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Pimentel Maldonado DA, Lisak R, Galetta S, Balcer L, Varkey T, Goodman A, Graves J, Racke M, Zamvil SS, Newsome S, Frohman EM, Frohman TC. Recurrent Optic Neuritis and Perineuritis Followed by an Unexpected Discovery. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200051. [DOI: 10.1212/nxi.0000000000200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing failed to confirm a specific diagnosis; hence, she was diagnosed with seronegative neuromyelitis optica spectrum disorder and treated with the immunotherapy rituximab, later in conjunction with mycophenolate mofetil. She achieved a durable remission for 9 years until she presented with paresthesia affecting her left fifth digit, right proximal thigh, and left foot, while also reporting a 25-pound weight loss over the prior 3 months. New imaging demonstrated a longitudinally extensive and enhancing optic nerve, in conjunction with multifocal enhancing lesions within the spinal cord, in a skip-like distribution. The differential diagnosis is discussed.
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Cózar Santiago M, Cánoves Llombart A, Sanz Llorens R, Soler López M, Escrivá Torres A, Ferrer Rebolleda J. Progresión de un linfoma folicular grado I en el sistema nervioso central. Rev Esp Med Nucl Imagen Mol 2023. [DOI: 10.1016/j.remn.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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3
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Cózar Santiago MP, Cánoves Llombart A, Sanz Llorens R, Soler López M, Escrivá Torres A, Ferrer Rebolleda J. Progression of follicular lymphoma grade I in the central nervous system. Rev Esp Med Nucl Imagen Mol 2022; 42:200-202. [PMID: 36592794 DOI: 10.1016/j.remnie.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Affiliation(s)
- M P Cózar Santiago
- Servicio de Medicina Nuclear, ASCIRES-Hospital General Universitario de Valencia, Spain.
| | - A Cánoves Llombart
- Servicio de Medicina Nuclear, ASCIRES-Hospital General Universitario de Valencia, Spain
| | - R Sanz Llorens
- Servicio de Medicina Nuclear, ASCIRES-Hospital General Universitario de Valencia, Spain
| | - M Soler López
- Servicio de Medicina Nuclear, ASCIRES-Hospital General Universitario de Valencia, Spain
| | - A Escrivá Torres
- Servicio de Medicina Nuclear, ASCIRES-Hospital General Universitario de Valencia, Spain
| | - J Ferrer Rebolleda
- Servicio de Medicina Nuclear, ASCIRES-Hospital General Universitario de Valencia, Spain
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Talybov R, Beylerli O, Mochalov V, Prokopenko A, Ilyasova T, Trofimova T, Sufianov A, Guang Y. Multiparametric MR Imaging Features of Primary CNS Lymphomas. Front Surg 2022; 9:887249. [PMID: 35510125 PMCID: PMC9058099 DOI: 10.3389/fsurg.2022.887249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Primary central nervous system lymphomas (PCNS) are relatively rare tumors, accounting for about 4% of all brain tumors. On neuroimaging, they are characterized by a low MR signal in T1, isointense in T2, bright uniform contrast enhancement, and diffusion restriction. The aim of this study is to note the lack of effectiveness of the MR/CT perfusion technique in complex multiparametric imaging in the differential diagnosis of primary lymphomas of the central nervous system in comparison with highly malignant gliomas and brain metastases. Materials and Methods This prospective study included 80 patients with CNS tumors examined/operated at the Federal Center for Neurosurgery (Tyumen, Russia) from 2018 to 2021. The patients were divided into 4 groups: group 1 consisted of 33 cases with primary CNS lymphomas (10 cases with atypical manifestations according to perfusion parameters and 23 cases of classic CNS lymphomas), group 2 with anaplastic astrocytomas—14 cases, group 3—23 cases with glioblastomas and group 4—10 cases with solitary metastatic lesions. The study was carried out on a General Electric Discovery W750 3T magnetic resonance tomograph, a Canon Aquilion One multispiral X-ray computed tomograph (Gadovist 7.5 ml, Yomeron 400 mg−50 ml). Additionally, immunohistochemical analysis was carried out with the following markers: CD3, CD20, CD34, Ki-67, VEGF. Results It has been established that MR/CT perfusion is not a highly sensitive method for visualizing primary CNS lymphomas, as previously thought, but at the same time, the method has a number of undeniable advantages that make it indispensable in the algorithm of a complex multiparametric diagnostic approach for this type of tumor. Nevertheless, PLCNS is characterized by an atypical manifestation, which is an exception to the rule. Conclusions The possibilities of neuroimaging of primary lymphomas, even with the use of improved techniques for collecting MR/CT data, are limited and do not always allow reliable differentiation from other neoplasms.
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Affiliation(s)
| | | | | | | | | | - Tatiana Trofimova
- V.M. Bekhterev Psychoneurological Research Institute, St. Petersburg, Russia
| | - Albert Sufianov
- Federal Center of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Albert Sufianov
| | - Yang Guang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
- *Correspondence: Yang Guang
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Balzano RF, Mannatrizio D, Castorani G, Perri M, Pennelli AM, Izzo R, Popolizio T, Guglielmi G. Imaging of Cerebral Microbleeds: Primary Patterns and Differential Diagnosis. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Gupta P, Ks L, Rastogi P, Malhotra P. Diagnostic utility of cerebrospinal fluid cytology and flow cytometric immunophenotyping in Burkitt lymphoma. Cytopathology 2021; 32:690-694. [PMID: 34033153 DOI: 10.1111/cyt.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lekshmon Ks
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pulkit Rastogi
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Huang S, Jin L, Yang J, Duan Y, Zhang M, Zhou C, Zhang YH. Characteristics of Central Nervous System (CNS) Involvement in Children With Non-Hodgkin's Lymphoma (NHL) and the Diagnostic Value of CSF Flow Cytometry in CNS Positive Disease. Technol Cancer Res Treat 2021; 20:15330338211016372. [PMID: 34060372 PMCID: PMC8173989 DOI: 10.1177/15330338211016372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the characteristics of central nervous system (CNS) involvement in children with non-Hodgkin's lymphoma (NHL) and the value of flow cytometry (FC) in the diagnosis of CNS disease in pediatric NHL. METHODS The data of 56 newly diagnosed pediatric NHL patients with CNS involvement (CNS+/mass, CNS+/palsy, CNS+/CSF) were analyzed. The proportions and formats of CNS disease in different pathological types were compared. In addition, FC and conventional cytology (CC) of cerebrospinal fluid (CSF) were carried out in 383 newly diagnosed NHL cases. RESULTS A total of 383 children with NHL were enrolled. Among these patients, 56 (14.6%) were diagnosed with positive CNS involvement (CNS+), 33 had bulky disease (tumor diameter >10 cm), 32 had bone marrow invasion, 32 had lactate dehydrogenase levels >1000 U/L, and 25 had invasion of more than 4 organs at the time of diagnosis. There were 14 patients with T lymphoblastic lymphoma (T-LBL), 9 with B lymphoblastic lymphoma (B-LBL), 26 with Burkitt's lymphoma (BL), and 2 with Epstein-Barr virus-positive diffuse large B cell lymphoma (EBV + DLBCL). Among the 56 CNS+ patients, 35 were CSF-positive (CSF+); there were 2 patients who were CSF+ via CC detection and 35 who were CSF+ via FC detection. The difference between CC and FC was statistically significant (P < 0.01). In the T-LBL group, 14 patients were CNS+/CSF, and in the B-LBL group, 8 were CNS+/mass. In the BL group, 22 patients were CNS+/mass and 15 were CNS+/CSF. In the anaplastic large-cell lymphoma group, 5 patients were CNS+/mass. Nine of the 56 CNS+ patients had events. The 2-year overall survival rate was 87% ± 0.046%, and the 2-year event-free survival rate was 76.2% ± 0.07%. CONCLUSION CNS+ diagnoses were more common in pediatric NHL patients with bulky disease and/or bone marrow involvement and/or involvement of more than 4 organs at the time of diagnosis, and they were also common in the EBV + DLBCL and BL groups. FC of CSF showed important clinical significance in the diagnosis of CNS disease in pediatric NHL patients, and it can be used to significantly improve the CNS+ detection rate.
