1
|
Thomas-Joulié A, Tran S, El Houari L, Seyve A, Bielle F, Birzu C, Lozano-Sanchez F, Mokhtari K, Giry M, Marie Y, Laigle-Donadey F, Dehais C, Houillier C, Psimaras D, Alentorn A, Laurenge A, Touat M, Sanson M, Hoang-Xuan K, Kas A, Rozenblum L, Habert MO, Nichelli L, Leclercq D, Galanaud D, Jacob J, Karachi C, Capelle L, Carpentier A, Mathon B, Belin L, Idbaih A. Prognosis of glioblastoma patients improves significantly over time interrogating historical controls. Eur J Cancer 2024; 202:114004. [PMID: 38493668 DOI: 10.1016/j.ejca.2024.114004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common devastating primary brain cancer in adults. In our clinical practice, median overall survival (mOS) of GBM patients seems increasing over time. METHODS To address this observation, we have retrospectively analyzed the prognosis of 722 newly diagnosed GBM patients, aged below 70, in good clinical conditions (i.e. Karnofsky Performance Status -KPS- above 70%) and treated in our department according to the standard of care (SOC) between 2005 and 2018. Patients were divided into two groups according to the year of diagnosis (group 1: from 2005 to 2012; group 2: from 2013 to 2018). RESULTS Characteristics of patients and tumors of both groups were very similar regarding confounding factors (age, KPS, MGMT promoter methylation status and treatments). Follow-up time was fixed at 24 months to ensure comparable survival times between both groups. Group 1 patients had a mOS of 19 months ([17.3-21.3]) while mOS of group 2 patients was not reached. The recent period of diagnosis was significantly associated with a longer mOS in univariate analysis (HR=0.64, 95% CI [0.51 - 0.81]), p < 0.001). Multivariate Cox analysis showed that the period of diagnosis remained significantly prognostic after adjustment on confounding factors (adjusted Hazard Ratio (aHR) 0.49, 95% CI [0.36-0.67], p < 0.001). CONCLUSION This increase of mOS over time in newly diagnosed GBM patients could be explained by better management of potentially associated non-neurological diseases, optimization of validated SOC, better management of treatments side effects, supportive care and participation in clinical trials.
Collapse
Affiliation(s)
- A Thomas-Joulié
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service d'Oncologie-Radiothérapie, F-75013 Paris, France
| | - S Tran
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - L El Houari
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Unité de Recherche Clinique, F-75013 Paris, France
| | - A Seyve
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - F Bielle
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - C Birzu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - F Lozano-Sanchez
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - K Mokhtari
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - M Giry
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, F-75013 Paris, France
| | - Y Marie
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, F-75013 Paris, France
| | - F Laigle-Donadey
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - C Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - C Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - D Psimaras
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Alentorn
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Laurenge
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - M Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - M Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - K Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Kas
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - L Rozenblum
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - M-O Habert
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - L Nichelli
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - D Leclercq
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - D Galanaud
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - J Jacob
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service d'Oncologie-Radiothérapie, F-75013 Paris, France
| | - C Karachi
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - L Capelle
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - A Carpentier
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - B Mathon
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - L Belin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France.
| |
Collapse
|
2
|
Choquet S, Soussain C, Azar N, Morel V, Metz C, Ursu R, Waultier-Rascalou A, di Blasi R, Houot R, Souchet L, Roos-Weil D, Uzunov M, Quoc SN, Jacque N, Boussen I, Gauthier N, Ouzegdouh M, Blonski M, Campidelli A, Ahle G, Guffroy B, Willems L, Corvilain E, Barrie M, Alcantara M, le Garff-Tavernier M, Psimaras D, Weiss N, Baron M, Bravetti C, Hoang-Xuan K, Davi F, Shor N, Alentorn A, Houillier C. CAR T-cell therapy induces a high rate of prolonged remission in relapsed primary CNS lymphoma: Real-life results of the LOC network. Am J Hematol 2024. [PMID: 38586986 DOI: 10.1002/ajh.27316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/24/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
The prognosis of relapsed primary central nervous system lymphoma (PCNSL) remains dismal. CAR T-cells are a major contributor to systemic lymphomas, but their use in PCNSL is limited. From the LOC network database, we retrospectively selected PCNSL who had leukapheresis for CAR-T cells from the third line of treatment, and, as controls, PCNSL treated with any treatment, at least in the third line and considered not eligible for ASCT. Twenty-seven patients (median age: 68, median of three previous lines, including ASCT in 14/27) had leukapheresis, of whom 25 received CAR T-cells (tisa-cel: N = 16, axi-cel: N = 9) between 2020 and 2023. All but one received a bridging therapy. The median follow-up after leukapheresis was 20.8 months. The best response after CAR-T cells was complete response in 16 patients (64%). One-year progression-free survival from leukapheresis was 43% with a plateau afterward. One-year relapse-free survival was 79% for patients in complete or partial response at CAR T-cell infusion. The median overall survival was 21.2 months. Twenty-three patients experienced a cytokine release syndrome and 17/25 patients (68%) a neurotoxicity (five grade ≥3). The efficacy endpoints were significantly better in the CAR T-cell group than in the control group (N = 247) (median PFS: 3 months; median OS: 4.7 months; p < 0.001). This series represents the largest cohort of PCNSL treated with CAR T-cells reported worldwide. CAR T-cells are effective in relapsed PCNSL, with a high rate of long-term remission and a reassuring tolerance profile. The results seem clearly superior to those usually observed in this setting.
Collapse
Affiliation(s)
- Sylvain Choquet
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Carole Soussain
- Service d'Hématologie Clinique, Institut Curie, site de Saint Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Nabih Azar
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Véronique Morel
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Carole Metz
- Unité REQPHARM, pharmacie à usage intérieur, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Renata Ursu
- Service de Neurologie, Université de Paris Cité, APHP, Hôpital Saint Louis, Paris, France
| | | | - Roberta di Blasi
- Service d'Oncohématologie, Université de Paris Cité, APHP, Hôpital Saint Louis, Paris, France
| | - Roch Houot
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, UMR U1236, INSERM Université de Rennes, Etablissement Français du Sang, Rennes, France
| | - Laetitia Souchet
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Damien Roos-Weil
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Madalina Uzunov
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Stéphanie Nguyen Quoc
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Nathalie Jacque
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Inès Boussen
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Nicolas Gauthier
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Maya Ouzegdouh
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Marie Blonski
- Service de Neuro-Oncologie, Centre Hospitalier Régional Universitaire (CHRU), Université de Lorraine, Centre de Recherche en Automatique de Nancy CRAN UMR 7039, CNRS, Nancy, France
| | - Arnaud Campidelli
- Service d'Hématologie Clinique, Hôpital Brabois, Centre Hospitalier Régional Universitaire (CHRU), Nancy, CNRS UMR 7563, Biopôle de l'Université de Lorraine, Vandoeuvre les Nancy, France
| | - Guido Ahle
- Service de Neurologie, Hôpital Pasteur-Hôpitaux civils de Colmar, France
| | - Blandine Guffroy
- Service d'Hématologie Clinique, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Lise Willems
- Service d'Hématologie Clinique, Hôpital Cochin, APHP, Paris, France
| | - Emilie Corvilain
- Service d'Immunologie Clinique, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | - Maryline Barrie
- Service de Neuro-oncologie, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Marseille, France
| | - Marion Alcantara
- Service d'Hématologie Clinique, Institut Curie, site de Saint Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Magali le Garff-Tavernier
- Service d'Hématologie Biologique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Dimitri Psimaras
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Nicolas Weiss
- AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Paris, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France
| | - Marine Baron
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Clotilde Bravetti
- Service d'Hématologie Biologique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Frédéric Davi
- Service d'Hématologie Biologique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Natalia Shor
- Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Agusti Alentorn
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Caroline Houillier
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| |
Collapse
|
3
|
Debliquis A, Ahle G, Houillier C, Soussain C, Hoang-Xuan K, Le Garff-Tavernier M. Analysis of cerebrospinal fluid for the diagnosis of CNS lymphoma: Comparison of the ESCCA/ISCCA protocol and real-world data of the CytHem/LOC French network. Cytometry B Clin Cytom 2024; 106:142-145. [PMID: 38450979 DOI: 10.1002/cyto.b.22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Agathe Debliquis
- Laboratoire d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Guido Ahle
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Caroline Houillier
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Carole Soussain
- Service d'Hématologie Clinique, Institut Curie, site de Saint Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Khê Hoang-Xuan
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Magali Le Garff-Tavernier
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, Inserm UMR S 1138, Paris, France
| |
Collapse
|
4
|
Rozenblum L, Houillier C, Baptiste A, Soussain C, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Galanaud D, Belin L, Hoang-Xuan K, Kas A. Interim FDG-PET improves treatment failure prediction in primary central nervous system Lymphoma: a LOC network prospective multicentric study. Neuro Oncol 2024:noae029. [PMID: 38366824 DOI: 10.1093/neuonc/noae029] [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: 10/30/2023] [Indexed: 02/18/2024] Open
Abstract
PURPOSE The purpose of our study was to assess the predictive and prognostic role of 2-18F-fluoro-2-deoxy-D-glucose (FDG) PET/MRI during high-dose methotrexate-based chemotherapy (HD-MBC) in de novo primary central nervous system lymphoma (PCNSL) patients aged 60 and above. METHODS This prospective multicentric ancillary study included 65 immunocompetents patients who received induction HD-MBC as part of the BLOCAGE01 phase III trial. FDG-PET/MRI were acquired at baseline, post two cycles (PET/MRI2), and post-treatment (PET/MRI3). FDG-PET response was dichotomized, with "positive" indicating persistent tumor uptake higher than the contralateral mirroring brain region. Performances of FDG-PET and International PCNSL Collaborative Group criteria in predicting induction response, progression-free survival (PFS), and overall survival (OS) were compared. RESULTS Of 48 PET2 scans performed, nine were positive and aligned with a partial response (PR) on MRI2. Among these, eight (89%) progressed by the end of the induction phase. In contrast, 35/39 (90%) of PET2-negative patients achieved complete response (CR). Among the 18 discordant responses at interim (PETCR/MRIPR), 83% ultimately achieved CR. 87% of the PET2-negative patients were disease-free at 6 months versus 11% of the PET2-positive patients (p<0.001). The MRI2 response did not significantly differentiate patients based on their PFS, regardless of whether they were in CR or PR. Both PET2 and MRI2 independently predicted OS in multivariate analysis, with PET2 showing stronger association. CONCLUSION Our study highlights the potential of interim FDG-PET for early management of PCNSL patients. Response-driven treatment based on PET2 may guide future clinical trials.
Collapse
Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
| | - Caroline Houillier
- Department of Neurology 2 Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Amandine Baptiste
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Carole Soussain
- Department of Haematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, 75005 Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Haematology, Cochin Hospital, APHP, Paris
| | - Sylvain Choquet
- Department of Haematology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, APHP, France
| | - Damien Galanaud
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lisa Belin
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology 2 Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
| |
Collapse
|
5
|
Aboubakr O, Houillier C, Choquet S, Dupont S, Hoang-Xuan K, Mathon B. Epileptic seizures in patients with primary central nervous system lymphoma: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)01116-5. [PMID: 38042665 DOI: 10.1016/j.neurol.2023.08.021] [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: 07/15/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) accounts for less than 5% of primary brain tumors. Epileptic seizures are a common manifestation of brain tumors; however, literature on the prevalence, characteristics, and oncological implications of seizures in patients with PCNSL is limited, and the management of antiepileptic drugs (AEDs) is unclear. This review aimed to summarize the existing knowledge on seizures in PCNSL, their potential association with surgery, oncological treatment, survival rates, and management of AEDs. METHODS A systematic review was performed according to the PRISMA recommendations and included articles published between 1953 and 2023 describing seizures in patients with PCNSL. RESULTS The search identified 282 studies, of which 21 were included. Up to 33% of patients with PCNSL developed seizures, mostly at the initial presentation. Little information was found on changes in seizure incidence through the course of the disease, and no details were found on seizure frequency, the percentage of treatment-resistant patients, or the evolution of seizures at remission. Younger age, cortical location, and immunodeficiency have been identified as potential risk factors for seizures, but evidence is very limited. The growing use of vigorous treatments including intensive chemotherapy with autologous stem cell transplantation and immunotherapy with CAR-T cells is associated with a higher incidence of seizures. The association between seizure development and patient mortality in PCNSL remains unknown. There are no data on AED prophylaxis or the use of specific AEDs in PCNSL. CONCLUSIONS Further studies are needed to investigate seizures in larger cohorts of PCNSL, to clarify their prevalence, better characterize them, identify risk factors, analyze survival rates, and make recommendations on AED management. We recommend following general practice guidelines for seizures symptomatic of brain tumors and not to prescribe AED prophylaxis in PCNSL.
Collapse
Affiliation(s)
- O Aboubakr
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - C Houillier
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Choquet
- Department of Hematology, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - B Mathon
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS 1127, 75013 Paris, France; GRC 23, Brain Machine Interface, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France.
| |
Collapse
|
6
|
Lacan C, Caron J, Tarantino N, Fouquet B, Cherai M, Parizot C, Morel V, Souchet L, Uzunov M, Gorochov G, Nguyen-Quoc S, Sourdeau E, Vieillard V, Miyara M, Vinit A, Solorzano S, Soussain C, Houillier C, Metz C, Autran B, Litvinova E, Le Garff-Tavernier M, Norol F, Roos-Weil D, Choquet S, Guihot A, Baron M. CAR T-cell therapy for central nervous system lymphomas: blood and cerebrospinal fluid biology, and outcomes. Haematologica 2023; 108:3485-3490. [PMID: 37345469 PMCID: PMC10690903 DOI: 10.3324/haematol.2023.282875] [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: 02/23/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
Not available.
