCID: PMC9113249 DOI: 10.1093/nop/npac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthijs van der Meulen
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Warren P Mason
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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de Faber SIPJ, Mutsaers PGNJ, van den Bent MJ, van der Meulen M. Subacute neurological deficits and respiratory insufficiency due to intrathecal methotrexate. J Clin Transl Res 2021; 7:809-810. [PMID: 34988333 PMCID: PMC8717579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND AIM We present a case of a 22-year-old male diagnosed with B-cell acute lymphoblastic leukemia who received intrathecal (IT) methotrexate (MTX) in addition to his systemic chemotherapy regime. During induction treatment, he presented with a rapidly progressive bilateral paresis, anarthria, and respiratory insufficiency requiring intubation. The brain magnetic resonance imaging showed bilateral lesions with diffusion restriction of the corona radiata/centrum semi-ovale without other abnormalities. He recovered spontaneously without neurological sequelae. The clinical course combined with the radiological findings is suspect for an IT-MTX-induced leukoencephalopathy. RELEVANCE FOR PATIENTS Although neurological deficits after IT-MTX are rare and in most cases self-limiting, it should be recognized as a cause for rapid neurological decline after excluding other causes.
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Affiliation(s)
- Sjoerd I. P. J. de Faber
- 1Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Centre Rotterdam, Rotterdam, The Netherlands,2Department of Neurology, Haga Hospital, The Hague, The Netherlands
| | - Pim G. N. J. Mutsaers
- 3Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin J. van den Bent
- 1Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Matthijs van der Meulen
- 1Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Centre Rotterdam, Rotterdam, The Netherlands,4Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands,Corresponding author: Matthijs van der Meulen Department of Neurology, Medisch Spectrum Twente, P.O. Box 50000, 7500 KA Enschede, The Netherlands. E-mail:
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9
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van der Meulen M, Dirven L, Habets EJJ, Bakunina K, Smits M, Achterberg HC, Seute T, Cull G, Schouten H, Zijlstra JM, Brandsma D, Enting RH, Beijert M, Taphoorn MJB, van den Bent MJ, Issa S, Doorduijn JK, Bromberg JEC. Neurocognitive functioning and radiologic changes in primary CNS lymphoma patients: results from the HOVON 105/ALLG NHL 24 randomized controlled trial. Neuro Oncol 2021; 23:1315-1326. [PMID: 33560442 DOI: 10.1093/neuonc/noab021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To analyze the effect of treatment on neurocognitive functioning and the association of neurocognition with radiological abnormalities in primary central nervous system lymphoma (PCNSL). METHODS One hundred and ninety-nine patients from a phase III trial (HOVON 105/ALLG NHL 24), randomized to standard chemotherapy with or without rituximab, followed in patients ≤60 years old by 30-Gy whole-brain radiotherapy (WBRT), were asked to participate in a neuropsychological evaluation before and during treatment, and up to 2 years posttreatment. Scores were transformed into a standardized z-score; clinically relevant changes were defined as a change in z-score of ≥1 SD. The effect of WBRT was analyzed in irradiated patients. All MRIs were centrally assessed for white matter abnormalities and cerebral atrophy, and their relation with neurocognitive scores over time in each domain was calculated. RESULTS 125/199 patients consented to neurocognitive evaluation. Statistically significant improvements in neurocognition were seen in all domains. A clinically relevant improvement was seen only in the motor speed domain, without differences between the arms. In the follow-up of irradiated patients (n = 43), no change was observed in any domain score, compared to after WBRT. Small but significant inverse correlations were found between neurocognitive scores over time and changes in white matter abnormalities (regression coefficients: -0.048 to -0.347) and cerebral atrophy (-0.212 to -1.774). CONCLUSIONS Addition of rituximab to standard treatment in PCNSL patients did not impact neurocognitive functioning up to 2 years posttreatment, nor did treatment with 30-Gy WBRT in patients ≤60 years old. Increased white matter abnormalities and brain atrophy showed weak associations with neurocognition.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Esther J J Habets
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Medical Psychology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Katerina Bakunina
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hakim C Achterberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gavin Cull
- Haematology Department, Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Harry Schouten
- Department of Hematology, University Medical Center, Maastricht, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC-Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Roelien H Enting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max Beijert