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Affiliation(s)
- Shuang Huang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ling Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jing Yang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanlong Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Meng Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunju Zhou
- Pathology Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yong-Hong Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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8
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Wu Y, Sun X, Bai X, Qian J, Zhu H, Cui Q, Xing R, Chen Y, Liu Q, Lai W, Li J, Wang Y, Sun S, Ji N, Liu Y. Treatment of secondary central nervous system involvement in systemic aggressive B cell lymphoma using R-MIADD chemotherapy: a single-center study. Chin Neurosurg J 2021; 7:20. [PMID: 33795020 PMCID: PMC8017776 DOI: 10.1186/s41016-021-00238-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/06/2021] [Indexed: 12/27/2022] Open
Abstract
Background Secondary central nervous system lymphoma (SCNSL) is defined as lymphoma involvement within the central nervous system (CNS) that originated elsewhere, or a CNS relapse of systemic lymphoma. Prognosis of SCNSL is poor and the most appropriate treatment is still undetermined. Methods We conducted a retrospective study to assess the feasibility of an R-MIADD (rituximab, high-dose methotrexate, ifosfamide, cytarabine, liposomal formulation of doxorubicin, and dexamethasone) regimen for SCNSL patients. Results Nineteen patients with newly diagnosed CNS lesions were selected, with a median age of 58 (range 20 to 72) years. Out of 19 patients, 11 (57.9%) achieved complete remission (CR) and 2 (10.5%) achieved partial remission (PR); the overall response rate was 68.4%. The median progression-free survival after CNS involvement was 28.0 months (95% confidence interval 11.0–44.9), and the median overall survival after CNS involvement was 34.5 months. Treatment-related death occurred in one patient (5.3%). Conclusions These single-centered data underscore the feasibility of an R-MIADD regimen as the induction therapy of SCNSL, further investigation is warranted.
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Affiliation(s)
- Yuchen Wu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xueyan Bai
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Qian
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Zhu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qu Cui
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruixian Xing
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuedan Chen
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qing Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenyuan Lai
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junhong Li
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Abd-Elrahman I, Nassar T, Khairi N, Perlman R, Benita S, Ben Yehuda D. Novel targeted mtLivin nanoparticles treatment for disseminated diffuse large B-cell lymphoma. Oncogene 2021; 40:334-344. [PMID: 33128043 DOI: 10.1038/s41388-020-01529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022]
Abstract
We previously showed that Livin, an inhibitor of apoptosis protein, is specifically cleaved to produce a truncated protein, tLivin, and demonstrated its paradoxical proapoptotic activity. We further demonstrated that mini-tLivin (MTV), a 70 amino acids derivative of tLivin, is a proapoptotic protein as potent as tLivin. Based on these findings, in this study we aimed to develop a venue to target MTV for the treatment of diffuse large B-cell lymphoma (DLBCL). MTV was conjugated to poly (lactide-co-glycolic acid) surface-activated nanoparticles (NPs). In order to target MTV-NPs we also conjugated CD40 ligand (CD40L) to the surface of the NPs and evaluated the efficacy of the bifunctional CD40L-MTV-NPs. In vitro, CD40L-MTV-NPs elicited significant apoptosis of DLBCL cells. In a disseminated mouse model of DLBCL, 37.5% of MTV-NPs treated mice survived at the end of the experiment. Targeting MTV-NPs using CD40L greatly improved survival and 71.4% of these mice survived. CD40L-MTV-NPs also greatly reduced CNS involvement of DLBCL. Only 20% of these mice presented infiltration of lymphoma to the brain in comparison to 77% of the MTV-NPs treated mice. In a subcutaneous mouse model, CD40L-MTV-NPs significantly reduced tumor volume in correlation with significant increased caspase-3 activity. Thus, targeted MTV-NPs suggest a novel approach to overcome apoptosis resistance in cancer.
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Affiliation(s)
- Ihab Abd-Elrahman
- Department of Hematology, Hadassah Medical Organization, Jerusalem, Israel
| | - Taher Nassar
- The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noha Khairi
- Department of Hematology, Hadassah Medical Organization, Jerusalem, Israel
| | - Riki Perlman
- Department of Hematology, Hadassah Medical Organization, Jerusalem, Israel
| | - Simon Benita
- The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dina Ben Yehuda
- Department of Hematology, Hadassah Medical Organization, Jerusalem, Israel. .,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Kuitunen H, Kaprio E, Karihtala P, Makkonen V, Kauppila S, Haapasaari KM, Kuusisto M, Jantunen E, Turpeenniemi-Hujanen T, Kuittinen O. Impact of central nervous system (CNS) prophylaxis on the incidence of CNS relapse in patients with high-risk diffuse large B cell/follicular grade 3B lymphoma. Ann Hematol 2020; 99:1823-1831. [PMID: 32577843 PMCID: PMC7340636 DOI: 10.1007/s00277-020-04140-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/10/2020] [Indexed: 12/22/2022]
Abstract
Although overall survival in diffuse large B cell lymphomas (DLBCL) has improved, central nervous system (CNS) relapse is still a fatal complication of DLBCL. For this reason, CNS prophylaxis is recommended for patients at high risk of CNS disease. However, no consensus exists on definition of high-risk patient and optimal CNS prophylaxis. Systemic high-dose methotrexate in combination with R-CHOP has been suggested as a potential prophylactic method, since methotrexate penetrates the blood-brain barrier and achieves high concentration in the CNS. In this retrospective analysis, we report treatment outcome of 95 high-risk DLBCL/FL grade 3B patients treated with R-CHOP or its derivatives with (N = 57) or without (N = 38) CNS prophylaxis. At a median follow-up time (51 months), CNS relapses were detected in twelve patients (12.6%). Ten out of twelve (83%) of CNS events were confined to CNS system only. Median overall survival after CNS relapse was 9 months. Five-year isolated CNS relapse rates were 5% in the prophylaxis group and 26% in the group without prophylaxis. These findings suggest that high-dose methotrexate-containing prophylaxis decreases the risk of CNS failure.
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Affiliation(s)
- Hanne Kuitunen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Elina Kaprio
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland. .,Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
| | - Peeter Karihtala
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O. Box 100, FI-00029, Helsinki, Finland
| | - Ville Makkonen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,The North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Saila Kauppila
- Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Medical Research Center, Department of Pathology, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Kirsi-Maria Haapasaari
- Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Medical Research Center, Department of Pathology, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Milla Kuusisto
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,The North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Taina Turpeenniemi-Hujanen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland
| | - Outi Kuittinen
- Medical Research Center, Department of Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Kajaanintie 50, P.O. Box 5000, 900l4, Oulu, Finland.,Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.,Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Santambrogio E, Nicolosi M, Vassallo F, Castellino A, Novo M, Chiappella A, Vitolo U. Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence. Expert Rev Hematol 2019; 12:787-796. [DOI: 10.1080/17474086.2019.1643232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Elisa Santambrogio
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Maura Nicolosi
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Francesco Vassallo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alessia Castellino
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Mattia Novo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Annalisa Chiappella
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Umberto Vitolo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
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12
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Li JJ, Qiu BS, Chen JX, Liu DW, Xing SH, Chen HB, Zeng JS, Feng HY, Fan YH. Multiple cranial nerve deficits as preceding symptoms of systemic non-Hodgkin's lymphoma. CNS Neurosci Ther 2019; 25:409-411. [PMID: 30600649 PMCID: PMC6488885 DOI: 10.1111/cns.13097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jing-Jing Li
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bao-Shan Qiu
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Xin Chen
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Da-Wei Liu
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shi-Hui Xing
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong-Bing Chen
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jin-Sheng Zeng
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hui-Yu Feng
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Hua Fan
- Department of Neurology and Stroke Center, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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13
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Shi J, Manzo J, Zhou Y, Agovino P, Wu S. A case report of B lymphoblastic lymphoma with brain metastases: Clinical and pathological significance of head trauma misdiagnosis. Medicine (Baltimore) 2018; 97:e10695. [PMID: 29768334 PMCID: PMC5976327 DOI: 10.1097/md.0000000000010695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/18/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION B lymphoblastic lymphoma (B-LBL) is a rare type of lymphoma that originates from precursor lymphocytes. B-BLB in adults with brain metastases is extremely rare as the disease mainly affects children and adults. Therefore, such a seldom-seen case can easily trigger a dispute regarding clinical diagnosis and treatment.This paper reports the case of a 22-year-old man hospitalized for a head injury that resulted from a physical altercation. Upon admission to the hospital, the patient was diagnosed with a diffuse axonal injury (DAI). Accordingly, the patient receiving follow-up treatments, but died 30 days later. After a systematic necropsy, immunohistochemical staining, radiological consultation, and a complete review of the clinical dates, we defined the case as a brain metastasis of B lymphoblastic lymphoma. Imaging results of the intracranial lymphoma were nearly indistinguishable from DAI during the acute phase, which led to misdiagnosis and incorrect treatment for B-LBL. CONCLUSION We present this case to broaden the scope of pathologic and clinical diagnosis for intracranial tumors and to inform physicians, general neurologists, and even medical examiners with an added degree of differential awareness in dealing with the clinical materials before further diacrisis and disposal.