Collapse
Affiliation(s)
- Claire Lacan
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris, France; Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Jonathan Caron
- Centre de recherche des Cordeliers, INSERM, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Université, Université Sorbonne Paris Cité, Université Paris Descartes, Université Paris Diderot, Paris
| | - Nadine Tarantino
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris
| | - Baptiste Fouquet
- Sorbonne Université, Department of Immunology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Mustapha Cherai
- Sorbonne Université, Department of Immunology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Christophe Parizot
- Sorbonne Université, Department of Immunology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Véronique Morel
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Laetitia Souchet
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Madalina Uzunov
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Guy Gorochov
- Sorbonne Université, Department of Immunology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Stéphanie Nguyen-Quoc
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris, France.; Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Elise Sourdeau
- Sorbonne Université, Department of Biological Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Vincent Vieillard
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris
| | - Makoto Miyara
- Sorbonne Université, Department of Immunology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Angélique Vinit
- Sorbonne Université, UMS37-PASS, Plateforme de cytométrie CyPS, Pitié-Salpêtrière Hospital, F-75013 Paris
| | - Silvia Solorzano
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Carole Soussain
- Hematology Unit, Institut Curie, site de Saint-Cloud et Center for Cancer Immunotherapy, Institut Curie, PSL Research University, INSERM U932, Paris
| | - Caroline Houillier
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Institut du Cerveau, ICM, Department of Neurology 2-Mazarin, AP-HP, Pitié Salpêtrière Hospital, F-75013 Paris
| | - Carole Metz
- Sorbonne Université, Unité REQPHARM, Pharmacie à Usage Intérieur, AP-HP, Pitié-Salpêtrière Hospital, F-75013 Paris France
| | - Brigitte Autran
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris
| | - Elena Litvinova
- Sorbonne Université, Department of Immunology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Magali Le Garff-Tavernier
- Centre de recherche des Cordeliers, INSERM, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Université, Université Sorbonne Paris Cité, Université Paris Descartes, Université Paris Diderot, Paris, France; Sorbonne Université, Department of Biological Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris
| | - Françoise Norol
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Damien Roos-Weil
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Sylvan Choquet
- Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France
| | - Amélie Guihot
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris
| | - Marine Baron
- Sorbonne Université, Inserm U1135, CNRS EMR 8255, CIMI-Paris, F-75013 Paris, France.; Sorbonne Université, Department of Clinical Haematology, AP-HP, Pitié- Salpêtrière Hospital, F-75013 Paris France.
| |
Collapse
|
7
|
Caillet A, Houillier C, Sourdeau E, Gazzano M, Uzunov M, Friser V, Ribeiro M, Nicelli L, Azar N, Baron M, Phina-Ziebin X, Choquet S, Roos-Weil D. Successful treatment by CAR T-cells in multi-refractory mantle cell lymphoma with central nervous system involvement. Ann Hematol 2023; 102:3295-3297. [PMID: 37580574 DOI: 10.1007/s00277-023-05408-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Adrien Caillet
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Caroline Houillier
- IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Elise Sourdeau
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Marianne Gazzano
- Department of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Madalina Uzunov
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Valérie Friser
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Monica Ribeiro
- IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Lucia Nicelli
- Neuroradiology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Nabih Azar
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Marine Baron
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Xavier Phina-Ziebin
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Damien Roos-Weil
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France.
| |
Collapse
|
8
|
Rozenblum L, Galanaud D, Houillier C, Soussain C, Baptiste A, Belin L, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Hoang-Xuan K, Kas A. [18F]FDG PET-MRI provides survival biomarkers in primary central nervous system lymphoma in the elderly: an ancillary study from the BLOCAGE trial of the LOC network. Eur J Nucl Med Mol Imaging 2023; 50:3684-3696. [PMID: 37462774 DOI: 10.1007/s00259-023-06334-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) incidence is rising among elderly patients, presenting challenges due to poor prognosis and treatment-related toxicity risks. This study explores the potential of combining [18F]fluorodeoxyglucose ([18F]FDG) PET scans and multimodal MRI for improving management in elderly patients with de novo PCNSL. METHODS Immunocompetent patients over 60 years with de novo PCNSL were prospectively enrolled in a multicentric study between January 2016 and April 2021. Patients underwent brain [18F]FDG PET-MRI before receiving high-dose methotrexate-based chemotherapy. Relationships between extracted PET (metabolic tumor volume (MTV), sum of MTV for up to five lesions (sumMTV), metabolic imaging lymphoma aggressiveness score (MILAS)) and MRI parameters (tumor contrast-enhancement size, cerebral blood volume (CBV), cerebral blood flow (CBF), apparent diffusion coefficient (ADC)) and treatment response and outcomes were analyzed. RESULTS Of 54 newly diagnosed diffuse large B-cell PCNSL patients, 52 had positive PET and MRI with highly [18F]FDG-avid and contrast-enhanced disease (SUVmax: 27.7 [22.8-36]). High [18F]FDG uptake and metabolic volume were significantly associated with low ADCmean values and high CBF at baseline. Among patients, 69% achieved an objective response at the end of induction therapy, while 17 were progressive. Higher cerebellar SUVmean and lower sumMTV at diagnosis were significant predictors of complete response: 6.4 [5.7-7.7] vs 5.4 [4.5-6.6] (p = 0.04) and 5.5 [2.1-13.3] vs 15.9 [4.2-19.5] (p = 0.01), respectively. Two-year overall survival (OS) was 71%, with a median progression-free survival (PFS) of 29.6 months and a median follow-up of 37 months. Larger tumor volumes on PET or enhanced T1-weighted MRI were significant predictors of poorer OS, while a high MILAS score at diagnosis was associated with early death (< 1 year). CONCLUSION Baseline cerebellar metabolism and sumMTV may predict response to end of chemotherapy in PCNSL. Tumor volume and MILAS at baseline are strong prognostic factors.
Collapse
Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.
| | - Damien Galanaud
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Caroline Houillier
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, 75005, Paris, France
| | - Amandine Baptiste
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Lisa Belin
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Hematology, Cochin Hospital, APHP, Paris, France
| | - Sylvain Choquet
- Department of Hematology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Service de Neurologie, Paris, France
| | - Khê Hoang-Xuan
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| |
Collapse
|
9
|
Schenone L, Alcantara M, Houillier C, Soussain C. First line treatments in primary central nervous system lymphomas in young patients. Curr Opin Oncol 2023; 35:357-363. [PMID: 37498049 DOI: 10.1097/cco.0000000000000975] [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] [Indexed: 07/28/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on current first-line treatments as well as on-going studies in immunocompetent patients with primary central nervous system lymphomas. RECENT FINDINGS High-dose methotrexate (HD-MTX)-based polychemotherapy is widely used in induction treatment (IT). Among HD-MTX-based regimens, the best association is not yet defined. IT should be followed by a consolidation or a maintenance according to patient's age and performance status. Thiotepa-based intensive chemotherapy (IC) followed by autologous stem cell transplantation (ASCT) has improved survival in eligible patients compared to a nonmyeloablative consolidation. Because of the high risk of neurotoxicity, conventional whole brain radiotherapy (WBRT; 36-40 Gy) has been abandoned. Reduced-WBRT (23.4 Gy) is an alternative option in patients under 60 years-old in complete response after IT. Its safety remains to be demonstrated in elderly patients. The benefit of maintenance strategies to reduce the risk of relapse is being assessed in several studies in patients beyond 70 years-old. SUMMARY HD-MTX-based polychemotherapy remains the corner stone of the IT, but the best regimen is not yet defined. Clinical trials assessing new IT regimens are ongoing. Intensive consolidation with IC + ASCT benefits patients up to 70 years-old. Predictive factors are under investigation to better define therapeutic response and guide treatment adjustment.
Collapse
Affiliation(s)
- Laurence Schenone
- Department of Hematology, CHRU de Nancy, Hôpitaux de Brabois
- Department of Neurology, CHRU de Nancy, Hôpital Central, Nancy
| | - Marion Alcantara
- Center for Cancer Immunotherapy, INSERM Unité 932, Institut Curie, PSL Research University, Paris
- Clinical Hematology Unit, Institut Curie, St Cloud
| | - Caroline Houillier
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Carole Soussain
- Center for Cancer Immunotherapy, INSERM Unité 932, Institut Curie, PSL Research University, Paris
- Clinical Hematology Unit, Institut Curie, St Cloud
| |
Collapse
|
10
|
Soussain C, Malaise D, Choquet S, Ghesquières H, Houillier C. Long-lasting CRs after ibrutinib monotherapy for relapse or refractory primary CNS lymphoma (PCNSL) and primary vitreoretinal lymphoma (PVRL): Long-term results of the iLOC study by the Lymphoma Study Association (LYSA) and the French Oculo-Cerebral Lymphoma (LOC) Network (clinical trial number: NCT02542514). Eur J Cancer 2023; 189:112909. [PMID: 37301714 DOI: 10.1016/j.ejca.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Carole Soussain
- Hematology, Institut Curie, Site Saint-Cloud, Saint-Cloud, France.
| | - Denis Malaise
- Ophthalmology, Institut Curie, Site Paris, Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Sylvain Choquet
- Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Hervé Ghesquières
- Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Caroline Houillier
- APHP, Sorbonne Université, IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| |
Collapse
|
11
|
Thomas A, Houillier C, Antoni D, Hoang-Xuan K, Soussain C, Jacob J, Feuvret L. Radiotherapy for newly diagnosed primary central nervous system lymphoma: role and perspective. Rep Pract Oncol Radiother 2023; 28:271-285. [PMID: 37456704 PMCID: PMC10348332 DOI: 10.5603/rpor.a2023.0028] [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] [Received: 02/10/2023] [Accepted: 05/02/2023] [Indexed: 07/18/2023] Open
Abstract
Whole brain radiotherapy (WBRT) has long been a key treatment of newly diagnosed primary central nervous system lymphoma (PCNSL). In the 1990s, the addition of high dose Methotrexate-based induction chemotherapy (HD MTX-based CT) has enabled a drastic improvement in PCNSL patients outcome. However, combined treatment has led to radiation-induced delayed neurotoxicity, especially in older patients. Alternative treatment strategies have been assessed to improve the efficacy and neurotoxicity ratio. Nowadays, in the elderly patients WBRT is widely omitted or deferred, and in younger patients WBRT is challenged by high dose chemotherapy with autologous stem cell transplant (HCT-ASCT) for consolidation treatment after HD MTX-based CT. In this setting, this review is addressed to clinicians with the aim to summarize the role of WBRT in the treatment of newly diagnosed PCNSL and its perspectives.
Collapse
Affiliation(s)
- Alice Thomas
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Caroline Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Khe Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie site de Saint-Cloud, France, and INSERM U932 Institut Curie, PSL Research University, Paris, France
| | - Julian Jacob
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Loic Feuvret
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
- Department of Radiation Oncology, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
12
|
Thomas-Joulié A, Houillier C, Antoni D, Créhange G, Jouglar E, Colin P, Benchalal M, Lang P, Alfonsi M, Hamidou H, Coutte A, Ahrweiller F, Dadoun N, Pointreau Y, Ammarguellat H, Bernier-Chastagner V, Belkacemi Y, Vieillot S, Hoang-Xuan K, Soussain C, Jacob J, Feuvret L. Brain radiotherapy in patients treated for a newly diagnosed primary central nervous system lymphoma: professional practice evaluation in 19 French centers. Acta Oncol 2023; 62:648-656. [PMID: 37338525 DOI: 10.1080/0284186x.2023.2225146] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The objective of this study was a multicentric evaluation of professional practices, analyzing the irradiation technique itself and its impact on survival and recurrence sites, in primary central nervous system lymphomas (PCNSLs). METHODS We retrospectively analyzed the technical and clinical records of 79 PCNSL patients included in the database of the national expert network for oculocerebral lymphoma ('LOC') who were treated with brain radiotherapy as first-line treatment for newly diagnosed primary central nervous system lymphoma between 2011 and 2018. RESULTS The number of patients treated with brain radiotherapy gradually decreased over time. The heterogeneity of radiotherapy prescriptions was significant, and 55% of them did not comply with published recommendations in terms of irradiation dose and/or volume. The proportion of complete responders to induction chemotherapy treated with reduced-dose radiotherapy increased over time. Partial brain radiotherapy was associated with significantly lower overall survival in univariate analysis. In partial responders to induction chemotherapy, increasing the total dose to the brain >30 Gy and adding a boost to the WBRT induced a trend toward improved progression-free and overall survival. Five recurrences (13%) occurred exclusively in the eyes, all in patients whose eyes had been excluded from the irradiation target volume and including 2 patients without ocular involvement at diagnosis. CONCLUSION The visibility of recommendations for prescribing brain radiotherapy for the treatment of newly diagnosed primary central nervous system lymphoma needs to be improved to harmonize practices and improve their quality. We propose an update of the recommendations.