- Department of Radiotherapy, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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van der Meulen M, Postma AA, Smits M, Bakunina K, Minnema MC, Seute T, Cull G, Enting RH, van der Poel M, Stevens WBC, Brandsma D, Beeker A, Doorduijn JK, Issa S, van den Bent MJ, Bromberg JEC. Extent of radiological response does not reflect survival in primary central nervous system lymphoma. Neurooncol Adv 2021; 3:vdab007. [PMID: 33615224 PMCID: PMC7883767 DOI: 10.1093/noajnl/vdab007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background In primary central nervous system lymphoma (PCNSL), small enhancing lesions can persist after treatment. It is unknown whether a difference in response category (complete response [CR], complete response unconfirmed [CRu], or partial response [PR]) reflects survival. We aimed to determine the value of a central radiology review on response assessment and whether the extent of response influenced progression-free and/or overall survival. Methods All patients in the HOVON 105/ALLG NHL 24 study with at least a baseline MRI and one MRI made for response evaluation available for central review were included. Tumor measurements were done by 2 independent central reviewers, disagreements were adjudicated by a third reviewer. Crude agreement and interobserver agreement (Cohen's kappa) were calculated. Differences in progression-free and overall survival between different categories of response at the end-of-protocol-treatment were assessed by the log-rank test in a landmark survival-analysis. Results Agreement between the central reviewers was 61.7% and between local and central response assessment was 63.0%. Cohen's kappa's, which corrects for expected agreement, were 0.44 and 0.46 (moderate), respectively. Progression agreement or not was 93.3% (kappa 0.87) between local and central response assessment. There were no significant differences in progression-free and overall survival between patients with CR, CRu, or PR at the end-of-protocol-treatment, according to both local and central response assessment. Conclusions Reliability of response assessment (CR/CRu/PR) is moderate even by central radiology review and these response categories do not reliably predict survival. Therefore, primary outcome in PCNSL studies should be survival rather than CR or CR/CRu-rate.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, School for Mental Health and Sciences, Maastricht, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katerina Bakunina
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gavin Cull
- Haematology Department, Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Australia.,University of Western Australia, Crawley, Australia
| | - Roelien H Enting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Aart Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Haematology, Middlemore Hospital, Auckland, New Zealand
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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11
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van der Meulen M, Dirven L, Bakunina K, van den Bent MJ, Issa S, Doorduijn JK, Bromberg JEC. MMSE is an independent prognostic factor for survival in primary central nervous system lymphoma. J Neurooncol 2021; 152:357-362. [PMID: 33611761 PMCID: PMC7997829 DOI: 10.1007/s11060-021-03708-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
Introduction To assess the value of the Mini-Mental State Examination (MMSE)-score at baseline in predicting survival in adult primary central nervous system lymphoma (PCNSL) patients. Methods In the HOVON 105/ ALLG NHL 24 phase III study patients with newly-diagnosed PCNSL were randomized between high-dose methotrexate-based chemotherapy with or without rituximab. Data on potential (MMSE-score), and known baseline prognostic factors (age, performance status, serum LDH, cerebrospinal fluid total protein, involvement of deep brain structures, multiple cerebral lesions, and the IELSG-score) were collected prospectively. Multivariable stepwise Cox regression analyses were used to assess the prognostic value of all factors on progression-free survival (PFS) and overall survival (OS) among patients with available MMSE score at baseline. Age was analyzed as continuous variable, the MMSE-score both as a continuous and as a categorical variable. Results In univariable analysis, age, MMSE-score and whether the patient received rituximab were statistically significantly prognostic factors for PFS. Age and MMSE-score were statistically significantly associated with OS. In a multivariable analysis of the univariately significant factors only MMSE-score was independently associated with the survival endpoints, as a continuous variable (HR for PFS 1.04, 95% CI 1.01–1.08; OS 1.06 (95% CI 1.02–1.10) and as categorical variable HR (< 27 versus ≥ 27 for PFS 1.55 (1.02–2.35); OS 1.68 (1.05–2.70). In our population, performance status, serum LDH, and CSF protein level were not of prognostic value. Conclusion Neurocognitive disturbances, measured with the MMSE at baseline, are an unfavorable prognostic factor for both PFS and OS in adult PCNSL patients up to 70 years-old. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03708-8.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Katerina Bakunina
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
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12