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Affiliation(s)
- Jian Shi
- The Third Xiangya Hospital, Central South University, Changsha, China
- Clinical and Translational Science Center, Weill Medical College, Cornell University, New York
| | - Jale Manzo
- Clinical and Translational Science Center, Weill Medical College, Cornell University, New York
| | - Yiwu Zhou
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Song Wu
- The Third Xiangya Hospital, Central South University, Changsha, China
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14
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Malikova H, Burghardtova M, Koubska E, Mandys V, Kozak T, Weichet J. Secondary central nervous system lymphoma: spectrum of morphological MRI appearances. Neuropsychiatr Dis Treat 2018; 14:733-740. [PMID: 29559780 PMCID: PMC5856045 DOI: 10.2147/ndt.s157959] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Secondary central nervous system lymphoma (SCNSL) is a rare and aggressive disease, which is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. According to previous reports, SCNSL presents mostly with leptomeningeal spread; however, our experience differs. In the present study, we demonstrate the diversity of magnetic resonance imaging (MRI) patterns in SCNSL. PATIENTS AND METHODS Initial morphological MRI findings in 21 patients (10 women and 11 men with mean age 62.3±16.2 years) with SCNSL were retrospectively evaluated. All patients suffered from neurological symptoms and underwent MRI, and all cases were histologically verified. Twelve patients were treated by corticosteroids at the time of the initial MRI. RESULTS Parenchymal lesions were present in 18 of 21 cases (85.7%), solitary meningeal infiltration was present in 1 patient (4.8%), leptomeningeal infiltration in combination with hypophyseal involvement in 1 patient (4.8%), and solitary involvement of the sixth cranial nerve (CN) was found in 1 patient (4.8%). Multiple lesions were present in 11 of 21 cases (52.4%). Diffusion restriction in all or part of the lesion was detected in 14 of 18 cases (77.8%). All parenchymal lesions had an infiltrative appearance and most enhanced homogenously (11 of 17 cases; 64.7%). A combination of parenchymal and meningeal involvement was found in 10 of 21 cases (47.6%). Infiltration of the CNs, basal ganglia, corpus callosum, and ependyma was present in 8 of 21 cases (38.1%) for each of the abovementioned structures; hypothalamic-hypophyseal axis was affected in 7 of 21 cases (33.3%). CONCLUSION In contrast to previous reports, SCNSL presented as parenchymal disease. MRI is not sufficient for differentiation between primary and secondary CNS lymphoma.
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Affiliation(s)
- Hana Malikova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Institute of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miroslava Burghardtova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Eva Koubska
- Radiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Vaclav Mandys
- Pathology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Tomas Kozak
- Hematooncology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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15
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Zheng M, Perry AM, Bierman P, Loberiza F, Nasr MR, Szwajcer D, Del Bigio MR, Smith LM, Zhang W, Greiner TC. Frequency of MYD88 and CD79B mutations, and MGMT methylation in primary central nervous system diffuse large B-cell lymphoma. Neuropathology 2017; 37:509-516. [PMID: 28856744 DOI: 10.1111/neup.12405] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022]
Abstract
Primary CNS diffuse large B-cell lymphoma (PCNS-DLBCL) and systemic DLBCL harbor mutations in MYD88 and CD79B. DNA methyltransferase (MGMT) is methylated in some DLBCL. Our goal was to investigate the frequencies of these events, which have not been previously reported within the same series of patients with PCNS-DLBCL. Fifty-four cases of PCNS-DLBCL from two institutions were analyzed by Sanger sequencing for MYD88 and CD79B, and pyrosequencing for MGMT. MYD88 mutations were identified in 68.8% (35 of 51 cases), with L265P being the most frequent mutation. Mutations other than L265P were identified in 21.6% of cases, of which eight novel MYD88 mutations were identified. Of mutated cases, 17.6% had homozygous/hemizygous MYD88 mutations, which has not been previously reported in PCNS-DLBCL. CD79B mutations were found in six of 19 cases (31.6%), all in the Y196 mutation hotspot. MGMT methylation was observed in 37% (20 of 54 cases). There was no significant difference in median overall survival (OS) between the wild type and mutated MYD88 cases, or between methylated and unmethylated MGMT cases. However, a significant difference (P = 0.028) was noted in median OS between the wild type and mutated CD79B cases.
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Affiliation(s)
- Mei Zheng
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anamarija M Perry
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip Bierman
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Fausto Loberiza
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michel R Nasr
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Szwajcer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marc R Del Bigio
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Weiwei Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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16
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Pham C, Griffiths JD, Kam A, Hunn MK. Bing-Neel syndrome - Bilateral cavernous sinus lymphoma causing visual failure. J Clin Neurosci 2017; 45:134-135. [PMID: 28765059 DOI: 10.1016/j.jocn.2017.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/23/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Abstract
We report the case of a 68-year-old male with right eye vision loss secondary to a compressive optic neuropathy from Waldenstrom macroglobulinaemia relapse in both cavernous sinuses. Central nervous system involvement is extremely uncommon in lymphoplasmacytic lymphoma. Known as Bing-Neel syndrome, this has not been previously reported to present simultaneously in bilateral cavernous sinuses. We discuss the pathophysiology, diagnostic and neuroradiological features of Bing-Neel syndrome. In this case, there was marked clinical and radiological response to chemotherapy. As outcomes following treatment for Waldenstrom macroglobulinaemia improve, greater awareness of its less common manifestations becomes important. Neurosurgical intervention may be indicated to obtain histological diagnosis or decompress critical structures.
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Affiliation(s)
- Chengde Pham
- Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - James D Griffiths
- Melbourne Haematology, Epworth Medical Centre, Suite 1.6, 173 Lennox St, Richmond, Victoria 3121, Australia.
| | - Anthony Kam
- Department of Radiology, Level 1, Phillip Block, The Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Martin K Hunn
- Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
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17
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Abstract
Primary central nervous system lymphoma (PCNSL) is a rare aggressive high-grade type of extranodal lymphoma. PCNSL can have a variable imaging appearance and can mimic other brain disorders such as encephalitis, demyelination, and stroke. In addition to PCNSL, the CNS can be secondarily involved by systemic lymphoma. Computed tomography and conventional MRI are the initial imaging modalities to evaluate these lesions. Recently, however, advanced MRI techniques are more often used in an effort to narrow the differential diagnosis and potentially inform diagnostic and therapeutic decisions.
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18
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Peñalver FJ, Sancho JM, de la Fuente A, Olave MT, Martín A, Panizo C, Pérez E, Salar A, Orfao A. Guidelines for diagnosis, prevention and management of central nervous system involvement in diffuse large B-cell lymphoma patients by the Spanish Lymphoma Group (GELTAMO). Haematologica 2016; 102:235-245. [PMID: 27846613 DOI: 10.3324/haematol.2016.149120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/07/2016] [Indexed: 02/01/2023] Open
Abstract
Diffuse large B-cell lymphoma patients have a 5% overall risk of central nervous system events (relapse or progression), which account for high morbidity and frequently fatal outcomes,1 and shortened overall survival of <6 months.2 Early diagnosis of central nervous system events is critical for successful treatment and improved prognosis. Identification of patients at risk of central nervous system disease is critical to accurately identify candidates for central nervous system prophylaxis vs. THERAPY 3-5 This report by the Spanish Lymphoma Group (GELTAMO) aims to provide useful guidelines and recommendations for the prevention, diagnosis, and treatment of central nervous system diffuse large B-cell lymphoma patients with, or at risk of, leptomeningeal and/or brain parenchyma lymphoma relapse. A panel of lymphoma experts working on behalf of GELTAMO reviewed all data published on these topics available in PubMed up to May 2016. Recommendations were classified according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach.6 A practical algorithm based on the proposed recommendations was then developed (Figure 1). Initial discussions among experts were held in May 2014, and final consensus was reached in June 2016. The final manuscript was reviewed by all authors and the Scientific Committee of GELTAMO.
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Affiliation(s)
| | - Juan-Manuel Sancho
- Clinical Hematology Department, ICO-IJC Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - María-Teresa Olave
- Department of Hematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Universitario de Salamanca, Department of Medicine, Cytometry Service (NUCLEUS) and Cancer Research Center (IBMCC-USAL-CSIC) and IBSAL, University of Salamanca, Pamplona, Spain
| | - Carlos Panizo
- Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Elena Pérez
- Department of Hematology, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Antonio Salar
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Alberto Orfao
- Department of Hematology, Hospital Universitario de Salamanca, Department of Medicine, Cytometry Service (NUCLEUS) and Cancer Research Center (IBMCC-USAL-CSIC) and IBSAL, University of Salamanca, Pamplona, Spain
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19
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Zahid MF, Khan N, Hashmi SK, Kizilbash SH, Barta SK. Central nervous system prophylaxis in diffuse large B-cell lymphoma. Eur J Haematol 2016; 97:108-20. [PMID: 27096423 DOI: 10.1111/ejh.12763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/20/2022]
Abstract
Central nervous system (CNS) involvement with diffuse large B-cell lymphoma (DLBCL) is a relatively uncommon manifestation; with most cases of CNS involvement occuring during relapse after primary therapy. CNS dissemination typically occurs early in the disease course and is most likely present subclinically at the time of diagnosis in many patients who later relapse in the CNS. CNS relapse in these patients is associated with poor outcomes. Based on a CNS relapse rate of 5% in DLBCL and weighing the benefits against the toxicities, universal application of CNS prophylaxis is not justified. The introduction of rituximab has significantly reduced the incidence of CNS relapse in DLBCL. Different studies have employed other agents for CNS prophylaxis, such as intrathecal chemotherapy and high-dose systemic agents with sufficient CNS penetration. If CNS prophylaxis is to be given, it should be preferably administered during primary chemotherapy. However, there is no strong evidence that supports any single approach for CNS prophylaxis. In this review, we outline different strategies of administering CNS prophylaxis in DLBCL patients reported in literature and discuss their advantages and drawbacks.