Collapse
Affiliation(s)
- Alice Thomas-Joulié
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Caroline Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Paris, France
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Nantes-Saint-Herblain, France
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Nantes-Saint-Herblain, France
| | - Philippe Colin
- Department of Radiation Oncology, Institut du Cancer Courlancy, Rouen, France
| | - Mohamed Benchalal
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, Bretagne, France
| | - Philippe Lang
- Federation Universitaire d'oncologie radiothérapie d'Occitanie, ICG CHU Caremeau, Nîmes, France
| | | | - Hadji Hamidou
- Department of Radiation Oncology, ICO Cancer Center, Centre Paul Papin, Angers, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Flora Ahrweiller
- Institut de cancérologie et radiothérapie bretillien, Saint Malo, France
| | - Nathalie Dadoun
- Department of Radiation Oncology, Centre de la Baie, Avranches, France
| | - Yohan Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Hanifa Ammarguellat
- Department of Radiation Oncology, Centre Hospitalier Simone Veil, Beauvais, France
| | | | - Yazid Belkacemi
- Department of Radiation Oncology, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Sabine Vieillot
- Department of Radiation Oncology, Centre Catalan d'Oncologie, Perpignan, France
| | - Khê Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie site de Saint-Cloud, Paris, France
- INSERM U932 Institut Curie, PSL Research University, Paris, France
| | - Julian Jacob
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Loïc Feuvret
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
- Department of Radiation Oncology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France
| |
Collapse
|
13
|
Benusiglio PR, Elder F, Touat M, Perrier A, Sanson M, Colas C, Guerrini-Rousseau L, Tran DT, Trabelsi N, Carpentier C, Marie Y, Adam C, Bernier M, Cazals-Hatem D, Mokhtari K, Tran S, Mathon B, Capelle L, Dhooge M, Idbaih A, Alentorn A, Houillier C, Dehais C, Hoang-Xuan K, Cuzzubbo S, Carpentier A, Duval A, Coulet F, Bielle F. Mismatch Repair Deficiency and Lynch Syndrome Among Adult Patients With Glioma. JCO Precis Oncol 2023; 7:e2200525. [PMID: 37262394 DOI: 10.1200/po.22.00525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/13/2023] [Accepted: 04/04/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE The Lynch syndrome (LS)-glioma association is poorly documented. As for mismatch repair deficiency (MMRd) in glioma, a hallmark of LS-associated tumors, there are only limited data available. We determined MMRd and LS prevalence in a large series of unselected gliomas, and explored the associated characteristics. Both have major implications in terms of treatment, screening, and prevention. METHODS Somatic next-generation sequencing was performed on 1,225 treatment-naive adult gliomas referred between 2017 and June 2022. For gliomas with ≥1 MMR pathogenic variant (PV), MMR immunohistochemistry (IHC) was done. Gliomas with ≥1 PV and protein expression loss were considered MMRd. Eligible patients had germline testing. To further explore MMRd specifically in glioblastomas, isocitrate dehydrogenase (IDH)-wild type (wt), we performed IHC, and complementary sequencing when indicated, in a series of tumors diagnosed over the 2007-2021 period. RESULTS Nine gliomas were MMRd (9/1,225; 0.73%). Age at glioma diagnosis was <50 years for all but one case. Eight were glioblastomas, IDH-wt, and one was an astrocytoma, IDH-mutant. ATRX (n = 5) and TP53 (n = 8) PV were common. There was no TERT promoter PV or EGFR amplification. LS prevalence was 5/1,225 (0.41%). One 77-year-old patient was a known LS case. Four cases had a novel LS diagnosis, with germline PV in MSH2 (n = 3) and MLH1 (n = 1). One additional patient had PMS2-associated constitutional mismatch repair deficiency. Germline testing was negative in three MSH6-deficient tumors. In the second series of glioblastomas, IDH-wt, MMRd prevalence was 12.5% in the <40-year age group, 2.6% in the 40-49 year age group, and 1.6% the ≥50 year age group. CONCLUSION Screening for MMRd and LS should be systematic in glioblastomas, IDH-wt, diagnosed under age 50 years.
Collapse
Affiliation(s)
- Patrick R Benusiglio
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Fikret Elder
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Mehdi Touat
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Alexandre Perrier
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Marc Sanson
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Chrystelle Colas
- Département de Génétique, Institut Curie, Paris, France
- INSERM U830, U 830 Unité de génétique et biologie des cancers, Institut Curie et Université de Paris, Paris, France
| | - Lea Guerrini-Rousseau
- Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Molecular Predictors and New Targets in Oncology, INSERM U981 Team "Genomics and Oncogenesis of pediatric Brain Tumors", Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Duy Thanh Tran
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Department of Pathology, VietDuc university hospital, Hoan Kiem, Hanoi, Vietnam
| | - Nesrine Trabelsi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Catherine Carpentier
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Yannick Marie
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Clovis Adam
- Service d'anatomopathologie, CHU de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Michèle Bernier
- Département d'Anatomie et Cytologie Pathologiques, Hôpital Foch, Suresnes, France
| | - Dominique Cazals-Hatem
- Département d'Anatomie Pathologique, Hôpital Beaujon, AP-HP, Université de Paris, Clichy, France
| | - Karima Mokhtari
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Suzanne Tran
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Bertrand Mathon
- Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Laurent Capelle
- Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Marion Dhooge
- Gastroentérologie et Oncologie Digestive, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Ahmed Idbaih
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Agusti Alentorn
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Caroline Houillier
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Caroline Dehais
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Khe Hoang-Xuan
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Stefania Cuzzubbo
- Service de Neurologie, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Paris, France
| | - Antoine Carpentier
- Service de Neurologie, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Paris, France
| | - Alex Duval
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Florence Coulet
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Franck Bielle
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| |
Collapse
|
14
|
Rachdi A, Hernandez-Tost H, Herzi D, Morales-Martinez A, Hernández-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Recent advances in the diagnosis and the treatment of primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:481-489. [PMID: 37045615 DOI: 10.1016/j.neurol.2023.03.012] [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: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
Collapse
Affiliation(s)
- A Rachdi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Institut Mongi Ben Hamida de neurologie de Tunis, Tunis, Tunisia
| | - H Hernandez-Tost
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - D Herzi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - A Morales-Martinez
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | | | - C Houillier
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; LOC network, France
| | - A Alentorn
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France
| | - K Hoang-Xuan
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France.
| |
Collapse
|
15
|
Dufour J, Choquet S, Hoang-Xuan K, Schmitt A, Ahle G, Houot R, Taillandier L, Gressin R, Casasnovas O, Marolleau JP, Tamburini J, Serrier C, Perez E, Paillassa J, Gyan E, Chauchet A, Ursu R, Kas A, Soussain C, Houillier C. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 2023; 102:1159-1169. [PMID: 36991231 DOI: 10.1007/s00277-023-05108-6] [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: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.
Collapse
Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtrière, Service d'Hématologie clinique, Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - A Schmitt
- Institut de Bergonie, Service d'Hématologie, Bordeaux, France
| | - G Ahle
- Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Service d'Hématologie, Rennes, France
| | - L Taillandier
- Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France
| | - R Gressin
- Hôpital Universitaire de Grenoble, Service d'Hématologie, Grenoble, France
| | - O Casasnovas
- Hôpital Universitaire de Dijon, Service d'hematologie clinique, Dijon, France
| | - J P Marolleau
- Hôpital Universitaire d'Amiens, Service d'Hematologie clinique, Amiens, France
| | - J Tamburini
- Hôpital Cochin, Service d'Hématologie, Paris, France
| | - C Serrier
- Centre Hospitalier de Perpignan, Service d'Hématologie, Perpignan, France
| | - E Perez
- Hôpital Universitaire de la Réunion, Service d'oncologie-hématologie, Paris, La Réunion, France
| | - J Paillassa
- Hôpital Universitaire d'Angers, Service d'Hématologie, Angers, France
| | - E Gyan
- Hôpital Universitaire de Tours, Service d'Hématologie, Tours, France
| | - A Chauchet
- Hôpital Universitaire de Besançon, Service d'Hématologie, Besançon, France
| | - R Ursu
- Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France
| | - A Kas
- Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - C Soussain
- Institut Curie, Service d'Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - C Houillier
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France.
| |
Collapse
|
16
|
Bravetti C, Degaud M, Armand M, Sourdeau E, Mokhtari K, Maloum K, Osman J, Verrier P, Houillier C, Roos-Weil D, Soussain C, Choquet S, Hoang-Xuan K, Le Garff-Tavernier M, Denis JA, Davi F. Combining MYD88 L265P mutation detection and clonality determination on CSF cellular and cell-free DNA improves diagnosis of primary CNS lymphoma. Br J Haematol 2023. [PMID: 36941788 DOI: 10.1111/bjh.18758] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Diagnosis of primary central nervous system lymphoma (PCNSL) is challenging, and although brain biopsy remains the gold standard, cerebrospinal fluid (CSF) constitutes a less invasive source of lymphomatous biomarkers. In a retrospective cohort of 54 PCNSL cases tested at diagnosis or relapse, we evaluated the contribution of immunoglobulin heavy chain (IGH) gene clonality and MYD88 L265P detection on both CSF cell pellets and supernatants, in comparison with cytology, flow cytometry, interleukin (IL)-10 and IL-6 quantification. Clonality assessment included a new assay to detect partial IGH-DJ rearrangements. Clonal IGH rearrangements and/or MYD88 L265P mutation were detected in 27 (50%) cell pellets and 24 (44%) supernatant cell-free (cf) DNA. Combining analyses on both compartments, 36 (66%) cases had at least one detectable molecular marker, present only in cfDNA for 9 (16%) of them. While cytology and flow cytometry were positive in only 7 (13.0%) and 9 (17.3%) cases respectively, high IL-10 levels were observed in 36 (66.7%) cases. Overall, taking into account molecular and cytokine results, 46/54 (85%) cases had at least one lymphomatous biomarker detectable in the CSF. These results show that this combination of biomarkers evaluated on both cell pellet and supernatant CSF fractions improves significantly the biological diagnosis of PCNSL.
Collapse
Affiliation(s)
- Clotilde Bravetti
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Michaël Degaud
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Marine Armand
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Elise Sourdeau
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Karima Mokhtari
- Department of Neuropathology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Karim Maloum
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Jennifer Osman
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Patricia Verrier
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Caroline Houillier
- Department of Neurology-2, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), IHU, ICM, Sorbonne Université, Paris, France
| | - Damien Roos-Weil
- Department of Clinical Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Carole Soussain
- Division of Hematology, Institut Curie, Site Saint-Cloud, and INSERM U932, PSL Research University, Paris, France
| | - Sylvain Choquet
- Department of Clinical Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Khe Hoang-Xuan
- Department of Neurology-2, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), IHU, ICM, Sorbonne Université, Paris, France
| | - Magali Le Garff-Tavernier
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Jérôme Alexandre Denis
- Department of Endocrine and Oncological Biochemistry, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Centre de recherche Saint-Antoine (UMR_S 938), Biologie et thérapeutiques du cancer, Paris, France
| | - Frédéric Davi
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| |
Collapse
|
17
|
Nguyen-Them L, Alentorn A, Ahle G, Soussain C, Mathon B, Le Garff Tavernier M, Houillier C, Hoang-Xuan K. CSF biomarkers in primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:141-149. [PMID: 36336490 DOI: 10.1016/j.neurol.2022.06.014] [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: 03/16/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
PCNSL is a non-Hodgkin lymphoma (NHL) affecting brain, spinal cord, eyes and leptomeninges. In the past two decades, its prognosis significantly improved due to therapeutic advances but it remains a highly aggressive tumor and early diagnosis is necessary for optimal management. Diagnosis relies on the identification of lymphoma cells in brain tissue obtained by stereotactic biopsy. Alternatively, lymphoma cells may be found in CSF through lumbar puncture (LP) or by a vitrectomy. For several reasons, the diagnosis of PCNSL may be challenging. Misleading radiological presentations are frequent. Dramatic response to steroids may bias histological analysis and deep brain location or frail health status can contraindicate brain biopsy. In the follow-up of patients who have been previously treated, differential diagnosis between tumor relapse and post-treatment may be also difficult. Therefore, the development of complementary reliable diagnostic tools is needed. This review will summarize several diagnostic or prognostic CSF biomarkers which have been proposed in PCNSL, their interests and limits.
Collapse
Affiliation(s)
- L Nguyen-Them
- Centre Hospitalier Saint Jean, 20 Avenue du Languedoc, 66000 Perpignan, France; Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - A Alentorn
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - G Ahle
- Hôpitaux Civils de Colmar, 39 Avenue Liberté, 68024 Colmar, France
| | - C Soussain
- Institut Curie - site de Saint Cloud, 35 Rue Dailly, 92210 Saint-Cloud, France
| | - B Mathon
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - M Le Garff Tavernier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Houillier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| |
Collapse
|
18
|
Hernández-Verdin I, Kirasic E, Wienand K, Mokhtari K, Eimer S, Loiseau H, Rousseau A, Paillassa J, Ahle G, Lerintiu F, Uro-Coste E, Oberic L, Figarella-Branger D, Chinot O, Gauchotte G, Taillandier L, Marolleau JP, Polivka M, Adam C, Ursu R, Schmitt A, Barillot N, Nichelli L, Lozano-Sánchez F, Ibañez-Juliá MJ, Peyre M, Mathon B, Abada Y, Charlotte F, Davi F, Stewart C, de Reyniès A, Choquet S, Soussain C, Houillier C, Chapuy B, Hoang-Xuan K, Alentorn A. Molecular and clinical diversity in primary central nervous system lymphoma. Ann Oncol 2023; 34:186-199. [PMID: 36402300 DOI: 10.1016/j.annonc.2022.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 08/31/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity. PATIENTS AND METHODS To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data. RESULTS Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue. CONCLUSIONS The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.