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van der Meulen M, Bromberg JEC, Nijland M, Visser O, Doorduijn JK, Dinmohamed AG. Primary therapy and survival in patients aged over 70-years-old with primary central nervous system lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Haematologica 2021; 106:597-600. [PMID: 32241841 PMCID: PMC7849552 DOI: 10.3324/haematol.2020.247536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/26/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Otto Visser
- Netherlands Comprehensive Cancer Organisation, Utrecht
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13
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Dinmohamed AG, van der Meulen M, Visser O, Doorduijn JK, Bromberg JEC. Conditional relative survival in primary central nervous system lymphoma: a population-based study in the Netherlands. Neurooncol Adv 2020; 2:vdaa133. [PMID: 33235997 PMCID: PMC7668442 DOI: 10.1093/noajnl/vdaa133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Matthijs van der Meulen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Neuro-oncology, Rotterdam, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Jeanette K Doorduijn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Neuro-oncology, Rotterdam, The Netherlands
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14
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van der Meulen M, Kleineberg NN, Schreier DR, García-Azorin D, Di Lorenzo F. COVID-19 and neurological training in Europe: from early challenges to future perspectives. Neurol Sci 2020; 41:3377-3379. [PMID: 32970238 PMCID: PMC7511670 DOI: 10.1007/s10072-020-04723-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022]
Abstract
The worldwide SARS-CoV-2 pandemic is dramatically affecting health systems with consequences also for neurological residency training. Here we report early experiences and challenges that European neurologists and residents faced. The breadth of the pandemic and the social restrictions induced substantial modifications in both inpatient and outpatient clinical care and academic activities as well, adversely affecting our residency training. On the other hand we see also opportunities, such as gaining more clinical and professional skills. All these drastic and sudden changes lead us to reconsider some educational aspects of our training program that need to be improved in order to better prepare the neurologists of the future to manage unexpected and large emergency situations like the one we are living in these days. A reconsideration of the neurological training program could be beneficial to guarantee high standard level of the residency training in this period and beyond.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, Rotterdam, GD, Netherlands.
| | - Nina N Kleineberg
- Department of Neurology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - David R Schreier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David García-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Francesco Di Lorenzo
- Noninvasive Brain Stimulation Unit, Scientific Institute for Research, Hospitalisation and Health Care Santa Lucia Foundation, Rome, Italy
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15
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van der Meulen M, Dirven L, Habets E, Bakunina K, Taphoorn M, van den Bent M, Issa S, Doorduijn JK, Bromberg JEC. NCOG-05. IMPACT OF ADDITIONAL RITUXIMAB TO STANDARD THERAPY ON COGNITIVE PERFORMANCES IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The goal of treatment of primary central nervous system lymphoma patients is to improve survival, without compromising neurocognitive functioning. The aim of this study was to analyze the effect of Rituximab and low-dose whole brain radiotherapy (WBRT) on cognition.
METHODS
199 patients from a phase III trial (HOVON 105/ ALLG NHL 24), randomized to standard chemotherapy (and 30Gy WBRT for patients < 61 years-old only) with or without Rituximab, were asked to participate in a short neuropsychological evaluation (NPE) before and during treatment, and up to 2 years of follow-up or until progression. A difference in z-score, corrected for sex, age and education, of ≥ 1 point was considered as clinically relevant. The primary outcome was a difference over time between the arms in multiple cognitive domains, assessed by linear mixed models (LMM). Changes in cognitive performances between baseline and 24 months after treatment were assessed for both arms in cross-sectional analyses. Effect of WBRT was analyzed in irradiated patients only.
RESULTS
105/199 patients completed at least one NPE; baseline characteristics were similar to the total trial population. Compliance was >60% at all evaluation points. No clinically relevant differences over time between the arms were seen in all domains in LMM analysis. Comparing changes from baseline to 24 months of follow-up, mean cognitive scores remained stable in both arms for attention, executive functioning (TMT B), and information processing speed. A clinically relevant improvement was seen in both arms for executive functioning (TMT A), memory and motor speed. In the irradiated patients (n=33) all scores remained stable after WBRT, up to 24 months of follow-up in all domains.
CONCLUSION
Cognitive performance remained stable or improved after treatment. Addition of Rituximab to standard treatment did not impact cognitive performance over time. After low-dose WBRT, cognition remained stable up to 2 years.