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Affiliation(s)
| | - Nadia Khan
- Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shahrukh K Hashmi
- Blood and Marrow Transplant Program, Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN, USA
| | | | - Stefan K Barta
- Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.,Temple Bone Marrow Transplantation Program, Temple University Health System, Philadelphia, PA, USA
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20
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González-Barca E, Canales M, Salar A, Ferreiro-Martínez JJ, Ferrer-Bordes S, García-Marco JA, Sánchez-Blanco JJ, García-Frade J, Peñalver J, Bello-López JL, Sancho JM, Caballero D. Central nervous system prophylaxis with intrathecal liposomal cytarabine in a subset of high-risk patients with diffuse large B-cell lymphoma receiving first line systemic therapy in a prospective trial. Ann Hematol 2016; 95:893-9. [PMID: 27025508 PMCID: PMC4853453 DOI: 10.1007/s00277-016-2648-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/17/2016] [Indexed: 10/26/2022]
Abstract
The dissemination in the central nervous system (CNS) is an uncommon but fatal complication occurring in patients with diffuse large B-cell lymphoma (DLBCL). Standard prophylaxis has been demonstrated to reduce CNS relapse and improve survival rates. Intrathecal (IT) liposomal cytarabine allows maintaining elevated drug levels in the cerebrospinal fluid for an extended period of time. Data on the efficacy and safety of liposomal cytarabine as CNS prophylaxis in patients with DLBCL are still insufficient. The objective of the present study was to evaluate the effectiveness and safety of the prophylaxis with IT liposomal cytarabine in prevention of CNS relapse in high-risk patients with DLBCL who were included in a trial of first line systemic therapy with 6 cycles of dose-dense R-CHOP every 14 days. Twenty-four (18.6 %) out of 129 patients were identified to have risk factors for CNS involvement, defined as follows: >30 % bone marrow infiltration, testes infiltration, retroperitoneal mass ≥10 cm, Waldeyer ring, or bulky cervical nodes involvement. Liposomal cytarabine (50 mg) was administered by lumbar puncture the first day of the 1st, 2nd, and 6th cycle of R-CHOP14 scheme. Among 70 IT infusions, grade 3-4 adverse events reported were headache (one patient) and nausea/vomiting (one patient). With a median follow-up of 40.1 months, no CNS involvement by DLBCL was observed in any patient. In conclusion, IT liposomal cytarabine is safe, feasible, and effective for CNS prophylaxis, causing few associated risks and little discomfort to patients with DLBCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Follow-Up Studies
- Humans
- Injections, Spinal
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Middle Aged
- Post-Exposure Prophylaxis/methods
- Prednisone/administration & dosage
- Prospective Studies
- Risk Factors
- Rituximab
- Survival Rate
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
- E González-Barca
- Institut Català d'Oncologia. IDIBELL., Hospital Duran i Reynals, Av. Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - M Canales
- Hospital Universitario La Paz, Madrid, Spain
| | - A Salar
- Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | - J Peñalver
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - J L Bello-López
- Complexo Hospitalario de Santiago, Santiago de Compostela, Spain
| | - J M Sancho
- Institut Català d'Oncologia - Hospital Germans Trias i Pujol, Badalona, Spain
| | - D Caballero
- Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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21
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Maciocia P, Badat M, Cheesman S, D'Sa S, Joshi R, Lambert J, Mohamedbhai S, Pule M, Linch D, Ardeshna K. Treatment of diffuse large B-cell lymphoma with secondary central nervous system involvement: encouraging efficacy using CNS-penetrating R-IDARAM chemotherapy. Br J Haematol 2016; 172:545-53. [PMID: 26684148 DOI: 10.1111/bjh.13867] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022]
Abstract
Diffuse large B-cell lymphoma with secondary involvement of the central nervous system (SCNS-DLBCL) is a rare condition carrying a poor prognosis. No optimal therapeutic regimen has been identified. We retrospectively analysed 23 patients with SCNS-DLBCL treated with R-IDARAM (rituximab 375 mg/m(2) IV day 1; methotrexate 12·5 mg by intrathecal injection day 1; idarubicin 10 mg/m(2) /day IV days 1 and 2; dexamethasone 100 mg/day IV infusion over 12 h days 1-3; cytosine arabinoside 1000 mg/m(2) /day IV over 1 h days 1 and 2; and methotrexate 2000 mg/m(2) IV over 2 h day 3. Ten out of 23 (44%) patients had CNS involvement at initial presentation ('new disease'), 10/23 (44%) had relapsed disease and 3/23 (13%) had primary refractory disease. 14/23 (61%) of patients responded - 6 (26%) complete response, 8 (35%) partial response. Grade 3-4 haematological toxicity was seen in all cycles, with no grade 3-4 or long-term neurological toxicity. Median follow-up for surviving patients was 49 months. At 2 years, estimated progression-free survival (PFS) was 39% and overall survival (OS) was 52%. Encouraging outcomes were reported in patients with new disease, with 5-year estimated PFS of 50% and OS 75%. R-IDARAM is a well-tolerated regimen with encouraging efficacy in patients with SCNS-DLBCL, although patients with relapsed or refractory disease continue to fare poorly.
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Affiliation(s)
- Paul Maciocia
- Cancer Institute, Department of Haematology, University College London, London, UK
| | - Mohsin Badat
- Department of Haematology, Royal London Hospital, London, UK
| | - Simon Cheesman
- Department of Pharmacy, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Rahul Joshi
- Department of Haematology, University College London Hospital, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London Hospital, London, UK
| | - Sajir Mohamedbhai
- Cancer Institute, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospital, London, UK
| | - Martin Pule
- Cancer Institute, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospital, London, UK
| | - David Linch
- Cancer Institute, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospital, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospital, London, UK
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22
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Kim YJ, Kim HK, Yang DH, Jung S, Noh MG, Lee JH, Lee KH, Moon KS. Pineal Diffuse Large B-Cell Lymphoma Concomitant With Pituitary Prolactinoma: Possible Correlation Between 2 Distinguished Pathologies: A Case Report. Medicine (Baltimore) 2016; 95:e2923. [PMID: 26937937 PMCID: PMC4779034 DOI: 10.1097/md.0000000000002923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This is the first reported case of pineal lymphoma with concomitant prolactin-producing pituitary adenoma.A 51-year-old male experienced worsening headaches accompanied by nausea, diplopia, and memory loss for 1 month. Cranial nerve examination revealed bilateral upward gaze limitation with convergence impairment, which is known as Parinaud syndrome. Magnetic resonance images revealed a mass in the pineal gland with a coexisting mass within the enlarged sella fossa. Hormone analysis revealed hyperprolactinemia. The pineal mass was removed without injuring the hypothalamus, brain stem, or any neighboring vessels. Pathology examination confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) involving the pineal gland. After further studies, the pineal lymphoma was determined to be a secondary tumor from a gastric primary tumor. The patient died 6 months after diagnosis due to systemic progression of DLBCL.Although the mechanistic link between hyperprolactinemia and lymphoma progression has not been clarified on a clinical basis, high prolactin levels may contribute to the rapid progression and therapeutic resistance of the lymphoma.