Collapse
Affiliation(s)
- I Hernández-Verdin
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - E Kirasic
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - K Wienand
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Mokhtari
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neuropathology, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
| | - S Eimer
- Department of Pathology, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - H Loiseau
- Department of Neurosurgery, Bordeaux University Hospital Center, Pellegrin Hospital, Bordeaux, France; EA 7435-IMOTION, University of Bordeaux, Bordeaux, France
| | - A Rousseau
- Department of Pathology, PBH, CHU Angers, Angers, France; CRCINA, Université de Nantes-université d'Angers, Angers, France
| | - J Paillassa
- Department of Hematology, CHU Angers, Angers, France
| | - G Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | - F Lerintiu
- Department of Neuropathology, Hôpitaux Civils de Colmar, Strasbourg, France
| | - E Uro-Coste
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, Toulouse, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - L Oberic
- Department of Hematology, IUC Toulouse Oncopole, Toulouse, France
| | - D Figarella-Branger
- Neuropathology Department, University Hospital Timone, Aix Marseille University, Marseille, France; Inst Neurophysiopathol, CNRS, INP, Aix-Marseille University, Marseille, France
| | - O Chinot
- Department of Neuro-oncology, CHU Timone, APHM, Marseille, France; Institute of NeuroPhysiopathology, CNRS, INP, Aix-Marseille University, Marseille, France
| | - G Gauchotte
- Department of Biopathology, CHRU Nancy, CHRU/ICL, Bâtiment BBB, Vandoeuvre-lès-Nancy, France; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France; INSERM U1256, University of Lorraine, Vandoeuvre-lès-Nancy, France; Centre de Ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | - L Taillandier
- Department of Neuro-oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - J-P Marolleau
- Department of Hematology, CHU Amiens-Picardie, Amiens, France
| | - M Polivka
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, University of Paris, Paris, France
| | - C Adam
- Pathology Department, Bicêtre University Hospital, Public Hospital Network of Paris, Le Kremlin Bicêtre, France
| | - R Ursu
- Department of Neurology, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - A Schmitt
- Department of Hematology, Institut Bergonié Hospital, Bordeaux, France
| | - N Barillot
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - L Nichelli
- Department of Neuroradiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Lozano-Sánchez
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | | | - M Peyre
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Mathon
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Y Abada
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Charlotte
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - F Davi
- Department Hematology, APHP, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Stewart
- Department Broad Institute of MIT and Harvard, Cambridge, USA
| | - A de Reyniès
- Department INSERM UMR_S1138-Centre de Recherche des Cordeliers-Université Pierre et Marie Curie et Université Paris Descartes, Paris, France
| | - S Choquet
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Soussain
- Department Hematology Unit, Institut Curie, Saint-Cloud, France
| | - C Houillier
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Chapuy
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Hoang-Xuan
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Alentorn
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
| |
Collapse
|
19
|
Laurenge A, Ursu R, Tabouret E, Harlay V, Ahle G, Choquet S, Soussain C, Moluçon-Chabrot C, Mathon B, Mokhtari K, Pourcher V, Nichelli L, Marot S, Touat M, Hoang-Xuan K, Houillier C. SARS-CoV-2 infection in patients with primary central nervous system lymphoma in the vaccination era. Leuk Lymphoma 2023; 64:221-224. [PMID: 36318828 DOI: 10.1080/10428194.2022.2131420] [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: 11/06/2022]
Affiliation(s)
- Alice Laurenge
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Renata Ursu
- Service de Neurologie, AP-HP, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Emeline Tabouret
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neurooncologie, Aix-Marseille University, Marseille, France
| | - Vincent Harlay
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neurooncologie, Aix-Marseille University, Marseille, France
| | - Guido Ahle
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie, site de Saint-Cloud et INSERM U932 Institut Curie, PSL Research University, Paris.,LOC Network, Paris, France
| | - Cécile Moluçon-Chabrot
- Service de Thérapie Cellulaire et Hématologie Clinique, CHU de Clermont-Ferrand - Hôpital d'Estaing, Clermont-Ferrand, France
| | - Bertrand Mathon
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Karima Mokhtari
- Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Service de Neuropathologie Laboratoire Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Valérie Pourcher
- INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Lucia Nichelli
- Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Stéphane Marot
- INSERM 1136, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Département de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Mehdi Touat
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France.,LOC Network, Paris, France
| | - Caroline Houillier
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France.,LOC Network, Paris, France
| |
Collapse
|
20
|
Younan N, Soussain C, Choquet S, Cassoux N, Touitou V, Schmitt A, Chinot O, Oberic L, Damaj G, Houot R, Ghesquières H, Laribi K, Ahle G, Taillandier L, Paillassa J, Gyan E, Jardin F, Delwail V, Marolleau JP, Tempescul A, Agapé P, Bourniquel M, Vacheret F, Jdid I, Le Garff-Tavernier M, Malaise D, Alentorn A, Xuan KH, Houillier C. Isolated intraocular relapses of primary cerebral lymphomas: An LOC network study. Hematol Oncol 2022; 40:976-986. [PMID: 35789106 DOI: 10.1002/hon.3044] [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: 03/08/2022] [Revised: 05/18/2022] [Accepted: 06/25/2022] [Indexed: 12/13/2022]
Abstract
Most relapses of primary central nervous system lymphoma (PCNSL) occur in the brain and are associated with a poor prognosis. Isolated intraocular relapses (IIORs) are rare and poorly described. We retrospectively selected from the French Lymphome Oculo-Cérébral database PCNSL patients who initially presented with cerebral localization and who experienced IIOR during the course of the disease. Of the 1472 patients included in the database, 55 patients presented an IIOR. Their median age was 68 years, and median Karnofsky Performance Status 80. IL-10 levels in the aqueous humor and/or in the vitreous were increased in 42/46 patients. 45/55 patients received systemic chemotherapy, and 11/55 received high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) as consolidation treatment. After a median follow-up of 69 months, 42/55 patients had relapsed, including 90% of the patients who did not receive HCT-ASCT at IIOR and 40% of the patients who received HCT-ASCT at IIOR (p < 0.001). The first relapse after the initial IIOR was exclusively in the eye in 23/42 patients, and 29/42 patients had a subsequent brain relapse during the course of the disease. The median progression-free survival, brain-free survival and overall survival from IIOR were 12.2, 48.6 and 57.1 months, respectively. Isolated intraocular relapse is not exceptional in the course of PCNSL and deserves systematic ophthalmological follow-up. Its prognosis is much better than the prognosis of brain relapse, with an evolution close to that of primary vitreoretinal lymphoma. With the exception of patients who received HCT-ASCT at IIOR, almost all patients subsequently relapsed, often with other IIORs.
Collapse
Affiliation(s)
- Nadia Younan
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Carole Soussain
- Hematology, Institut Curie, Site Saint-Cloud, INSERM U932, PSL Research University, Paris, France
| | - Sylvain Choquet
- Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Nathalie Cassoux
- Ophthalmology, Institut Curie, Site Paris, Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Valérie Touitou
- Ophthalmology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Olivier Chinot
- Neuro-oncology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Lucie Oberic
- Hematology, Institut Universitaire du Cancer de Toulouse Oncopôle, Toulouse, France
| | - Gandhi Damaj
- Hematology, Centre Hospitalier Universitaire de Caen, Université de Caen-Normandie, Caen, France
| | - Roch Houot
- Hematology, Centre Hospitalier Universitaire de Rennes, Université de Rennes, INSERM U1236, Rennes, France
| | - Hervé Ghesquières
- Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Kamel Laribi
- Hematology, Centre Hospitalier du Mans, Le Mans, France
| | - Guido Ahle
- Neurology, Hôpital Pasteur - Hôpitaux Civils de Colmar, Colmar, France
| | - Luc Taillandier
- Neurology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jérôme Paillassa
- Hematology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Emmanuel Gyan
- Hematology and Cell Therapy Department, Centre Hospitalier Universitaire de Tours, Centre d'Investigations Cliniques INSERM U1517, Tours, France
| | | | - Vincent Delwail
- Hematology, CHU de Poitiers, INSERM, CIC 1402, Centre d'Investigation Clinique, Université de Poitiers, Poitiers, France
| | | | - Adrian Tempescul
- Hematology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Philippe Agapé
- Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Marie Bourniquel
- Ophthalmology, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | | | - Ibrahim Jdid
- Hematology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Magali Le Garff-Tavernier
- Service d'hématologie biologique, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Denis Malaise
- Ophthalmology, Laboratoire d'Imagerie Translationnelle en Oncologie, Institut Curie, Paris, France.,PSL University, Inserm U1288, Orsay, France
| | - Agusti Alentorn
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Khê Hoang Xuan
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Caroline Houillier
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| |
Collapse
|
21
|
Morales-Martinez A, Nichelli L, Hernandez-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Prognostic factors in primary central nervous system lymphoma. Curr Opin Oncol 2022; 34:676-684. [PMID: 36093869 DOI: 10.1097/cco.0000000000000896] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal diffuse large B cell lymphoma. Despite its apparent immunopathological homogeneity, PCNSL displays a wide variability in outcome. Identifying prognostic factors is of importance for patient stratification and clinical decision-making. The purpose of this review is to focus on the clinical, neuroradiological and biological variables correlated with the prognosis at the time of diagnosis in immunocompetent patients. RECENT FINDINGS Age and performance status remain the most consistent clinical prognostic factors. The current literature suggests that neurocognitive dysfunction is an independent predictor of poor outcome. Cumulating data support the prognostic value of increased interleukin-10 level in the cerebrospinal fluid (CSF), in addition to its interest as a diagnostic biomarker. Advances in neuroimaging and in omics have identified several semi-quantitative radiological features (apparent diffusion restriction measures, dynamic contrast-enhanced perfusion MRI (pMRI) pattern and 18F-fluorodeoxyglucose metabolism) and molecular genetic alterations with prognostic impact in PCNSL. SUMMARY Validation of new biologic and neuroimaging markers in prospective studies is required before integrating future prognostic scoring systems. In the era of radiomic, large clinicoradiological and molecular databases are needed to develop multimodal artificial intelligence algorithms for the prediction of accurate outcome.
Collapse
Affiliation(s)
| | - Lucia Nichelli
- APHP, Sorbonne Université, IHU, ICM, Service de Neuroradiologie, Groupe Hospitalier Salpêtrière
| | - Isaias Hernandez-Verdin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| | | | - Agustí Alentorn
- APHP, Sorbonne Université, IHU, Service de Neurologie 2-Mazarin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| | - Khê Hoang-Xuan
- APHP, Sorbonne Université, IHU, Service de Neurologie 2-Mazarin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| |
Collapse
|
22
|
Desjardins C, Larrieu-Ciron D, Choquet S, Mokhtari K, Charlotte F, Nichelli L, Mathon B, Ahle G, Le Garff-Tavernier M, Dehais C, Hoang-Xuan K, Houillier C. P11.09.B Chemotherapy is an efficient treatment in primary CNS MALT lymphoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.198] [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: 11/13/2022] Open
Abstract
Abstract
Background
Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and still poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors and their management, and to better appreciate their long-term prognosis after treatment.
Material and Methods
Adult immunocompetent patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. All cases had double-read for pathology.
Results
Eleven PCNSML representing 1.7% of the 662 PCNSL included in the database were selected, There were 9 women and two men, all immunocompetent. Their median age was 56 years (min 29; max 78). The median time from first symptoms to diagnosis was 13 months and the median KPS at diagnosis was 90. Location was dural in 8 cases, suggestive of meningioma in 7 cases and of subdural hematoma in 1 case, and parenchymal in 3 cases. The disease was unifocal/localized in 4 cases and multifocal/diffuse in 7 cases. In 3 cases, it was the second reading that allowed making the diagnosis. In first-line treatment, all patients received chemotherapy (CT): “systemic” CT, i.e usually used in systemic MALT lymphomas, in 7 cases (n=7) and “CNS” CT, i.e usually used in CNS lesions in 4 cases. CT was preceded by surgery in 4 cases. No patient received radiotherapy in first line. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had a persistent contrast enhancement, stable without any treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one of the 2 patients who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months (95% CI [43.4;NA[) and the 10-year overall survival rate was 90% (95% CI [0.7;1[).
Conclusion
This series confirms the classical clinical and radiological presentation of PCNSML. Compared to the literature where the treatment was based on radiotherapy in almost two thirds of cases, the therapeutic approach presented here appears unconventional. This is the first series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of their therapeutic response.
Collapse
Affiliation(s)
- C Desjardins
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - D Larrieu-Ciron
- Neurology department, Hôpital Purpan, CHU de Toulouse, France , Paris , France
| | - S Choquet
- Clinical Hematology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - K Mokhtari
- Neuropathology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - F Charlotte
- Service d’Anatomie et Cytologie Pathologiques, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Sorbonne Université , Paris , France
| | - L Nichelli
- Neuroradiology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - B Mathon
- Neurosurgery department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - G Ahle
- Neurology department, Hospices Civils, Colmar, France , Paris , France
| | - M Le Garff-Tavernier
- Hematobiology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - C Dehais
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - K Hoang-Xuan
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - C Houillier
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| |
Collapse
|
23
|
Houillier C, Dureau S, Taillandier L, Houot R, Chinot O, Moluçon-Chabrot C, Schmitt A, Gressin R, Choquet S, Damaj G, Peyrade F, Abraham J, Delwail V, Gyan E, Sanhes L, Cornillon J, Garidi R, Delmer A, Al Jijakli A, Morel P, Waultier A, Paillassa J, Chauchet A, Gastinne T, Laadhari M, Plissonnier AS, Feuvret L, Cassoux N, Touitou V, Ricard D, Hoang-Xuan K, Soussain C. Radiotherapy or Autologous Stem-Cell Transplantation for Primary CNS Lymphoma in Patients Age 60 Years and Younger: Long-Term Results of the Randomized Phase II PRECIS Study. J Clin Oncol 2022; 40:3692-3698. [PMID: 35834762 DOI: 10.1200/jco.22.00491] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported the results of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma (age 18-60 years). Patients were treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). The median follow-up was 33 months. In this report, we provide long-term data (median follow-up, 8 years) regarding the outcomes and toxicities. Fifty-three and 44 patients received induction chemotherapy followed by WBRT or ASCT, respectively. Their 8-year event-free survival from random assignment was 67% and 39% in the ASCT and WBRT arms, respectively (P = .03), with a significantly lower risk of relapse after ASCT (hazard ratio = 0.13, P < .001). One third of patients who relapsed after WBRT were alive after salvage treatment. Five and four patients died of ASCT and WBRT-related toxicities, respectively. The 8-year overall survival was 69% and 65% in the ASCT and WBRT arms, respectively (not significant). Balance (52% v 10%, P ≤ 0.001) and neurocognition (64% v 13%, P < .001) significantly deteriorated after WBRT compared with ASCT during the follow-up. This study shows that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses while ASCT appears to be highly efficient in preventing relapses.