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Affiliation(s)
| | - Linda Dirven
- Leiden University Medical Center, Leiden, Netherlands
| | - Esther Habets
- Haaglanden Medisch Centrum, lokatie Antonius Hove, Leidschendam, Netherlands
| | | | - Martin Taphoorn
- Haaglanden Medisch Centrum, lokatie Antonius Hove, Leidschendam, Netherlands
| | | | - Samar Issa
- Middlemore Hospital, Middlemore, Auckland, New Zealand
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16
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van der Meulen M, Dirven L, Habets EJJ, van den Bent MJ, Taphoorn MJB, Bromberg JEC. Cognitive functioning and health-related quality of life in patients with newly diagnosed primary CNS lymphoma: a systematic review. Lancet Oncol 2019; 19:e407-e418. [PMID: 30102235 DOI: 10.1016/s1470-2045(18)30356-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
Incidence of primary CNS lymphoma (PCNSL) is increasing, while prognosis is improving as treatments advance. However, declined cognitive functioning remains a major challenge in the treatment of PCNSL. This cognitive decline, in conjunction with other symptoms caused by the disease or its treatment, or both, can compromise health-related quality of life (HRQOL). The aim of this Review was to give a comprehensive overview on cognitive functioning and HRQOL for patients with PCNSL, including an evaluation of patient-related and treatment-related factors that can influence cognitive functioning and HRQOL. We reviewed the literature for studies on cognitive functioning and HRQOL in newly diagnosed adult patients with PCNSL using MEDLINE/PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, CINAHL EBSCO, and Google Scholar, up to Jan 4, 2018. Articles were selected using predetermined inclusion and exclusion criteria; 42 articles were eligible for inclusion. Findings show that the tumour itself has a great effect on cognitive functioning and HRQOL. Initially, induction chemotherapy results in improvement of cognition and HRQOL in most patients. In the long-term, the addition of whole-brain radiotherapy has a negative effect on cognitive functioning, but the magnitude of this effect is not always clinically relevant. HRQOL scores were worse compared with controls, and worse after combined chemotherapy and radiotherapy when compared with chemotherapy only, particularly in the long term. Therefore, combined chemotherapy and radiotherapy seems to have a negative effect on HRQOL and cognition in patients with PCNSL. Although prolonged progression-free survival is achieved with combined treatment, information on its effect on cognition and HRQOL should be included in clinical decision-making.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Esther J J Habets
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands; Department of Medical Psychology, Haaglanden Medical Center, The Hague, Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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17
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van der Meulen M, Bromberg JE, Lam KH, Dammers R, Langerak AW, Doorduijn JK, Kros JM, van den Bent MJ, van der Velden VH. Flow cytometry shows added value in diagnosing lymphoma in brain biopsies. Cytometry B Clin Cytom 2018; 94:928-934. [PMID: 29747221 PMCID: PMC6585701 DOI: 10.1002/cyto.b.21641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Background To assess the sensitivity, specificity and turnaround time of flow cytometric analysis on brain biopsies compared to histology plus immunohistochemistry analysis in tumors with clinical suspicion of lymphoma. Methods All brain biopsies performed between 2010 and 2015 at our institution and analyzed by both immunohistochemistry and flow cytometry were included in this retrospective study. Immunohistochemistry was considered the gold standard. Results In a total of 77 biopsies from 71 patients, 49 lymphomas were diagnosed by immunohistochemistry, flow cytometry results were concordant in 71 biopsies (92.2%). We found a specificity and sensitivity of flow cytometry of 100% and 87.8%, respectively. The time between the biopsy and reporting the result (turnaround time) was significantly shorter for flow cytometry, compared to immunohistochemistry (median: 1 vs. 5 days). Conclusions Flow cytometry has a high specificity and can confirm the diagnosis of a lymphoma significantly faster than immunohistochemistry. This allows for rapid initiation of treatment in this highly aggressive tumor. However, since its sensitivity is less than 100%, we recommend to perform histology plus immunohistochemistry in parallel to flow cytometry. © 2018 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Jacoline E.C. Bromberg
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - King H. Lam
- Department of PathologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Ruben Dammers
- Department of NeurosurgeryErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Anton W. Langerak
- Department of Immunology, Laboratory Medical ImmunologyErasmus MC, University Medical CenterRotterdamthe Netherlands
| | - Jeanette K. Doorduijn
- Department of HematologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Johan M. Kros
- Department of PathologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Martin J. van den Bent
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Vincent H.J. van der Velden
- Department of Immunology, Laboratory Medical ImmunologyErasmus MC, University Medical CenterRotterdamthe Netherlands
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