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Affiliation(s)
- Yeong-Jin Kim
- From the Department of Neurosurgery (Y-JK, SJ, K-SM); Department of Internal Medicine (HKK, D-HY); and Departments of Pathology, Chonnam National University Research Institute of Medical Sciences (M-GN, J-HL, K-HL), Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Jeollanamdo, South Korea
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23
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Law MF, Chan HN, Lai HK, Ha CY, Ng C, Yeung YM, Yip SF. Effects of addition of rituximab to chemotherapy on central nervous system events in patients with diffuse large B-cell lymphoma. Mol Clin Oncol 2015; 3:747-752. [PMID: 26171174 DOI: 10.3892/mco.2015.546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 01/17/2023] Open
Abstract
The aim of this study was to evaluate whether the addition of rituximab to chemotherapy reduces central nervous system (CNS) events and to identify the risk factors associated with CNS involvement. Patients who were diagnosed with diffuse large B-cell lymphoma (DLBCL) between January, 1995 and December, 2012, without prior CNS disease, were recruited in this study. The patients received chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) or CHOP with rituximab (R-CHOP), with curative intent. The incidence rate of subsequent CNS events was compared between the two groups. A total of 110 patients were recruited, 45 (41%) of whom received CHOP and 65 (59%) R-CHOP. A total of 12 patients (10.9%) subsequently exhibited CNS involvement. The median time from the initial DLBCL diagnosis to CNS disease was 6.7 months (range, 1.3-23.8 months). The CNS disease rate was 15.5% (7/45) in the CHOP group vs. 7.6% (5/65) in the R-CHOP group. The projected 3-year CNS disease rate was 18% in the CHOP group vs. 9% in the R-CHOP group (P=0.15). The survival of patients with CNS disease was poor, with a median survival of 5.8 months. On multivariate analysis using the Cox proportional model, stage IV disease remained an independent predictor of CNS disease (hazard ratio = 7.75, 95% confidence interval: 1.67-35.92, P=0.009). In conclusion, the addition of rituximab to chemotherapy did not appear to reduce the risk of CNS events in our study. Other effective prophylactic measures are required to reduce the incidence of CNS events. High-dose intravenous methotrexate crosses the blood-brain barrier and may be used as CNS prophylaxis in high-risk patients.
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Affiliation(s)
- Man Fai Law
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China ; Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR 999077, P.R. China
| | - Hay Nun Chan
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
| | - Ho Kei Lai
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
| | - Chung Yin Ha
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
| | - Celia Ng
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
| | - Yiu Ming Yeung
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
| | - Sze Fai Yip
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
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24
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Ghose A, Elias HK, Guha G, Yellu M, Kundu R, Latif T. Influence of Rituximab on Central Nervous System Relapse in Diffuse Large B-Cell Lymphoma and Role of Prophylaxis--A Systematic Review of Prospective Studies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:451-7. [PMID: 25816933 DOI: 10.1016/j.clml.2015.02.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/26/2015] [Indexed: 12/22/2022]
Abstract
Despite the improvement in overall survival in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era, the occurrence of central nervous system (CNS) relapse heralds a very poor prognosis. The evidence is conflicting on the incidence and pattern of CNS relapse in the rituximab era compared with before the rituximab era and on the role of CNS prophylaxis. We conducted a systematic analysis of the data from 7 prospective studies, studying the incidence and type of CNS relapse, the role of prophylaxis, and survival after CNS relapse, with and without rituximab-based chemotherapy. No statistically significant difference was found in the incidence of CNS relapse with the use of rituximab-based chemotherapy compared with CHOP (cyclophosphamide, doxorubicin, vincristine [Oncovin], prednisone) chemotherapy. Leptomeningeal disease was more common and the survival after CNS disease was better in the rituximab era. No difference was found in the incidence of isolated CNS relapse. Chemoprophylaxis significantly decreased the incidence of CNS recurrence. The use of rituximab has not influenced the incidence of CNS relapse compared with the use of CHOP. Chemoprophylaxis plays a significant role in high-risk patients with DLBCL in decreasing CNS recurrence. Large randomized clinical trials are warranted to differentiate between intrathecal and systemic chemoprophylaxis.
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Affiliation(s)
- Abhimanyu Ghose
- Division of Hematology Oncology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | | | - Gunjan Guha
- School of Chemical and Biotechnology, Shanmugha Arts, Science, Technology and Research Academy University, Thanjavur, India
| | - Mahender Yellu
- Division of Hematology Oncology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ria Kundu
- Good Samaritan Hospital, Cincinnati, OH
| | - Tahir Latif
- Division of Hematology Oncology, University of Cincinnati College of Medicine, Cincinnati, OH
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25
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Ghose A, Kundu R, Latif T. Prophylactic CNS directed therapy in systemic diffuse large B cell lymphoma. Crit Rev Oncol Hematol 2014; 91:292-303. [DOI: 10.1016/j.critrevonc.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 12/22/2022] Open
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26
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Liu L, Cao F, Wang S, Zhou J, Yang G, Wang C. Detection of malignant B lymphocytes by PCR clonality assay using direct lysis of cerebrospinal fluid and low volume specimens. Int J Lab Hematol 2014; 37:165-73. [PMID: 24815498 DOI: 10.1111/ijlh.12255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The diagnosis of lymphoid malignancies is often challenging in paucicellular specimens. PCR may also be limited by insufficient cells for DNA isolation and incomplete coverage of gene rearrangements. This study aims to evaluate a PCR method for IgH clonality using direct cell lysates. METHODS PCR amplification used cell lysate from detergent-based lysis and BIOMED-2 primers. CSF specimens were tested for 20 patients with primary CNS lymphoma or systemic lymphoma suspected for CNS involvement. Cytology and flow cytometry analysis was performed in parallel with PCR. RESULTS Direct lysis produced a better yield than the column-based method for DNA isolation. PCR using lysate showed an efficiency of clonality detection from a minimum of 20 tumor cells. PCR clonality was found in nine of the 20 CSFs, and positive PCR was concordant with both cytology and flow cytometry in seven cases. There were two cases positive for PCR, but indeterminate for flow cytometry because of insufficient cell events. Of the eleven PCR-negative cases, two were considered as false negative, as flow cytometry showed positive for malignant cells. The PCR was also performed successfully with a specimen from the anterior chamber of the eye. CONCLUSION PCR clonality with direct cell lysis of CSF is feasible, and it may overcome the limitation of DNA isolation. This PCR method may be particularly useful for small volume and low cell CSF when flow cytometry is inconclusive.
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Affiliation(s)
- L Liu
- Department of Hematology, The First Hospital of Harbin Medical University, Harbin, China
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Qin B, Dong L, Guo X, Jiang J, He Y, Wang X, Li L, Zhao J. Expression of G protein-coupled estrogen receptor in irritable bowel syndrome and its clinical significance. Asian Pac J Cancer Prev 2014; 15:4733-8. [PMID: 24966932 DOI: 10.7314/apjcp.2014.15.11.4733] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Estrogen is suggested to participate in pathogenesis of irritable bowel syndrome (IBS), but expression of G protein-coupled estrogen receptor (GPER) in the colon of IBS patients has never been investigated. The aim of this study was to investigate the expression of GPER and classical estrogen receptors in the colon of IBS patients and healthy controls. METHODS Colonic biopsies were obtained by endoscopy from patients with IBS (n=46) and healthy subjects (n=13). Expression of GPER, estrogen receptor α (ERα) and estrogen receptor β (ERβ) in mast cells were measured by double-labelling immunofluorescence. Quantification of mRNA expression was performed for GPER, ERα and ERβ by real-time polymerase chain reaction. RESULTS Differential distribution of GPER, ERα and ERβ were detected in human colonic mucosa. The expression of GPER in the cytoplasm of mast cells and GPER-positive cells was significantly higher in diarrhea-predominant IBS (D-IBS) patients than that in constipation-predominant IBS (C-IBS, P<0.001) patients and healthy subjects (P=0.005). ERα and ERβ were not detected in majority of mast cells in colonic mucosa and no difference of immunostaining results for ERα and ERβ was found among these three groups. A positive correlation (r=0.451, P=0.011) between GPER-positive cell counts and abdominal pain severity was observed in D-IBS group. Relative mRNA expression of GPER in D-IBS was also higher than that in C-IBS (P=0.018) and healthy subjects (P=0.011). CONCLUSIONS The present study, for the first time, demonstrated the expression of GPER in human colonic mucosa and its correlation with abdominal pain severity.
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Affiliation(s)
- Bin Qin
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Lei Dong
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Xiaoyan Guo
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Jiong Jiang
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Yangxin He
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Xiaoyan Wang
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Lu Li
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Juhui Zhao
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
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Kose D, Paksoy Y, Koksal Y, Unal E. Neurological complication of non Hodgkin lymphoma in childhood: experience from a single center in Turkey. Childs Nerv Syst 2014; 30:639-45. [PMID: 23989474 DOI: 10.1007/s00381-013-2267-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Lymphomas are the third most common childhood malignant disease after leukemia and central nervous system (CNS) tumors. Early diagnosis of these complications will reduce mortality and morbidity. In this study we aimed to review the neurological complications of childhood non Hodgkin Lymphoma (NHL). PATIENTS AND METHODS Forty four children with NHL between 2006 and 2012 were investigated retrospectively and 14 cases with neurological complications were identified. RESULTS The most common symptom was alteration of the consciousness (10 patients, 71.4 %) followed by convulsion (5 patients, 35.7 %), and hallucination (4 patients, 28.5 %); headache, eye pain, neurogenic bladder, speech disability and facial paralysis, and hemiplegia, were less common and each of them was seen in 1 (7.1 %) of the patients. The neurological complications were mostly seen in children with precursor T lymphoblastic lymphoma followed by anaplastic large cell lymphoma. The complications were secondary to medications (Eight patients) infection (two patients); CNS relapse (two patients); or CNS involvement of the primary disease (two patients). Chemotherapy-related neurologic complications were secondary to intrathecal methotrexate, L-asparaginase, vincristine, and ifosfamide CONCLUSION Advanced disease and PTLL subtype can be suggested as predictors of neurological complication. The survival rates of neurological complications are fairly good unless it is secondary to involvement of the primary disease. In patients with drug-induced neurological complications, the treatment can be safely re-administered after controlling the neurological complications. Therefore, clinicians managing children with NHL must be informative about neurological complications.