Collapse
Affiliation(s)
- Caroline Houillier
- APHP, Sorbonne Université, IHU, ICM, Service de Neurologie-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | | | - Roch Houot
- Service d'Hématologie, CHU de Rennes, Inserm U1236 Université de Rennes 1, France
| | - Olivier Chinot
- Aix-Marseille Université, CNRS, INP, AP-HM, Service de Neuro-Oncologie, CHU de la Timone, France
| | | | - Anna Schmitt
- Service d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Rémy Gressin
- Onco-Haematology Department, CHU de Grenoble, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gandhi Damaj
- Service d'Hématologie, CHU d'Amiens, France.,Current address: Hematology Institute, University Hospital Normandy, Caen, France
| | | | - Julie Abraham
- Service d'Hématologie et de Thérapie cellulaire, CHU de Limoges, France
| | - Vincent Delwail
- Service d'Oncologie Hématologique et de Thérapie Cellulaire, CHU de Poitiers, INSERM, CIC 1402, Poitiers, Centre d'Investigation Clinique, Université de Poitiers, Poitiers, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre d'Investigations Cliniques INSERM U1517, Centre hospitalier universitaire, Université de Tours, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, France
| | - Jérôme Cornillon
- Service d'Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France.,Current affiliation: Département d'Hématologie Clinique, CHU de ST-Etienne, France
| | - Reda Garidi
- Service d'Hématologie, Centre Hospitalier de Saint Quentin, France
| | | | | | - Pierre Morel
- Service d'Hématologie, Centre Hospitalier de Lens, France.,Current affiliation: Service d'Hématologie, CHU d'Amiens, France
| | | | | | | | | | - Mouna Laadhari
- Département d'Imagerie Médicale, Institut Curie, Site Saint-Cloud, France
| | | | - Loïc Feuvret
- Service de Radiothérapie, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nathalie Cassoux
- Service d'Ophtalmologie, Institut Curie, site de Paris, et Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Valérie Touitou
- Service d'Ophtalmologie, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Ricard
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Ecole du Val-de-Grâce, Service de Santé des Armées, Clamart, France
| | - Khê Hoang-Xuan
- APHP, Sorbonne Université, IHU, ICM, Service de Neurologie-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie, site de Saint-Cloud et INSERM U932 Institut Curie, PSL Research University, Paris, France
| |
Collapse
|
24
|
Desjardins C, Larrieu-Ciron D, Choquet S, Mokhtari K, Charlotte F, Nichelli L, Mathon B, Ahle G, Le Garff-Tavernier M, Morales-Martinez A, Dehais C, Hoang-Xuan K, Houillier C. Chemotherapy is an efficient treatment in primary CNS MALT lymphoma. J Neurooncol 2022; 159:151-161. [PMID: 35725885 DOI: 10.1007/s11060-022-04052-1] [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: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors, their management and their long-term prognosis. METHODS Patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. RESULTS Of 662 PCNSL, 11 (1.7%) PCNSML (9 females and 2 males, median age: 56 years) were selected. The median time from first symptoms to diagnosis was 13 months. Location was dural in 8 cases and parenchymal in 3 cases. The disease was multifocal/diffuse in 7 cases. In first line, all patients received chemotherapy (high-dose methotrexate (HD-MTX) based chemotherapy (n = 4) and non-HD-MTX-based chemotherapy (n = 7)), preceded by surgery in 4 cases. None received radiotherapy. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had persistent contrast enhancement, stable with no treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one patient who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months and the 10-year overall survival rate was 90%. CONCLUSION This is the largest series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of response.
Collapse
Affiliation(s)
- Clément Desjardins
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Delphine Larrieu-Ciron
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France.,Neurology Department, Hôpital Pierre Paul Riquet, CHU de Toulouse Purpan, Toulouse, France
| | - Sylvain Choquet
- Clinical Hematology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Karima Mokhtari
- Neuropathology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Frédéric Charlotte
- Service d'Anatomie et Cytologie Pathologiques, Groupe Hospitalier Pitié-Salpétrière-Charles Foix, Sorbonne Université, Paris, France
| | - Lucia Nichelli
- Neuroradiology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Bertrand Mathon
- Neurosurgery Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Guido Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | | | - Andrea Morales-Martinez
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Caroline Dehais
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Khê Hoang-Xuan
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Caroline Houillier
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France.
| |
Collapse
|
25
|
Houillier C. Lymphome cérébral primitif. Rev Neurol (Paris) 2022. [DOI: 10.1016/j.neurol.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Valyraki N, Maillart E, Dehais C, Pourcher V, Houillier C, Deschamps R. Humanpegivirus identifié chez 4 patients transplantés présentant un tableau sévère de neuromyélite optique, un rôle pathogène pour ce virus ? Rev Neurol (Paris) 2022. [DOI: 10.1016/j.neurol.2022.02.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
27
|
Houillier C, Chabrot CM, Moles-Moreau MP, Willems L, Ahle G, Waultier-Rascalou A, Fornecker LM, Hoang-Xuan K, Soussain C. Rituximab-Lenalidomide-Ibrutinib Combination for Relapsed/Refractory Primary CNS Lymphoma: A Case Series of the LOC Network. Neurology 2021; 97:628-631. [PMID: 34580183 DOI: 10.1212/wnl.0000000000012515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the efficacy and tolerance of the association rituximab-lenalidomide-ibrutinib (R2I) in relapsed/refractory (R/R) primary CNS lymphoma (PCNSL). METHODS R/R PCNSL patients treated with R2I were retrospectively selected and analyzed from the French LOC database. RESULTS Fourteen patients (median age: 63 years, median Karnofsky Performance Status: 75%) received R2I, administered after a median of 2 previous lines of chemotherapy, including autologous stem cell transplantation (ASCT) in 5 cases. The best response was complete response in 4/14 patients and partial response in 4/14 patients, achieved in a median of 2.5 months. Three responder patients received consolidation treatment (WBRT: N = 2, ASCT: N = 1) after R2I, and R2I served as a bridge before CAR-T cell therapy for one patient. R2I was discontinued due to toxicity in 3/14 patients. There were no toxicity-related deaths. DISCUSSION The R2I combination resulted in a high rate of response of rapid-onset in heavily pretreated patients with poor prognosis, with manageable toxicity, and allowed 3 patients to proceed to consolidation. Although preliminary, these results support the use of R2I for R/R PCNSL failing conventional chemotherapies. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that combination of rituximab-lenalidomide-ibrutinib induces a high rate of response in heavily pretreated R/R PCNSL.
Collapse
Affiliation(s)
- Caroline Houillier
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris.
| | - Cecile Moluçon Chabrot
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Marie-Pierre Moles-Moreau
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Lise Willems
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Guido Ahle
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Agathe Waultier-Rascalou
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Luc-Matthieu Fornecker
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Khê Hoang-Xuan
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| | - Carole Soussain
- From the APHP (C.H., K.H.-X.), Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service d'Hématologie (C.M.C.), CHU de Clermont-Ferrand, Clermont-Ferrand; Service des Maladies du Sang (M.-P.M.-M.), CHU d'Angers; APHP (L.W.), Hôpital Cochin, Service d'Hématologie, Paris; Service de Neurologie (G.A.), Hôpitaux Civils, Colmar; Service d'Hématologie (A.W.-R.), CHU de Nîmes; Service d'Hématologie (L.-M.F.), Institut de Cancérologie de Strasbourg Europe, Strasbourg; Service d'Hématologie (C.S.), Institut Curie, Site Saint Cloud; INSERM U932 (C.S.), Institut Curie, PSL Research University, Paris
| |
Collapse
|
28
|
Dufour J, Choquet S, Schmitt A, Ahle G, Houot R, Taillandier L, Ursu R, Hoang-Xuan K, Soussain C, Houillier C. P14.48 Extracerebral relapses of primary CNS lymphoma (PCNSL): a LOC network retrospective study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.161] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Classically PCNSL remain confined within the CNS throughout their evolution for reasons still unknown (> 80% cerebral relapses). The aim of this study was to describe the characteristics and outcomes of the rare extracerebral relapses of PCNSL.
MATERIAL AND METHODS
This is a multicenter, retrospective study. We included all immunocompetent patients newly diagnosed with diffuse large B-cell PCNSL registered in the national LOC network database since 2010 and followed prospectively, who presented an extracerebral relapse, pure (extracerebral only site) or associated with concomitant CNS relapse (mixed). All had body scan and/or TEP -CT at diagnosis work up.
RESULTS
Of the 1968 PCNSL included in the database, 29 (1.5%) patients presented a systemic relapse [median age 71 years, median KPS 70% at relapse], either pure (n=19) or mixed (n=10), with a histological confirmation in 19 cases (66%). The median delay between initial diagnosis and systemic relapse was 15 months [2–49 months], with 5 very early relapses (<8 months) and 10 late relapses (>21 months). 27 patients had symptoms, 21 related to the location of relapse and 6 with only general symptoms. The localization was thoracic (n=11), abdominal/pelvic (n=14), head/neck (n=6) and limbs (n=9). We found visceral (n=24, 83%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n=12, 41%) and peripheral nervous system (PNS) (n=8, 28%; 4 plexus and 4 extradural roots) involvement. 27 patients were treated with chemotherapy, either with only systemic target (n=8) (R-CHOP alone) or mixed systemic and CNS target (n=19) (R-CHOP-MTX, R-ICE, GEMOX, RDHAC) and consolidated by high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) in 4 cases [median age 55 years, median KPS 80%], with 34% of complete response. After systemic relapse, median progression-free survival was 8 months and overall survival (OS) was 9 months, 15 months for pure systemic and 4.5 months for mixed relapses. KPS>70%, pure systemic relapses and complete response were significantly associated with higher OS in univariate analysis.
CONCLUSION
Extracerebral PCNSL relapses are very rare, mainly extranodal and involve a large spectrum of anatomical sites, the most frequent being testis, breast and PNS. Prognosis was worse in case of mixed relapse than in pure systemic relapse that was similar to non PCNSL lymphomas. Very early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic work up that should include systematically a FDG PET-CT. More studies are needed to refine their treatment and to specify the role of HCT-ASCT. Paired tumor tissues at diagnosis (CNS)/relapse (extracerebral) analysis would provide a better understanding of underlying molecular mechanisms.
Collapse
Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtriere, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtriere, Paris, France
| | - A Schmitt
- Institut de Bergonie, Bordeaux, France
| | - G Ahle
- Centre hospitalier de Colmar, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Rennes, France
| | | | - R Ursu
- Hôpital Saint-Louis, Paris, France
| | | | | | | |
Collapse
|
29
|
Nilles C, Delgadillo D, Martin Duverneuil N, Mokhtari K, Mathon B, Hoang-Xuan K, Duran-Pena A, Morales A, Houillier C. P03.04 Primary CNS lymphoma of the corpus callosum: presentation and neurocognitive prognosis. Study of a monocentric cohort of 27 patients. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.056] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The corpus callosum (CC) is frequently involved in primary central nervous system lymphomas (PCNSL). The aim of our study was to describe the impact of these lesions on neurocognition of patients presenting with PCNSL of the CC (PCNSL-CC) and their post-therapeutic evolution.
MATERIAL AND METHODS
This is a retrospective single-center study. Patients newly diagnosed at Pitié Salpêtrière Hospital from (1999–2018) were included in this study according to the following criteria: age >18, immunocompetent patient, pathological confirmation (Diffuse Large B cell lymphoma) and CC as main location of the tumor on MRI. Clinical, neuroradiological and neuropsychological data of the patients were collected. In addition, prognostic factors for the neurocognitive outcome of the patients were investigated.
RESULTS
27 patients were included (median age: 67 years, median KPS: 70). At the time of diagnosis, 74% of patients had cognitive impairment and 59% of patients had balance disorders. The cognitive functions most frequently affected were memory and executive functions. Tumor lesions in the CC had a median maximum diameter of 5 cm with a so called “butterfly pattern” in 92% of cases. All patients received a high dose methotrexate based polychemotherapy, including one with radiation therapy, and 67% of patients achieved a complete remission (CR). Median PFS and OS were 33.3 months and 177.9 months respectively. With a median follow-up of 48 months (range 6–156), despite CR, there were still abnormal values in 17% of patients on overall efficiency, 17–55% of patients on executive function tests, 45–55% of patients on memory tests. No significant impaired values were found for visuo-spatial and language tests. Splenial location and age ≥ 60 years were significantly associated with worse episodic memory scores throughout the follow-up.
CONCLUSION
PCNSL-CC are associated with frequent cognitive dysfunctions, especially memory impairment, which may recover only partially despite CR, that warrant specific rehabilitation. Older age (≥ 60) and splenial location have worse neurocognition outcome.
Collapse
Affiliation(s)
- C Nilles
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - D Delgadillo
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | | | - K Mokhtari
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - B Mathon
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - K Hoang-Xuan
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - A Duran-Pena
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - A Morales
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - C Houillier
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| |
Collapse
|
30
|
Valyraki N, Ahle G, Tabouret E, Houot R, Jardin F, Ghesquieres H, Choquet S, Moles M, Hoang-Xuan K, Houillier C. P14.54 Primary central nervous system lymphoma of the spinal cord: a LOC network cohort study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.165] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% of the cases), Very little data can be found in the literature on PCNSL with spinal cord localization.
MATERIAL AND METHODS
We present a retrospective study based on the French LOC network database. We selected adult immunocompetentpatients, with a histological or cytological diagnosis of PCNSL, and a spinal cord localization at initial diagnosis.
RESULTS
Of the 2043 PCNSLof the LOC database newly diagnosed since 2011, 14 patients (9 men, median age 68, median Karnofsky performance status 50%)met the selection criteria. The median diagnostic delay was 82 days (min 15-max 1080) compared to 35 days in primary cerebral lymphomas. At diagnosis, walking was impossible in 7/14 patients and 5/14 had indwelling urinary catheter. On MRI, 100% had enlargement of the spinal cord with homogeneous contrast enhancement in 13/14 cases. Spinal cord lesions were unique in 9/14 patients and multiples in 5/14 patients. CSF IL10 level was increased in 6/7 patients. Brain lesions were found in 9/14 patients, located in the posterior fossa in 5/9 cases. The diagnosis was made either on a brain biopsy (N=6), a spinal cord biopsy or surgery (N=5) or the cytologic analysis of the CSF (N=3).4/5 patients had neurological sequel after spinal cord biopsy or surgery. All the patients were treated by high-dose methotrexate-based chemotherapy, followed by spinal cord irradiation (N=1) or autograft (N=2). There was an overall response rate of 71% (complete response in 8/14). 8/14 patients relapsed, 5 in the brain, 2 in the spinal cord, and 1 both in the spinal cord and in the brain. 2-year PFS and OS were 45% and 64%, respectively. Among the long-term responders, 50% remained in wheel chair, while only 10% could walk normally.
CONCLUSION
Considering the high risk of a spinal cord biopsy,the rarity of the disease, as well as the numerous differential diagnoses, the diagnosis of spinal cord lymphoma is difficult. Searching for other lymphomatous locations or assaying CSF IL10 may be helpful in this disease where delay in diagnosis is often prolonged et can cause irreversible handicap.
