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Moisala M, Kalashnikov I, Haataja N, Leppä S, Pollari M. Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System-Outcomes in Finland: A Nationwide Population-Based Study. EJHAEM 2025; 6:e70021. [PMID: 40438704 PMCID: PMC12118592 DOI: 10.1002/jha2.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 02/25/2025] [Indexed: 06/01/2025]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive malignancy commonly presenting with a rapid disease course and poor prognosis. Recent clinical trials have indicated improved treatment outcomes in a highly selected patient population. However, real-world data focusing on long-term, population-based outcomes remain largely unexplored. We analyzed trends in relative survival (RS) in patients diagnosed with PCNSL in Finland from 1995 to 2018. We identified 718 PCNSL patients from the comprehensive Finnish Cancer Registry (FCR) (51% males, median age 67.8 years). For the entire cohort, 5-year overall survival (OS) and RS rates were 21% and 22%, respectively. The 2-year RS was 39% for patients younger than 75 years and 14% for older patients. A gradual increase in the 2-year RS rate was observed over successive chronological diagnostic periods. Age above 75 years at diagnosis (HR 3.65, 95% CI: 2.73-4.89) and diagnosis during a calendar period of 1995-2006 (HR 1.30, 95% CI: 1.10-1.53) were associated with a significantly increased risk of death. An increase in the number of patients diagnosed with PCNSL during the study period was confirmed, and the prognosis of patients diagnosed after the age of 75 years continues to be dismal.
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Affiliation(s)
- Mikko Moisala
- Department of NeurologyTampere University HospitalTampereFinland
- Research Programs Unit and University of HelsinkiHelsinkiFinland
| | - Ilja Kalashnikov
- Research Programs Unit and University of HelsinkiHelsinkiFinland
- Department of OncologyUniversity of HelsinkiHelsinkiFinland
| | - Niklas Haataja
- Department of OncologyUniversity of HelsinkiHelsinkiFinland
| | - Sirpa Leppä
- Research Programs Unit and University of HelsinkiHelsinkiFinland
- Department of OncologyUniversity of HelsinkiHelsinkiFinland
- Department of OncologyHelsinki University Hospital Comprehensive Cancer CentreHelsinkiFinland
| | - Marjukka Pollari
- Research Programs Unit and University of HelsinkiHelsinkiFinland
- Department of OncologyTays Cancer CenterTampere University HospitalTampereFinland
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Guo Y, Zhang X, Wu L, Ma J, Zhang R, Yan H, Li X. Correlation between immune microenvironment and clinicopathological characteristics and prognosis of primary large B-cell lymphoma of immune-privileged sites. Pathol Res Pract 2024; 264:155720. [PMID: 39536543 DOI: 10.1016/j.prp.2024.155720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 11/07/2024] [Accepted: 11/08/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES To explore the correlation between tumor-associated macrophages (TAMs), tumor-infiltrating lymphocytes (TILs), and tumor-associated angiogenesis (TAA) in the tumor microenvironment with the clinicopathological characteristics and prognosis of primary large B-cell lymphoma of immune-privileged sites (LBCL-IP). METHODS A total of 46 cases of LBCL-IP from the Department of Pathology, the Third Affiliated Hospital of Xinjiang Medical University, from January 2010 to February 2024, were collected, along with clinical and follow-up data of LBCL-IP patients. Immunohistochemistry and triple immunofluorescence were used to detect related proteins of TAMs, TILs, and TAA, and to analyze the correlation between TAMs, TILs, TAA, and the polarization of TAMs with the clinical and prognostic factors of LBCL-IP patients. RESULTS There are 30 cases (65.2 %) showed high expression of CD68 proteins, 32 cases (69.6 %) showed high expression of CD163 proteins, 19 cases (41.3 %) showed high expression of CD4 proteins, 34 cases (73.9 %) showed high expression of CD8 proteins, and 25 cases (54.3 %) showed high expression of CD34 proteins. A total of 28 cases (60.9 %) showed CD68+CD163+/CD68+CD86+≥1. The chi-square tests showed that high expression of CD163 proteins was positively correlated with elevated LDH and BMG values, and the count of CD68+CD163+/CD68+CD86+≥1 was positively correlated with ECOG scores ≥2, Ann Arbor staging III-IV, and increased BMG value. High expression of CD8 proteins was positively correlated with a Ki-67 proliferation index ≥70 %, and high MVD values were positively correlated with Ann Arbor staging III-IV. The Kaplan-Meier estimator analysis showed that LBCL-IP patients with low expression of CD68 proteins, high expression of CD163 proteins, CD68+CD163+/CD68+CD86+≥1, low expression of CD8 proteins, high MVD values, ECOG scores ≥2, Ann Arbor staging III-IV, LDH ≥250 U/L, BMG ≥2.2 mg/L, and IPI scores ≥2 had shorter survival times. Multivariate Cox regression analysis showed that low expression of CD8 proteins, CD68+CD163+/CD68+CD86+≥1, LDH ≥250 U/L, and ECOG scores ≥2 are independent risk factors affecting the survival of LBCL-IP patients. CONCLUSION M2-polarized TAMs and low infiltration of CD8+ TILs were more strongly correlated with poor clinical pathological indicators and worse prognosis, and MVD values may serve as an aiding means for the diagnosis and prognostic prediction of LBCL-IP disease.