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Affiliation(s)
- Dogan Kose
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Selçuk University, Konya, Turkey,
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Kellogg RG, Straus DC, Karmali R, Munoz LF, Byrne RW. Impact of therapeutic regimen and clinical presentation on overall survival in CNS lymphoma. Acta Neurochir (Wien) 2014; 156:355-65. [PMID: 24078063 DOI: 10.1007/s00701-013-1878-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/05/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The authors present a retrospective analysis of 45 patients who underwent treatment of CNS lymphoma (both primary and secondary) at a single institution between 2005 and 2012. METHODS This study involves 21 female and 24 male patients with a mean age of 59.2 years. All medical records and pathology reports were reviewed for each patient. Univariate and multivariate analyses of overall survival were performed. RESULTS Presentation with altered mental status was a significant risk factor for worse overall survival. An HIV infection, deep lesion location, and age over 60 did not impact survival. A survival benefit was demonstrated with the use of systemic therapy, specifically rituximab, and radiation. The CNS Lymphoma Score was derived from this cohort, which proved a powerful predictive tool for overall survival. The surgical complication rate in this series was 17.8 %. CONCLUSIONS This study highlights the prognostic importance of presenting mental status on outcomes in CNS lymphoma and demonstrates a summative benefit of rituximab and whole brain radiation therapy. Considering these factors together provides an easily applicable and meaningful stratification for this patient population. The surgical complication rate in this patient population is not negligible. The high percentage of wound-related surgical complications suggests the need for a waiting period between surgery and initiation of chemotherapy to allow for wound healing.
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Benevolo G, Chiappella A, Vitolo U. The risk of CNS involvement in aggressive lymphomas in the rituximab era. Expert Rev Hematol 2013; 6:643-52. [PMID: 24168678 DOI: 10.1586/17474086.2013.850896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The risk of CNS dissemination and CNS prophylaxis strategies in aggressive non-Hodgkin lymphoma (NHL) is still debated. CNS dissemination is a rare but fatal event. A CNS prophylaxis is common for Burkitt and B-cell lymphoblastic lymphoma; however, in other NHLs, prophylactic treatments are not systematically warranted. Current risk models showed low sensitivity in predicting CNS involvement, implying overtreatment in roughly 70% of high-risk patients. Risk models in the rituximab era were modulated for the detection of occult CNS disease at diagnosis using flow cytometry. The optimal regimen for CNS prophylaxis in aggressive lymphoma patients has not been established thus far and should be modulated at different levels of 'intensity' such as standard intrathecal chemotherapy, 'active' intrathecal chemotherapy with liposomal cytarabine or more aggressive systemic treatment with high doses of drugs having good CNS bioavailability reserved for patients who are truly at high risk of CNS dissemination.
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Affiliation(s)
- Giulia Benevolo
- Hematology, Città della Salute e della Scienza Hospital, Corso Bramante 88 10126, Torino, Italy
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The incidence of secondary central nervous system involvement in patients with non-Hodgkin's lymphoma as detected by 18F-FDG PET/CT. Nucl Med Commun 2013; 34:50-6. [PMID: 23111376 DOI: 10.1097/mnm.0b013e32835aaa48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Secondary central nervous system (CNS) involvement is a devastating and usually fatal complication of non-Hodgkin's lymphoma (NHL). We aimed to evaluate the incidence of secondary CNS involvement and the value of (18)F-FDG PET/computed tomography (CT) imaging in the detection of secondary CNS involvement in patients with NHL. METHODS A total of 123 immunocompetent patients (58 men, 65 women; mean age: 56.5±19.2) with biopsy-proven NHL who underwent (18)F-FDG PET/CT for primary staging (n=68) and restaging (n=55) of recurrent disease were reviewed retrospectively. Those with secondary CNS involvement as diagnosed on PET/CT were identified. CNS involvement was confirmed by MRI and cerebrospinal fluid cytology. RESULTS The clinical Ann Arbor stages of the patient population were as follows: stage I - 10 patients; stage II - 44 patients; stage III - 32 patients, and stage IV - 37 patients. PET/CT detected CNS involvement in six patients. The ages of patients with CNS disease ranged from 23 to 68 (mean: 47.2) years. Three patients presented with CNS involvement associated with systemic disease manifestation at initial diagnosis; one patient had isolated CNS relapse and two had relapsed systemic NHL with progression to CNS involvement. Relapse interval was 8-12 months following initial diagnosis. The types of CNS involvement in patients were as follows: parenchymal (n=2), leptomeningeal (n=2), both parenchymal and leptomeningeal (n=1), and pituitary gland involvement (n=1), which is an uncommon manifestation. Median duration of survival was 2.5 months after the diagnosis of CNS involvement. CONCLUSION The incidence of secondary CNS involvement was 4.4% at initial diagnosis and 5.4% among patients with relapse of lymphoma in our study. PET/CT is a sensitive, objective, and valuable method for the diagnosis of secondary CNS involvement in patients with NHL. In addition, pituitary gland involvement, as a very rare manifestation of secondary CNS lymphoma, has been shown.
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Benevolo G, Chiappella A, Vitolo U. XVI. CNS prophylaxis in aggressive lymphomas: for whom and how. Hematol Oncol 2013; 31 Suppl 1:89-91. [DOI: 10.1002/hon.2074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Giulia Benevolo
- Hematology 2; Città della Salute e della Scienza Hospital; Turin; Italy
| | | | - Umberto Vitolo
- Hematology 2; Città della Salute e della Scienza Hospital; Turin; Italy
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Korfel A, Elter T, Thiel E, Hänel M, Möhle R, Schroers R, Reiser M, Dreyling M, Eucker J, Scholz C, Metzner B, Röth A, Birkmann J, Schlegel U, Martus P, Illerhaus G, Fischer L. Phase II study of central nervous system (CNS)-directed chemotherapy including high-dose chemotherapy with autologous stem cell transplantation for CNS relapse of aggressive lymphomas. Haematologica 2012; 98:364-70. [PMID: 23242601 DOI: 10.3324/haematol.2012.077917] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The prognosis of patients with central nervous system relapse of aggressive lymphoma is very poor with no therapy established so far. In a prospective multicenter phase II study, we evaluated a potentially curative chemotherapy-only regimen in these patients. Adult immunocompetent patients 65 years of age or under received induction chemotherapy with MTX/IFO/DEP (methotrexate 4 g/m(2) intravenously (i.v.) Day 1, ifosfamide 2 g/m(2) i.v. Days 3- 5 and liposomal cytarabine 50 mg intrathecally (i.th) Day 6) and AraC/TT/DEP (cytarabine 3g/m(2) i.v. Days 1-2, thiotepa 40 mg/m(2) i.v. Day 2 and i.th. liposomal cytarabine 50 mg i.th. Day 3) followed by high-dose chemotherapy with carmustine 400 mg/m(2) i.v. Day -5, thiotepa 2×5 mg/kg i.v. Days -4 to -3 and etoposide 150 mg/m(2) i.v. Days -5 to -3, and autologous stem cell transplantation Day 0 (HD-ASCT). Thirty eligible patients (median age 58 years) were enrolled. After HD-ASCT (n=24), there was a complete remission in 15 (63%), partial remission in 2 (8%) and progressive disease in 7 (29%) patients. Myelotoxicity was the most adverse event with CTC grade 3/4 infections in 12% of MTX/IFO/DEP courses, 21% of AraC/TT/DEP courses and 46% of HD-ASCT courses. The 2-year time to treatment failure was 49%±19 for all patients and 58%±22 for patients completing HD-ASCT. The protocol assessed proved feasible and highly active with long-lasting remissions in a large proportion of patients. (ClinicalTrials.govIdentifier NCT01148173).
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Affiliation(s)
- Agnieszka Korfel
- Department of Hematology and Oncology, Charite Universitätsmedizin Berlin, Germany.