Collapse
Affiliation(s)
- N Valyraki
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - G Ahle
- Hôpital Pasteur - Hôpitaux civils de Colmar, Colmar, France
| | - E Tabouret
- Hôpitaux Unoversitaires de la Timone, Marseilel, France
| | - R Houot
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - F Jardin
- Centre Henri Becquerel, Rouen, France
| | | | - S Choquet
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - M Moles
- Centre Hospitalier Universitaire d’Anger, Angers, France
| | - K Hoang-Xuan
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - C Houillier
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| |
Collapse
|
31
|
Laurenge A, Ursu R, Houillier C, Abdi B, Tebano G, Quemeneur C, Choquet S, Di Blasi R, Lozano F, Morales A, Durán-Peña A, Sirven-Villaros L, Mathon B, Mokhtari K, Bielle F, Martin-Duverneuil N, Delattre JY, Marcelin AG, Pourcher V, Alentorn A, Idbaih A, Carpentier AF, Leblond V, Hoang-Xuan K, Touat M. SARS-CoV-2 infection in patients with primary central nervous system lymphoma. J Neurol 2021; 268:3072-3080. [PMID: 33387015 PMCID: PMC7776286 DOI: 10.1007/s00415-020-10311-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer patients may be at higher risk for severe coronavirus infectious disease-19 (COVID-19); however, the outcome of Primary Central Nervous System Lymphoma (PCNSL) patients with SARS-CoV-2 infection has not been described yet. METHODS We conducted a retrospective study within the Lymphomes Oculo-Cérébraux national network (LOC) to assess the clinical characteristics and outcome of SARS-CoV-2 infection in PCNSL patients (positive real-time polymerase chain reaction of nasopharyngeal swab or evocative lung computed tomography scan). We compared clinical characteristics between patients with severe (death and/or intensive care unit admission) and mild disease. RESULTS Between March and May 2020, 13 PCNSL patients were diagnosed with SARS-CoV-2 infection, 11 (85%) of whom were undergoing chemotherapy at the time of infection. The mortality rate was 23% (3/13), and two additional patients (15%) required mechanical ventilation. Two patients (15%) had no COVID-19 symptoms. History of diabetes mellitus was more common in severe patients (3/5 vs 0/8, p = 0.03). Two patients recovered from COVID-19 after mechanical ventilation during more than two weeks and resumed chemotherapy. In all, chemotherapy was resumed after COVID-19 recovery in nine patients (69%) after a median delay of 16 days (range 3-32), none of whom developed unusual chemotherapy complication nor SARS-Cov2 reactivation. CONCLUSION This preliminary analysis suggests that, while being at higher risk be for severe illness, PCNSL patients with COVID-19 might be treated maximally especially if they achieved oncological response at the time of SARS-CoV-2 infection. Chemotherapy might be resumed without prolonged delay in PCNSL patients with COVID-19.
Collapse
Affiliation(s)
- Alice Laurenge
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Renata Ursu
- Service de Neurologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Caroline Houillier
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Basma Abdi
- Laboratoire de virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
- Sorbonne Université, INSERM 1136, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, 75013, Paris, France
| | - Gianpiero Tebano
- Service de Maladies infectieuses et Tropicales, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Cyril Quemeneur
- Département d'anesthésie et réanimation, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Sylvain Choquet
- Service d'hématologie clinique, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Roberta Di Blasi
- Service d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Fernando Lozano
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Andrea Morales
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Alberto Durán-Peña
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Lila Sirven-Villaros
- Service de Neurologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Bertrand Mathon
- Service de neurochirurgie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Karima Mokhtari
- Service de Neuropathologie Laboratoire Escourolle, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Franck Bielle
- Service de Neuropathologie Laboratoire Escourolle, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Nadine Martin-Duverneuil
- Service de neuroradiologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Jean-Yves Delattre
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Anne-Geneviève Marcelin
- Laboratoire de virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
- Sorbonne Université, INSERM 1136, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, 75013, Paris, France
| | - Valérie Pourcher
- Sorbonne Université, INSERM 1136, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, 75013, Paris, France
- Service de Maladies infectieuses et Tropicales, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Agusti Alentorn
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Ahmed Idbaih
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Antoine F Carpentier
- Service de Neurologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Véronique Leblond
- Service d'hématologie clinique, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Khê Hoang-Xuan
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Mehdi Touat
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
32
|
Malaise D, Houillier C, Touitou V, Choquet S, Maloum K, Le Garff-Tavernier M, Davi F, Vincent-Salomon A, Feuvret L, Hoang-Xuan K, Cassoux N, Soussain C. Primary vitreoretinal lymphoma: short review of the literature, results of a European survey and French guidelines of the LOC network for diagnosis, treatment and follow-up. Curr Opin Oncol 2021; 33:420-431. [PMID: 34292201 DOI: 10.1097/cco.0000000000000776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to highlight the diagnostic and management challenges of primary vitreoretinal lymphoma (PVRL) through a review of the literature and a European survey on real-life practices for PVRL. RECENT FINDINGS The care of PVRL patients is heterogeneous between specialists and countries. Upfront systemic treatment based on high-dose methotrexate chemotherapy, with or without local treatment, might reduce or delay the risk of brain relapse.Ibrutinib, lenalidomide with or without rituximab, and temozolomide are effective for patients with relapsed/refractory PVRL and should be tested as first-line treatments. SUMMARY The prognosis of PVRL remains dismal. No firm conclusion regarding optimal treatment can yet be drawn. The risk of brain relapse remains high. Diagnostic procedures and assessment of therapeutic responses need to be homogenized. Collaboration between specialists involved in PVRL and multicentric prospective therapeutic studies are strongly needed. The recommendations of the French group for primary oculocerebral lymphoma (LOC network) are provided, as a basis for further European collaborative work.
Collapse
Affiliation(s)
- Denis Malaise
- Institut Curie, Ophthalmology Department, Paris
- Institut Curie, PSL University, Inserm U1288, Laboratoire d'Imagerie Translationnelle en Oncologie, Orsay
- Member of European Reference Network on Rare Hematological Diseases (ERN-EuroBloodNet)
| | - Caroline Houillier
- Sorbonne Université, IHU, ICM, Department of Neuro-Oncology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris
- French Network for Oculo-cerebral Lymphomas (LOC network)
| | - Valérie Touitou
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Sorbonne Université, Department of Ophthalmology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
| | - Sylvain Choquet
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Sorbonne Université, Department of Clinical Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
| | - Karim Maloum
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Sorbonne Université, Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
| | - Magali Le Garff-Tavernier
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Sorbonne Université, Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
| | - Frédéric Davi
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Sorbonne Université, Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
| | - Anne Vincent-Salomon
- Institut Curie, PSL Research University, Department of Pathology, Department of Theranostic and Diagnostic Medicine
| | - Loïc Feuvret
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Sorbonne Université, Department of Radiotherapy, Hôpital Pitié- Salpêtrière, Assistance Publique-Hôpitaux de Paris
| | - Khê Hoang-Xuan
- Sorbonne Université, IHU, ICM, Department of Neuro-Oncology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris
- French Network for Oculo-cerebral Lymphomas (LOC network)
| | - Nathalie Cassoux
- Institut Curie, Ophthalmology Department, Paris
- Member of European Reference Network on Rare Hematological Diseases (ERN-EuroBloodNet)
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Université de Paris, UMR 144 CNRS
| | - Carole Soussain
- Member of European Reference Network on Rare Hematological Diseases (ERN-EuroBloodNet)
- French Network for Oculo-cerebral Lymphomas (LOC network)
- Institut Curie, Site de Saint-Cloud, Hematology Department, Saint-Cloud
- INSERM U932 Institut Curie, PSL Research University, Paris, France
| |
Collapse
|
33
|
Lam M, Touitou V, Choquet S, Cassoux N, Ghesquières H, Kodjikian L, Schmitt A, Gattoussi S, Tabouret É, Sampo M, Blonski M, Angioi‐Duprez K, Houot R, Mouriaux F, Gyan E, Le Lez M, Moles M, Croisé F, Chauchet A, Schwartz C, Ahle G, Meyer L, Gressin R, Chiquet C, Oberic L, Ollé P, Marolleau J, Jany B, Tempescul A, Cochener B, Damaj G, Quintyn J, Moluçon‐Chabrot C, Rousseau E, Franciane P, Schneider C, Massé H, Tamburini‐Bonnefoy J, Brézin A, Fornecker L, Ballonzoli L, Le Garff‐Tavernier M, Hoang‐Xuan K, Bodaghi B, Soussain C, Houillier C. Intravenous high-dose methotrexate based systemic therapy in the treatment of isolated primary vitreoretinal lymphoma: An LOC network study. Am J Hematol 2021; 96:823-833. [PMID: 33864703 DOI: 10.1002/ajh.26199] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022]
Abstract
The treatment of primary vitreoretinal lymphoma (PVRL) remains controversial regarding the use of local, systemic, or combined treatments. The aim of this study was to analyze the efficacy and toxicity of intravenous high-dose methotrexate (IV HD-MTX) based systemic therapy in a uniformly treated population of PVRL patients. From a nationwide French database, we retrospectively selected 59 patients (median age: 70 years, median Karnofsky Performance Status: 90%) with isolated PVRL at diagnosis who received first-line treatment with HD-MTX between 2011 and 2018. 8/59 patients also received a local treatment. No deaths or premature discontinuations of MTX due to toxicity were reported. A complete response was obtained in 40/57 patients after chemotherapy. Before treatment, IL-10 was elevated in the aqueous humor (AH) or in the vitreous in 89% of patients. After treatment, AH IL-10 was undetectable in 87% of patients with a CR/uCR/PR and detectable in 92% of patients with PD/SD. After a median follow-up of 61 months, 42/59 (71%) patients had relapsed, including 29 isolated ocular relapses as the first relapse and a total of 22 brain relapses. The median overall survival, progression-free survival, ocular-free survival and brain-free survival were 75, 18, 29 and 73 months, respectively. IV HD-MTX based systemic therapy as a first-line treatment for isolated PVRL is feasible, with acceptable toxicity, even in an elderly population. This strategy seems efficient to prevent brain relapse with prolonged overall survival. However, the ocular relapse rate remains high. New approaches are needed to improve local control of this disease, and ocular assessment could be completed by monitoring AH IL-10.
Collapse
Affiliation(s)
- Marion Lam
- Ophthalmology, Assistance Publique – Hôpitaux de Paris (APHP) Groupe Hospitalier Pitié‐Salpêtrière Paris France
- Sorbonne Université Paris France
| | - Valérie Touitou
- Ophthalmology, Assistance Publique – Hôpitaux de Paris (APHP) Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Sylvain Choquet
- Hematology APHP, Groupe Hospitalier Pitié‐Salpêtrière, Sorbonne Université Paris France
| | - Nathalie Cassoux
- Ophthalmology, Institut Curie, Site Paris Université Paris V Descartes et PSL (Paris Science et Lettre) Paris France
| | - Hervé Ghesquières
- Hematology, Centre Hospitalier Lyon Sud Université Claude Bernard Lyon 1 Pierre‐Bénite France
| | - Laurent Kodjikian
- Ophthalmology, Croix‐Rousse University Hospital Université Claude Bernard Lyon 1 Lyon France
- Laboratoire UMR‐CNRS 5510 Matéis Université Lyon 1 Lyon France
| | | | - Sarra Gattoussi
- Ophthalmology Centre Hospitalier Universitaire de Bordeaux Bordeaux France
- University of Bordeaux, INSERM Bordeaux France
| | - Émeline Tabouret
- Neuro‐oncology, Assistance Publique – Hôpitaux de Marseille (AP‐HM), Timone Marseille France
- Aix‐Marseille Université, CRO2, UMR911 Marseille France
| | - Magali Sampo
- Ophthalmology Centre Hospitalier Intercommunal Toulon Toulon France
| | - Marie Blonski
- Neurology Centre Hospitalier Universitaire de Nancy Nancy France
| | - Karine Angioi‐Duprez
- Ophthalmology Centre Hospitalier Universitaire de Nancy, Université de Lorraine Nancy France
| | - Roch Houot
- Hematology Centre Hospitalier Universitaire de Rennes, Université de Rennes, INSERM U1236 Rennes France
| | - Frédéric Mouriaux
- Ophthalmology Centre Hospitalier Universitaire de Rennes Rennes France
| | - Emmanuel Gyan
- Hematology Centre Hospitalier Universitaire de Tours Tours France
| | | | | | - Fabien Croisé
- Ophthalmology Centre Hospitalier Universitaire de Angers Angers France
| | - Adrien Chauchet
- Hematology Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz Besançon France
| | - Claire Schwartz
- Ophthalmology Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz Besançon France
| | - Guido Ahle
- Neurology Hôpital Pasteur – Hôpitaux Civils de Colmar Colmar France
| | - Laurent Meyer
- Ophthalmology Hôpitaux civils de Colmar Colmar France
| | - Rémy Gressin
- Hematology Centre Hospitalier Universitaire de Grenoble Grenoble France
| | - Christophe Chiquet
- Grenoble Alpes University Grenoble France
- Ophthalmolgy Grenoble Alpes University Hospital Grenoble France
| | - Lucie Oberic
- Hematology Institut Universitaire du Cancer de Toulouse Oncopôle Toulouse France
| | | | | | - Benjamin Jany
- Ophthalmology Centre Hospitalier Universitaire de Amiens Amiens France
| | - Adrian Tempescul
- Hematology Centre Hospitalier Universitaire de Brest Brest France
| | - Béatrice Cochener
- Ophthalmology Centre Hospitalier Universitaire de Brest Brest France
| | - Gandhi Damaj
- Hematology Centre Hospitalier Universitaire de Caen, Université de Caen‐Normandie Caen France
| | | | | | - Eve Rousseau
- Ophthalmology Centre Hospitalier Universitaire de Gabriel Montpied Clermont‐Ferrand France
| | - Paul Franciane
- Hematology, Saint Eloi Hospital Montpellier University Hospital Montpellier France
| | - Christelle Schneider
- Ophthalmology Centre Hospitalier Universitaire Gui de Chauliac Montpellier France
| | - Hélène Massé
- Ophthalmology Centre Hospitalier Universitaire de Nantes Nantes France
| | | | | | | | - Laurent Ballonzoli
- Ophthalmology Centre Hospitalier Universitaire de Strasbourg Strasbourg France
| | | | - Khê Hoang‐Xuan
- Neurology APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Bahram Bodaghi
- Ophthalmology, Assistance Publique – Hôpitaux de Paris (APHP) Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Carole Soussain
- Hematology Institut Curie Site Saint‐Cloud Paris France
- INSERM U932, Institut Curie, PSL Research University Paris France
| | - Caroline Houillier
- Neurology APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié‐Salpêtrière Paris France
| |
Collapse
|
34
|
Dufour J, Houillier C, Jacob J, Delattre JY. Brain radionecrosis with severe dementia occurring more than 20 years after radiotherapy: a case report. Rev Neurol (Paris) 2021; 177:1008-1010. [PMID: 34167807 DOI: 10.1016/j.neurol.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- J Dufour
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, 75013 Paris, France
| | - C Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, 75013 Paris, France.