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Final results of a multicenter trial addressing role of CSF flow cytometric analysis in NHL patients at high risk for CNS dissemination. Blood 2012; 120:3222-8. [DOI: 10.1182/blood-2012-04-423095] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AbstractThis prospective study compared diagnostic and prognostic value of conventional cytologic (CC) examination and flow cytometry (FCM) of baseline samples of cerebrospinal fluid (CSF) in 174 patients with newly diagnosed aggressive non-Hodgkin lymphoma (NHL). FCM detected a neoplastic population in the CSF of 18 of 174 patients (10%), CC only in 7 (4%; P < .001); 11 patients (14%) were discordant (FCM+/CC−). At a median follow-up of 46 months, there were 64 systemic progressions and 10 CNS relapses, including 2 patients with both systemic and CNS relapses. Two-year progression-free and overall survival were significantly higher in patients with FCM− CSF (62% and 72%) compared with those FCM+ CSF (39% and 50%, respectively), with a 2-year CNS relapse cumulative incidence of 3% (95% confidence interval [CI], 0-7) versus 17% (95% CI, 0-34; P = .004), respectively. The risk of CNS progression was significantly higher in FMC+/CC− versus FCM−/CC− patients (hazard ratio = 8.16, 95% CI, 1.45-46). In conclusion, FCM positivity in the CSF of patients with high-risk NHL is associated with a significantly higher CNS relapse risk and poorer outcome. The combination of IV drugs with a higher CNS bioavailability and intrathecal chemotherapy is advisable to prevent CNS relapses in FCM+ patients.
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van Dongen JJM, Lhermitte L, Böttcher S, Almeida J, van der Velden VHJ, Flores-Montero J, Rawstron A, Asnafi V, Lécrevisse Q, Lucio P, Mejstrikova E, Szczepański T, Kalina T, de Tute R, Brüggemann M, Sedek L, Cullen M, Langerak AW, Mendonça A, Macintyre E, Martin-Ayuso M, Hrusak O, Vidriales MB, Orfao A. EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukemia 2012; 26:1908-75. [PMID: 22552007 PMCID: PMC3437410 DOI: 10.1038/leu.2012.120] [Citation(s) in RCA: 654] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 02/14/2012] [Accepted: 04/19/2012] [Indexed: 12/21/2022]
Abstract
Most consensus leukemia & lymphoma antibody panels consist of lists of markers based on expert opinions, but they have not been validated. Here we present the validated EuroFlow 8-color antibody panels for immunophenotyping of hematological malignancies. The single-tube screening panels and multi-tube classification panels fit into the EuroFlow diagnostic algorithm with entries defined by clinical and laboratory parameters. The panels were constructed in 2-7 sequential design-evaluation-redesign rounds, using novel Infinicyt software tools for multivariate data analysis. Two groups of markers are combined in each 8-color tube: (i) backbone markers to identify distinct cell populations in a sample, and (ii) markers for characterization of specific cell populations. In multi-tube panels, the backbone markers were optimally placed at the same fluorochrome position in every tube, to provide identical multidimensional localization of the target cell population(s). The characterization markers were positioned according to the diagnostic utility of the combined markers. Each proposed antibody combination was tested against reference databases of normal and malignant cells from healthy subjects and WHO-based disease entities, respectively. The EuroFlow studies resulted in validated and flexible 8-color antibody panels for multidimensional identification and characterization of normal and aberrant cells, optimally suited for immunophenotypic screening and classification of hematological malignancies.
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Affiliation(s)
- J J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Rotterdam, The Netherlands.
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Armitage JO. My treatment approach to patients with diffuse large B-cell lymphoma. Mayo Clin Proc 2012; 87:161-71. [PMID: 22305028 PMCID: PMC3497705 DOI: 10.1016/j.mayocp.2011.11.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 11/10/2011] [Indexed: 11/28/2022]
Abstract
My favored treatment approach for patients with diffuse large B-cell lymphoma continues to evolve. Diffuse large B-cell lymphoma can now be cured in more than 50% of patients. This is a result of improved definitions of the disease, improved diagnostic capabilities, better staging and restaging techniques, a useful prognostic index to guide therapeutic decisions, and the development of increasingly effective therapies. Positron emission tomographic scans have improved the accuracy of both staging and restaging. Findings on a positron emission tomographic scan at the end of therapy are the best predictors of a good treatment outcome. Numerous subtypes of diffuse large B-cell lymphoma have been identified that require specific treatment approaches. For example, plasmablastic lymphoma typically lacks CD20 and does not benefit from treatment with rituximab. Diffuse large B-cell lymphoma originating in specific extranodal sites such as the central nervous system, testes, and skin presents special problems and requires specific treatment approaches. A subgroup of diffuse large B-cell lymphoma with a very high proliferative rate seems to have a poor outcome when treated with CHOP-R and does better with regimens used for patients with Burkitt lymphoma. New insights into the biology of these disorders are likely to further change treatment approaches. Recognition that diffuse large B-cell lymphoma is not one disease, but a variety of clinicopathologic syndromes provides the opportunity to further improve our ability to benefit patients.
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MESH Headings
- Adult
- Aged
- Algorithms
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Central Nervous System Neoplasms/diagnosis
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/radiotherapy
- Central Nervous System Neoplasms/therapy
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/therapeutic use
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Neoplasm Staging
- Prednisone/therapeutic use
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Secondary Prevention
- Survival Analysis
- Treatment Outcome
- Vincristine/therapeutic use
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Affiliation(s)
- James O Armitage
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198-7835, USA.
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Palus V, Volk HA, Lamb CR, Targett MP, Cherubini GB. MRI FEATURES OF CNS LYMPHOMA IN DOGS AND CATS. Vet Radiol Ultrasound 2011; 53:44-9. [DOI: 10.1111/j.1740-8261.2011.01872.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Viktor Palus
- Dick White Referrals; Veterinary Specialist Centre; Six Mile Bottom; Suffolk; CB8 0UH; UK
| | - Holger A. Volk
- Department of Veterinary Clinical Sciences; The Royal Veterinary College; University of London; North Mymms; Hertfordshire; AL9 7TA; UK
| | - Christopher R. Lamb
- Department of Veterinary Clinical Sciences; The Royal Veterinary College; University of London; North Mymms; Hertfordshire; AL9 7TA; UK
| | - Mike P. Targett
- and School of Veterinary Medicine and Science; University of Nottingham; Sutton Bonington; Leicestershire; LE12 5RD; UK
| | - Giunio Bruto Cherubini
- Dick White Referrals; Veterinary Specialist Centre; Six Mile Bottom; Suffolk; CB8 0UH; UK
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Canova F, Marino D, Trentin C, Soldà C, Ghiotto C, Aversa SML. Intrathecal chemotherapy in lymphomatous meningitis. Crit Rev Oncol Hematol 2011; 79:127-34. [DOI: 10.1016/j.critrevonc.2010.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 06/18/2010] [Accepted: 07/13/2010] [Indexed: 01/08/2023] Open
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Senocak E, Oguz KK, Ozgen B, Mut M, Ayhan S, Berker M, Ozdemir P, Cila A. Parenchymal lymphoma of the brain on initial MR imaging: A comparative study between primary and secondary brain lymphoma. Eur J Radiol 2011; 79:288-94. [DOI: 10.1016/j.ejrad.2010.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 01/13/2010] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
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Chihara D, Oki Y, Matsuo K, Onoda H, Taji H, Yamamoto K, Morishima Y. Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: analyses with competing risk regression model. Leuk Lymphoma 2011; 52:2270-5. [DOI: 10.3109/10428194.2011.596966] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miwa A, Sekiguchi N, Tanimura A, Homma C, Shikai T, Takezako Y, Yamagata N, Takezako N. Ranimustine, ifosfamide, procarbazine, dexamethasone, and etoposide therapy for central nervous system recurrence of diffuse large B-cell lymphoma in patients with poor performance status: a pilot study. Leuk Lymphoma 2011; 52:1898-903. [PMID: 21649542 DOI: 10.3109/10428194.2011.588759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prognosis of patients with diffuse large B-cell lymphoma with central nervous system (CNS) involvement is still poor. We performed a pilot study to establish treatment for patients who had refractory or recurrent CNS involvement without employing high-dose chemotherapy or stem cell support. Eight patients with diffuse large B-cell lymphoma and CNS disease after first-line chemotherapy were enrolled. They were treated with MIND-E therapy (ranimustine, ifosfamide, procarbazine, dexamethasone, and etoposide) every 4 weeks. Three patients achieved complete remission, two patients achieved partial remission, and three patients did not respond. One patient received an autologous peripheral stem cell transplant after MIND-E therapy. Three patients are still alive. In conclusion, MIND-E therapy was effective for CNS disease in patients with B-cell lymphoma who were judged to be poor candidates for intensive chemotherapy. Its toxicity was tolerable. A prospective study should be done to confirm the efficacy of this regimen.