| | - J Jacob
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Department of Radiation Oncology, 75013 Paris, France
| | - J Y Delattre
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, 75013 Paris, France
| |
Collapse
|
35
|
Houillier C, Moluçon‐Chabrot C, Moles M, Willems L, Ahle G, Waultier A, Fornecker L, Hoang‐Xuan K, Soussain C. COMBINATION OF RITUXIMAB‐LENALIDOMIDE‐IBRUTINIB IN RELAPSED/REFRACTORY PRIMARY CNS LYMPHOMA: A COHORT STUDY OF THE LOC NETWORK. Hematol Oncol 2021. [DOI: 10.1002/hon.73_2880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C Houillier
- Hôpital Pitié‐Salpêtrière Neuro‐oncology Paris France
| | | | | | | | - G. Ahle
- Hospices Civils Neurology Colmar France
| | | | - L.‐M. Fornecker
- Institut de Cancérologie de Strasbourg Europe Hematology Strasbourg France
| | - K. Hoang‐Xuan
- Hôpital Pitié‐Salpêtrière Neuro‐oncology Paris France
| | - C. Soussain
- Institut Curie Hematology Saint Cloud France
| |
Collapse
|
36
|
Alcantara M, Houillier C, Garff‐Tavernier M, Souchet L, Roos‐Weil D, Morel V, Uzunov M, Metz C, Nguyen‐Quoc S, Jacque N, Gauthier N, Cann M, Norol F, Willems L, Waultier Rascalou A, Salanoubat C, Fior R, Blonski M, Rubio M, Soussain C, Choquet S. CAR‐T CELL THERAPY IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): THE EXPERIENCE OF THE FRENCH NETWORK FOR OCULO‐CEREBRAL LYMPHOMAS (LOC). Hematol Oncol 2021. [DOI: 10.1002/hon.74_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - C. Houillier
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | | | - L. Souchet
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - D. Roos‐Weil
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - V. Morel
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - M. Uzunov
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - C. Metz
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - S. Nguyen‐Quoc
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - N. Jacque
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - N. Gauthier
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - M. Cann
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | - F. Norol
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| | | | | | - C. Salanoubat
- Centre Hospitalier Sud Francilien 91106 Corbeil Essonnes France
| | - R. Fior
- Hôpital Antoine‐Béclère 92140 Clamart France
| | - M. Blonski
- Centre Hospitalier Régional et Universitaire de Nancy 54035 Nancy France
| | - M.‐T. Rubio
- Centre Hospitalier Régional et Universitaire de Nancy 54035 Nancy France
| | | | - S. Choquet
- Hôpital Universitaire Pitié‐Salpêtrière 75013 Paris France
| |
Collapse
|
37
|
Labreche K, Daniau M, Sud A, Law PJ, Royer-Perron L, Holroyd A, Broderick P, Went M, Benazra M, Ahle G, Soubeyran P, Taillandier L, Chinot OL, Casasnovas O, Bay JO, Jardin F, Oberic L, Fabbro M, Damaj G, Brion A, Mokhtari K, Philippe C, Sanson M, Houillier C, Soussain C, Hoang-Xuan K, Houlston RS, Alentorn A. A genome-wide association study identifies susceptibility loci for primary central nervous system lymphoma at 6p25.3 and 3p22.1: a LOC Network study. Neuro Oncol 2021; 21:1039-1048. [PMID: 31102405 DOI: 10.1093/neuonc/noz088] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/23/2023] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare form of extra-nodal non-Hodgkin lymphoma. PCNSL is a distinct subtype of non-Hodgkin lymphoma, with over 95% of tumors belonging to the diffuse large B-cell lymphoma (DLBCL) group. We have conducted a genome-wide association study (GWAS) on immunocompetent patients to address the possibility that common genetic variants influence the risk of developing PCNSL. METHODS We performed a meta-analysis of 2 new GWASs of PCNSL totaling 475 cases and 1134 controls of European ancestry. To increase genomic resolution, we imputed >10 million single nucleotide polymorphisms using the 1000 Genomes Project combined with UK10K as reference. In addition we performed a transcription factor binding disruption analysis and investigated the patterns of local chromatin by Capture Hi-C data. RESULTS We identified independent risk loci at 3p22.1 (rs41289586, ANO10, P = 2.17 × 10-8) and 6p25.3 near EXOC2 (rs116446171, P = 1.95 x 10-13). In contrast, the lack of an association between rs41289586 and DLBCL suggests distinct germline predisposition to PCNSL and DLBCL. We found looping chromatin interactions between noncoding regions at 6p25.3 (rs11646171) with the IRF4 promoter and at 8q24.21 (rs13254990) with the MYC promoter, both genes with strong relevance to B-cell tumorigenesis. CONCLUSION To our knowledge this is the first study providing insight into the genetic predisposition to PCNSL. Our findings represent an important step in defining the contribution of common genetic variation to the risk of developing PCNSL.
Collapse
Affiliation(s)
- Karim Labreche
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK.,(i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France
| | - Mailys Daniau
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,ICM, iGenSeq Platform, Paris, France
| | - Amit Sud
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Philip J Law
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Louis Royer-Perron
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,Neurology Service 2 (Mazarin), Public Assistance-Hospitals of Paris, Hospital Group of Pitié-Salpêtrière, Paris, France; Pierre and Marie Curie University, Paris 6, Paris, France
| | - Amy Holroyd
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Peter Broderick
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Molly Went
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Marion Benazra
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,ICM, iGenSeq Platform, Paris, France
| | - Guido Ahle
- Department of Neurology, Colmar Civil Hospitals, Colmar Cedex, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Bergnoié Institute, Bordeaux, France.,Inserm Research Unit U1218, Bordeaux, France
| | - Luc Taillandier
- Neuro-oncology Department, Nancy University Hospital and The Center of Research in Automatic Control of Nancy, Joint Research Unit 7039, National Center for Scientific Research, SBS BEAM Department, Nancy University, Vandoeuvre-lès-Nancy, France
| | - Olivier L Chinot
- Department of Pathology and Neuropathology, Timone Hospital, Aix-Marseille University (AMU), Public Assistance-Hospitals of Marseille, Marseille, France.,AMU Research Center in Oncology Biology and Oncopharmacology, Marseille, France
| | | | - Jacques-Olivier Bay
- Department of Hematology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Fabrice Jardin
- Department of Hematology, Henri Becquerel Cancer Center, Rouen, France and Inserm U1245, Henri Becquerel Cancer Center, Institute of Research and Innovation in Biomedicine, University of Normandy, Rouen, France
| | - Lucie Oberic
- Department of Hematology, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | | | - Gandhi Damaj
- Department of Hematology, University Hospital of Caen, Caen, France
| | - Annie Brion
- Department of Hematology, Regional and University Hospitals Besançon, Besançon, France
| | - Karima Mokhtari
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,Raymond Escourolle Department of Neuropathology, Public Assistance-Hospitals of Paris, Hospital Group of Pitié-Salpêtrière, Paris, France.,OncoNeuroTek, ICM, Paris, France
| | | | - Marc Sanson
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,Neurology Service 2 (Mazarin), Public Assistance-Hospitals of Paris, Hospital Group of Pitié-Salpêtrière, Paris, France; Pierre and Marie Curie University, Paris 6, Paris, France.,OncoNeuroTek, ICM, Paris, France
| | - Caroline Houillier
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France
| | - Carole Soussain
- Department of Hematology, René Huguenin Hospital, Curie Institute, Saint-Cloud, France
| | - Khê Hoang-Xuan
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,Neurology Service 2 (Mazarin), Public Assistance-Hospitals of Paris, Hospital Group of Pitié-Salpêtrière, Paris, France; Pierre and Marie Curie University, Paris 6, Paris, France
| | - Richard S Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Agusti Alentorn
- (i) National Institute of Health and Medical Research (Inserm) U 1127, Paris, France, (ii) National Center for Scientific Research, Joint Research Unit 7225, Paris, France, (iii) Brain and Spine Institute (ICM), Paris, France, and (iv) Sorbonne University, Pierre and Marie Curie University, Paris 6, Paris, France.,Neurology Service 2 (Mazarin), Public Assistance-Hospitals of Paris, Hospital Group of Pitié-Salpêtrière, Paris, France; Pierre and Marie Curie University, Paris 6, Paris, France
| | | |
Collapse
|
38
|
Perrain V, Bihan K, Bompaire F, Houillier C, Jomier F, Leclercq D, Combret S, Mahé J, Ricard D, Berzero G, Psimaras D. Leukoencephalopathy with transient splenial lesions related to 5-fluorouracil or capecitabine. Eur J Neurol 2021; 28:2396-2402. [PMID: 33817933 DOI: 10.1111/ene.14857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU) and its oral prodrug capecitabine have been rarely but consistently associated with acute central nervous system toxicity, including transient leukoencephalopathies involving the splenium of the corpus callosum. METHODS We performed a retrospective search in the French Pharmacovigilance database (FPDB) (January 1985-July 2020) for adult patients affected by solid cancers who developed acute toxic leukoencephalopathies with splenial lesions following treatment with 5-FU or capecitabine. A comprehensive review of the literature helped to circumstantiate our findings. RESULTS Our research in the FPDB identified six patients who, within 3 days from their first cycle of 5-FU or capecitabine, developed acute neurological symptoms, including gait ataxia (n = 4), dysarthria (n = 3), dysmetria (n = 2), headache (n = 2), and confusion (n = 2). Brain magnetic resonance imaging (MRI) showed T2/FLAIR (fluid-attenuated inversion recovery) hyperintensities in the corpus callosum, with diffusion restriction and no contrast enhancement, generally accompanied by additional alterations in the bilateral supratentorial white matter (n = 5). All patients discontinued the agent supposedly responsible for the toxicity and experienced full recovery after a median of 8.5 days from symptom onset. Control MRI showed a progressive normalization of acute MRI abnormalities. Literature review identified 26 cases with similar clinical and paraclinical characteristics. A single patient from the literature resumed 5-FU at a lower dose, with no recurrent toxicity. CONCLUSIONS 5-FU and capecitabine might be responsible for acute leukoencephalopathies with transient splenial lesions that are generally reversible upon drug discontinuation. Resuming the agent responsible for toxicity might be feasible in selected cases, after having excluded dihydropyrimidine dehydrogenase deficiency, if expected benefits outweigh the risks.
Collapse
Affiliation(s)
- Valentine Perrain
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Kevin Bihan
- Regional Pharmacovigilance Center, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France
| | - Flavie Bompaire
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France.,Department of Neurology, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Caroline Houillier
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Fanny Jomier
- Service de Neurologie, Hôpital Saint Joseph, Paris, France
| | - Delphine Leclercq
- Service de Neuroradiologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sandrine Combret
- Department of Pharmacology, Regional Pharmacovigilance Center, Dijon, France
| | - Julien Mahé
- Department of Pharmacology, Regional Pharmacovigilance Center, Nantes, France
| | - Damien Ricard
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France.,Department of Neurology, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Giulia Berzero
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dimitri Psimaras
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France
| |
Collapse
|
39
|
Laurenge A, Ursu R, Houillier C, Abdi B, Choquet S, Hoang-Xuan K, Touat M. Infection par le SARS-CoV 2 chez les patients avec lymphome cérébral primitif du système nerveux central : étude préliminaire de la sévérité et des facteurs pronostics. Rev Neurol (Paris) 2021. [PMCID: PMC8036149 DOI: 10.1016/j.neurol.2021.02.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Les patients avec cancer semblent à risque d’atteinte sévère de la maladie liée au coronavirus 19 (COVID-19). Néanmoins, ces données ne permettent pas d’établir de recommandations dans les cancers rares. Objectifs L’objectif de cette étude était de décrire le pronostic des patients avec lymphome cérébral primitif du système nerveux central (PCNSL) présentant une infection par le SARS-CoV-2. Patients et méthodes Nous avons réalisé une étude rétrospective dans le réseau national Lymphomes Oculo-Cérébraux (LOC) afin d’évaluer les caractéristiques cliniques et le devenir après infection par le SARS-CoV-2 chez les patients suivis pour PCNSL (diagnostic par PCR sur prélèvement nasopharyngé ou scanner thoracique évocateur). Nous avons comparé les caractéristiques cliniques des patients avec atteinte sévère (décès ou admission en réanimation) ou modérée et étudié les facteurs pronostics. Résultats Entre mars et mai 2020, 13 patients PCNSL ont présenté une infection au SARS-CoV-2, dont 85 % étaient en cours de chimiothérapie. Trente-huit pour cent ont présenté une forme sévère : 23 % de décès, 15 % de ventilation mécanique (VM). Quinze pour cent sont restés asymptomatiques. Un antécédent de diabète était plus fréquent en cas d’atteinte sévère (3/5 vs 0/8, p = 0,03). La chimiothérapie a été reprise chez 9 patients après un délai médian de 16 jours après guérison clinique, sans complication inhabituelle ni réactivation virale, y compris chez 2 patients ayant nécessité une VM. Discussion Cette analyse préliminaire suggère que, bien qu’à plus haut risque d’infection sévère, les patients PCNSL infectés par le SARS-CoV-2 devraient être pris en charge de façon maximale, en particulier s’ils sont en réponse oncologique lors de l’infection au SARS-CoV-2. Ces données représentent la première série de PCNSL rapportée et aideront à l’établissement de recommandations internationales pour cette population. Conclusion La chimiothérapie pourrait être reprise sans délai prolongé chez les patients suivis pour PCNSL avec COVID-19.
Collapse
|
40
|
Nilles C, Hoang-Xuan K, Delgadillo D, Duverneuil NM, Mokhtari K, Mathon B, Houillier C. Lymphome du corps calleux : présentation et pronostic neurocognitif. Étude d’une cohorte monocentrique de 27 patients. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
41
|
Dufour J, Choquet S, Hoang-Xuan K, Soussain C, Schmitt A, Taillandier L, Houillier C. Rechutes systémiques des lymphomes cérébraux primitifs : une cohorte rétrospective nationale. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
42
|
Valyraki N, Pourcher V, Bielle F, Mathon B, Touat M, Dehais C, Houillier C. Infection à pegivirus (HPgV) responsable d’un tableau de myélite et névrite optique chez un patient immunodéprimé. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Seckendorff AFV, Desjardins C, Laurent C, Karima M, Morales A, Houillier C, Touat M, Hoang-Xuan K. Lymphome primitif du système nerveux central (LPSNC) et « lésion sentinelle ». Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
44
|
Roos-Weil D, Weiss N, Guihot A, Uzunov M, Bellanger A, Eymard B, Saadoun D, Houillier C, Idbaih A, Demeret S, Deback C, Leblond V, Galanaud D, Shor N, Pourcher V. Immune checkpoint inhibitors for progressive multifocal leukoencephalopathy: a new gold standard? J Neurol 2021; 268:2458-2465. [DOI: 10.1007/s00415-021-10414-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
|
45
|
Autier L, Le Garff-Tavernier M, Mathon B, Martin-Duverneuil N, Hoang-Xuan K, Houillier C. Cerebrospinal fluid interleukin-10 may be a useful biomarker for atypical primary central nervous system lymphoma relapse. Rev Neurol (Paris) 2020; 177:436-439. [PMID: 33190919 DOI: 10.1016/j.neurol.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/01/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
- L Autier
- Department of neurology 2-Mazarin, IHU, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France.
| | - M Le Garff-Tavernier
- Inserm UMRS 1138, cell death and drug resistance in lymphoproliferative disorders, department of biological hematology, centre de recherche des Cordeliers, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - B Mathon
- Department of neurosurgery, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - N Martin-Duverneuil
- Department of neuroradiology, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - K Hoang-Xuan
- Department of neurology 2-Mazarin, IHU, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - C Houillier
- Department of neurology 2-Mazarin, IHU, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| |
Collapse
|
46
|
Rudà R, Houillier C, Maschio M, Reijneveld JC, Hellot S, De Backer M, Chan J, Joeres L, Leunikava I, Glas M, Grant R. Effectiveness and tolerability of lacosamide as add-on therapy in patients with brain tumor-related epilepsy: Results from a prospective, noninterventional study in European clinical practice (VIBES). Epilepsia 2020; 61:647-656. [PMID: 32329527 PMCID: PMC7384112 DOI: 10.1111/epi.16486] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Received: 12/03/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022]
Abstract
Objective To evaluate the effectiveness and tolerability of lacosamide added to one or two antiepileptic drugs (AEDs) in the treatment of patients with brain tumor–related epilepsy (BTRE), and to evaluate patients’ global impression of change and quality of life (QoL). Methods This was a prospective, multicenter, single‐arm, noninterventional study with a 6‐month observation period (EP0045; NCT02276053). Eligible patients (≥16 years old) had active BTRE secondary to low‐grade glioma (World Health Organization grade 1 and 2) and were receiving treatment with one or two AEDs at baseline. Lacosamide was initiated by the treating physician in the course of routine clinical practice. Primary outcomes were 50% responders (≥50% reduction in focal seizure frequency from baseline) and Patient's Global Impression of Change (PGIC) at month 6. Secondary outcomes included seizure‐free status and Clinical Global Impression of Change (CGIC) at month 6, change in QoL (5‐Level EuroQol‐5 Dimension Quality of Life Assessment) and symptom outcomes (MD Anderson Symptom Inventory–Brain Tumor) from baseline to month 6, and Kaplan‐Meier estimated 6‐month retention on lacosamide. Safety variables included adverse drug reactions (ADRs). Results Patients were recruited from 24 sites in Europe. Ninety‐three patients received lacosamide (mean [standard deviation] age = 44.5 [14.7] years; 50 [53.8%] male; median baseline focal seizure frequency = five seizures/28 days [range = 1‐280]), of whom 79 (84.9%) completed the study. At 6 months, 66 of 86 (76.7%) patients were 50% responders and 30 of 86 (34.9%) were seizure‐free. Improvements on PGIC were reported by 49 of 76 (64.5%) patients. Based on CGIC, 52 of 81 (64.2%) patients improved. QoL and symptoms outcome measures remained stable. Kaplan‐Meier estimated 6‐month retention rate was 86.0% (N = 93). Fifteen (16.1%) patients reported ADRs; four (4.3%) had ADRs leading to discontinuation (N = 93). Significance Results of this prospective, noninterventional study suggest that add‐on lacosamide is effective and generally well tolerated in patients with BTRE.
Collapse
Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Caroline Houillier
- AP-HP, Sorbonne Université, IHU, ICM, Public Hospital Network of Paris, Service de Neurologie 2-Mazarin, Hôpitaux, Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Jaap C Reijneveld
- Amsterdam UMC, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | | | | | | | | | | | - Martin Glas
- Division of Clinical Neuro-oncology, Department of Neurology, West German Cancer Center and German Cancer Consortium Partner Site, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
47
|
Valyraki N, Houillier C, Touat M, Hoang-Xuan K. Le lymphome primitif du système nerveux central : une rare cause de myélopathie subaiguë. Rev Neurol (Paris) 2020. [DOI: 10.1016/j.neurol.2020.01.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Touat M, Li YY, Boynton AN, Spurr LF, Iorgulescu B, Bohrson CL, Cortes-Ciriano I, Geduldig JE, Pelton K, Lim-Fat MJ, Pal S, Ramkissoon SH, Dubois F, Bellamy C, Currimjee N, Qian K, Malinowski S, Shetty A, Chow KH, Verreault M, Guillerm E, Ammari S, Beuvon F, Mokhtari K, Alentorn A, Dehais C, Houillier C, Laigle-Donadey F, Psimaras D, Carpentier A, Cornu P, Capelle L, Mathon B, Barnholtz-Sloan JS, Chakravarti A, Bi WL, Frampton GM, Sanson M, Alexander BM, Cherniack A, Wen PY, Reardon DA, Marabelle A, Park PJ, Idbaih A, Beroukhim R, Bandopadhayay P, Bielle F, Ligon KL. Abstract 5705: Mechanisms and therapeutic implications of hypermutation in gliomas. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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]
Abstract
Abstract
High tumor mutational burden (hypermutation) is observed in some gliomas; however, its mechanisms of development and whether it predicts immunotherapy response are poorly understood. Here, we comprehensively analyze the molecular determinants of mutational burden and signatures in 10,294 gliomas including AACR Project GENIE and institutional datasets. We delineate two main pathways to hypermutation: a de novo pathway associated with constitutional defects in DNA polymerase and mismatch repair (MMR) genes, and a more common post-treatment pathway associated with acquired resistance driven by MMR defects in chemotherapy-sensitive gliomas that recur after temozolomide treatment. Experimentally, the mutational signature of post-treatment hypermutated gliomas was only recapitulated by temozolomide-induced damage in cells harboring MMR deficiency. MMR-deficient gliomas exhibited unique features including the lack of prominent T-cell infiltrates, extensive intratumoral heterogeneity, poor survival and low response rate to PD-1 blockade. Moreover, while microsatellite instability in MMR-deficient gliomas was not detected by bulk analyses, single-cell whole-genome sequencing of post-treatment hypermutated glioma cells demonstrated microsatellite mutations. This study shows that chemotherapy can drive acquisition of hypermutated populations without promoting response to PD-1 blockade and supports diagnostic use of mutational burden and signatures in cancer.
Citation Format: Mehdi Touat, Yvonne Y. Li, Adam N. Boynton, Liam F. Spurr, Bryan Iorgulescu, Craig L. Bohrson, Isidro Cortes-Ciriano, Jack E. Geduldig, Kristine Pelton, Mary J. Lim-Fat, Sangita Pal, Shakti H. Ramkissoon, Frank Dubois, Charlotte Bellamy, Naomi Currimjee, Kenin Qian, Seth Malinowski, Aniket Shetty, Kin-Hoe Chow, Maïté Verreault, Erell Guillerm, Samy Ammari, Frédéric Beuvon, Karima Mokhtari, Agusti Alentorn, Caroline Dehais, Caroline Houillier, Florence Laigle-Donadey, Dimitri Psimaras, Alexandre Carpentier, Philippe Cornu, Laurent Capelle, Bertrand Mathon, Jill S. Barnholtz-Sloan, Arnab Chakravarti, Wenya L. Bi, Garrett M. Frampton, Marc Sanson, Brian M. Alexander, Andrew Cherniack, Patrick Y. Wen, David A. Reardon, Aurelien Marabelle, Peter J. Park, Ahmed Idbaih, Rameen Beroukhim, Pratiti Bandopadhayay, Franck Bielle, Keith L. Ligon. Mechanisms and therapeutic implications of hypermutation in gliomas [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5705.
Collapse
Affiliation(s)
| | | | | | - Liam F. Spurr
- 2Broad Institute of MIT and Harvard, Cambridge, MA, MA
| | | | | | - Isidro Cortes-Ciriano
- 4European Molecular European Bioinformatics Institute, Wellcome Genome Campus, HInxton, United Kingdom
| | | | | | | | - Sangita Pal
- 5Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Frank Dubois
- 5Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | - Kenin Qian
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Erell Guillerm
- 8Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | | | - Alexandre Carpentier
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Philippe Cornu
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Laurent Capelle
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Bertrand Mathon
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | - Arnab Chakravarti
- 13Arthur G. James Hospital/Ohio State Comprehensive Cancer Center, Cleveland, OH
| | - Wenya L. Bi
- 14Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Franceschi E, Frappaz D, Rudà R, Hau P, Preusser M, Houillier C, Lombardi G, Asioli S, Dehais C, Bielle F, Di Nunno V, van den Bent M, Brandes AA, Idbaih A. Rare Primary Central Nervous System Tumors in Adults: An Overview. Front Oncol 2020; 10:996. [PMID: 32676456 PMCID: PMC7333775 DOI: 10.3389/fonc.2020.00996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/24/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
Overall, tumors of primary central nervous system (CNS) are quite common in adults with an incidence rate close to 30 new cases/100,000 inhabitants per year. Significant clinical and biological advances have been accomplished in the most common adult primary CNS tumors (i.e., diffuse gliomas). However, most CNS tumor subtypes are rare with an incidence rate below the threshold defining rare disease of 6.0 new cases/100,000 inhabitants per year. Close to 150 entities of primary CNS tumors have now been identified by the novel integrated histomolecular classification published by the World Health Organization (WHO) and its updates by the c-IMPACT NOW consortium (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy). While these entities can be better classified into smaller groups either by their histomolecular features and/or by their location, assessing their treatment by clinical trials and improving the survival of patients remain challenging. Despite these tumors are rare, research, and advances remain slower compared to diffuse gliomas for instance. In some cases (i.e., ependymoma, medulloblastoma) the understanding is high because single or few driver mutations have been defined. The European Union has launched European Reference Networks (ERNs) dedicated to support advances on the clinical side of rare diseases including rare cancers. The ERN for rare solid adult tumors is termed EURACAN. Within EURACAN, Domain 10 brings together the European patient advocacy groups (ePAGs) and physicians dedicated to improving outcomes in rare primary CNS tumors and also aims at supporting research, care and teaching in the field. In this review, we discuss the relevant biological and clinical characteristics, clinical management of patients, and research directions for the following types of rare primary CNS tumors: medulloblastoma, pineal region tumors, glioneuronal and rare glial tumors, ependymal tumors, grade III meningioma and mesenchymal tumors, primary central nervous system lymphoma, germ cell tumors, spinal cord tumors and rare pituitary tumors.
Collapse
Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Didier Frappaz
- Department of Neuro-Oncology and Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Peter Hau
- Wilhelm Sander NeuroOncology-Unit, Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Caroline Houillier
- Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Giuseppe Lombardi
- Department of Oncology, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Sofia Asioli
- Section of Anatomic Pathology "M. Malpighi", Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, Bologna, Italy
| | - Caroline Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Franck Bielle
- Department of Neuropathology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Sorbonne Université, SIRIC Curamus, Paris, France
| | - Vincenzo Di Nunno
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | |
Collapse
|
50
|
Garcilazo-Reyes Y, Ibáñez-Juliá MJ, Hernández-Verdin I, Nguyen-Them L, Younan N, Houillier C, Hoang-Xuan K, Alentorn A. Treating central nervous system lymphoma in the era of precision medicine. Expert Review of Precision Medicine and Drug Development 2020. [DOI: 10.1080/23808993.2020.1777853] [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: 10/24/2022]
Affiliation(s)
- Ytel Garcilazo-Reyes
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Maria-José Ibáñez-Juliá
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Department of Neurology, CH Perpignan, Perpignan, France
| | | | - Ludovic Nguyen-Them
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Department of Neurology, CH Perpignan, Perpignan, France
| | - Nadia Younan
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| | - Caroline Houillier
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Réseau Expert National LOC (Lymphomes Oculo-Cérébraux), Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Khê Hoang-Xuan
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
- Réseau Expert National LOC (Lymphomes Oculo-Cérébraux), Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Agusti Alentorn
- APHP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| |
Collapse
|