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Affiliation(s)
- Akiyoshi Miwa
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
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42
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Matmati K, Matmati N, Hannun YA, Rumboldt Z, Patel S, Lazarchick J, Stuart R, Giglio P. Dural MALT lymphoma with disseminated disease. Hematol Rep 2010; 2:e10. [PMID: 22184513 PMCID: PMC3222263 DOI: 10.4081/hr.2010.e10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 12/16/2022] Open
Abstract
Central nervous system (CNS) lymphoma involving the dura mater is very rare and histologically is usually a subtype of non-Hodgkin's lymphoma (NHL) termed mucosa-associated lymphoid tissue (MALT) lymphoma. We present a case of a 46-year old woman with dural MALT lymphoma that was found to also involve a lacrimal gland, inguinal lymph nodes, and bone marrow. Magnetic resonance imaging of the brain showed an extra-axial enhancing mass approximately 6 cm in maximum diameter along the right frontotemporal convexity. Histopathology of the resected dural mass showed MALT lymphoma expressing CD20, CD52, CD19, and CD38. Molecular studies of the B-cell receptor heavy chain demonstrated monoclonality at the involved sites. The patient was treated with four cycles of fludarabine, mitoxantrone, and rituximab with complete remission. She had recurrence in the subcutaneous tissue of the back at 12 months but has remained free of intracranial disease for 31 months. A review of the literature reveals 57 cases of dural MALT lymphoma. Only 4 had extra-CNS involvement at presentation, and only 3 had local recurrence of the dural tumor. Because of the indolent behavior of this tumor, the intracranial portion can be treated conservatively after resection with or without chemotherapy. Deferral of brain radiation can be considered with close clinical and neuroimaging follow up.
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Affiliation(s)
- Kelly Matmati
- Medical University of South Carolina, Charleston, SC, USA
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Secondary central nervous system (CNS) involvement in patients with diffuse large B-cell lymphoma: a therapeutic dilemma. Ann Hematol 2010; 90:539-46. [DOI: 10.1007/s00277-010-1104-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 10/08/2010] [Indexed: 11/27/2022]
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Anthony S. Non-Hodgkin's lymphoma presenting with multiple cranial nerve deficits. ACTA ACUST UNITED AC 2010; 81:510-5. [DOI: 10.1016/j.optm.2010.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/20/2010] [Accepted: 01/29/2010] [Indexed: 11/16/2022]
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Torgerson S, Olteanu H, Tinguely M, Fenske TS. Central nervous system Hodgkin lymphoma: case report and review of the literature. J Neurooncol 2010; 102:329-34. [DOI: 10.1007/s11060-010-0320-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 07/19/2010] [Indexed: 11/28/2022]
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Saunders TS, Anis S, Doych Y, Moran A, Hou, JS, Chen X, Yanoff M. Systemic non-Hodgkin's lymphoma involving the orbit and leptomeninges. Digit J Ophthalmol 2010; 16:9-12. [PMID: 23362375 PMCID: PMC3516149 DOI: 10.5693/djo.02.2010.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of diffuse large B-cell lymphoma in a 46-year-old female presenting in an unusual manner with stage IVB disease including concurrent orbital and leptomeningeal involvement. The cytologic features and cytogenetics of the malignancy are noted, and the management and progression of the disease, with attention to orbital involvement, is recorded for a period of over 2.5 years, until the patient's death.
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Haldorsen IS, Espeland A, Larsson EM. Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol 2010; 32:984-92. [PMID: 20616176 DOI: 10.3174/ajnr.a2171] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CNS lymphoma consists of 2 major subtypes: secondary CNS involvement by systemic lymphoma and PCNSL. Contrast-enhanced MR imaging is the method of choice for detecting CNS lymphoma. In leptomeningeal CNS lymphoma, representing two-thirds of secondary CNS lymphomas, imaging typically shows leptomeningeal, subependymal, dural, or cranial nerve enhancement. Single or multiple periventricular and/or superficial contrast-enhancing lesions are characteristic of parenchymal CNS lymphoma, representing one-third of secondary CNS lymphomas and almost 100% of PCNSLs. New CT and MR imaging techniques and metabolic imaging have demonstrated characteristic findings in CNS lymphoma, aiding in its differentiation from other CNS lesions. Advanced imaging techniques may, in the future, substantially improve the diagnostic accuracy of imaging, ultimately facilitating a noninvasive method of diagnosis. Furthermore, these imaging techniques may play a pivotal role in planning targeted therapies, prognostication, and monitoring treatment response.
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Affiliation(s)
- I S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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Villa D, Connors J, Shenkier T, Gascoyne R, Sehn L, Savage K. Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: the impact of the addition of rituximab to CHOP chemotherapy. Ann Oncol 2010; 21:1046-52. [DOI: 10.1093/annonc/mdp432] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Quijano S, López A, Manuel Sancho J, Panizo C, Debén G, Castilla C, Antonio García-Vela J, Salar A, Alonso-Vence N, González-Barca E, Peñalver FJ, Plaza-Villa J, Morado M, García-Marco J, Arias J, Briones J, Ferrer S, Capote J, Nicolás C, Orfao A. Identification of Leptomeningeal Disease in Aggressive B-Cell Non-Hodgkin's Lymphoma: Improved Sensitivity of Flow Cytometry. J Clin Oncol 2009; 27:1462-9. [DOI: 10.1200/jco.2008.17.7089] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeHere, we evaluate the sensitivity and specificity of a new 11-parameter flow cytometry (FCM) approach versus conventional cytology (CC) for detecting neoplastic cells in stabilized CSF samples from newly diagnosed aggressive B-cell non-Hodgkin's lymphoma (B-NHL) at high risk of CNS relapse, using a prospective, multicentric study design.Patients and MethodsMoreover, we compared the distribution of different subpopulations of CSF leukocytes and the clinico-biologic characteristics of CSF+ versus CSF−, patients, in an attempt to define new algorithms useful for predicting CNS disease.ResultsOverall, 27 (22%) of 123 patients showed infiltration by FCM, while CC was positive in only seven patients (6%), with three other cases being suspicious (2%). CC+/FCM+ samples typically had more than 20% neoplastic B cells and/or ≥ one neoplastic B cell/μL, while FCM+/CC− samples showed lower levels (P < .0001) of infiltration. Interestingly, in Burkitt lymphoma, presence of CNS disease by FCM could be predicted with a high specificity when increased serum β2-microglobulin and neurological symptoms coexisted, while peripheral blood involvement was the only independent parameter associated with CNS disease in diffuse large B-cell lymphoma, with low predictive value.ConclusionFCM significantly improves the sensitivity of CC for the identification of leptomeningeal disease in aggressive B-NHL at higher risk of CNS disease, particularly in paucicellular samples.
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Affiliation(s)
- Sandra Quijano
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Antonio López
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Juan Manuel Sancho
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Carlos Panizo
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Guillermo Debén
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Cristina Castilla
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - José Antonio García-Vela
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Antonio Salar
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Natalia Alonso-Vence
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Eva González-Barca
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Francisco Javier Peñalver
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Josefa Plaza-Villa
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Marta Morado
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - José García-Marco
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Jesús Arias
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Javier Briones
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Secundino Ferrer
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Javier Capote
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Concepción Nicolás
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
| | - Alberto Orfao
- From the Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca; Servicio de Hematología, Hospital Universitario Germans Trias I Pujol Badalona, Universidad Autónoma de Barcelona; Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona; Servicio de Hematología, Hospital Juan Canalejo, La Coruña; Servicio de Hematología, Hospital Morales Meseguer, Murcia; Servicio de Hematología, Hospital Universitario
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Kraan J, Gratama JW, Haioun C, Orfao A, Plonquet A, Porwit A, Quijano S, Stetler-Stevenson M, Subira D, Wilson W. Flow cytometric immunophenotyping of cerebrospinal fluid. CURRENT PROTOCOLS IN CYTOMETRY 2008; Chapter 6:Unit 6.25. [PMID: 18770650 PMCID: PMC10790684 DOI: 10.1002/0471142956.cy0625s45] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Leptomeningeal disease is an important adverse complication occurring in patients with B and T cell lymphomas and acute leukemias of lymphoid and myeloid origin. Recent reports suggest that multiparameter flow cytometry immunophenotypic assessment of spinal fluid samples could improve the efficiency of detection of CNS involvement, due to its high specificity and greater sensitivity. However, spinal fluid samples are frequently paucicellular with a rapidly decreasing cell viability. Staining of spinal fluid therefore requires dedicated sample storage/transport, staining, and preparation protocols. The Basic Protocol in this unit outlines a consensus multiparameter (3- to 8-color) flow cytometry immunophenotypic protocol for the evaluation of CNS involvement of cerebrospinal fluid (CSF) samples by neoplastic cells. A Support Protocol describing the simultaneous assessment of surface and cytoplasmic antigens is also provided. Finally, in the Alternate Protocol, we describe a method to calculate absolute numbers of both normal and pathological cell subpopulations by adding counting beads to the assay.
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Affiliation(s)
- Jaco Kraan
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
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