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MESH Headings
- Humans
- Tumor Microenvironment/immunology
- Male
- Female
- Middle Aged
- Prognosis
- Adult
- Aged
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/pathology
- Tumor-Associated Macrophages/immunology
- Tumor-Associated Macrophages/metabolism
- Tumor-Associated Macrophages/pathology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Neovascularization, Pathologic/pathology
- Young Adult
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Affiliation(s)
- Yawen Guo
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China
| | - Xiaoxian Zhang
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China
| | - Luyao Wu
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China
| | - Jiajia Ma
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China
| | - Ran Zhang
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China
| | - Huifang Yan
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China
| | - Xinxia Li
- Department of Pathology, The Tumor Hospital Affiliated to Xinjiang Medical University, No. 789 Suzhou Dongjie, Urumqi, Xinjiang Uygur 830011, PR China.
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Therkelsen KE, Omuro A. Advances in Primary Central Nervous System Lymphoma. Curr Neurol Neurosci Rep 2024; 25:5. [PMID: 39585484 DOI: 10.1007/s11910-024-01389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2024] [Indexed: 11/26/2024]
Abstract
PURPOSE OF REVIEW Optimal initial management can have a significant impact in long-term outcome in primary CNS lymphoma. This article reviews recent advances and the state of the field. RECENT FINDINGS Genomic analysis of CSF cell-free DNA has emerged as a new diagnostic tool for PCNSL. Treatment options have likewise evolved, with mature data from first-line chemotherapy-based prospective trials disclosing excellent results in younger (< 60-65) patients, with a cure achieved in a majority. However, results in older patients remain dismal, with several new salvage options under investigation including BTK pathway-targeted therapies, and CAR-T cell treatments. Meanwhile, low-dose radiation has emerged as an additional alternative for consolidation therapy. For younger PCNSL patients, the goal of treatment is now a cure, with the next frontier being the development of therapies affording optimized neurocognitive outcome and lower toxicity. Treatment for older patients remains however an unmet need, with several promising clinical trials ongoing.
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Affiliation(s)
- Kate E Therkelsen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 875 Blake Wilbur, MC 6510, Stanford, Palo Alto, CA, 94305, USA.
| | - Antonio Omuro
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 875 Blake Wilbur, MC 6510, Stanford, Palo Alto, CA, 94305, USA
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McBriar JD, Papadimitriou K, Golub D, Donaldson H, Li JY, Khattar P, Singer S, Black KS, Link TW. Posterior fossa Hodgkin's lymphoma radiographically mimicking an arteriovenous malformation: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24238. [PMID: 39038366 DOI: 10.3171/case24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/08/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Intracranial Hodgkin's lymphoma (HL) is an exceedingly rare condition that is at an increased risk of misdiagnosis and mismanagement, especially when initial radiographic evidence points to an alternative pathology. OBSERVATIONS The authors describe the case of a 75-year-old female who presented with a posterior fossa lesion initially concerning for a vascular malformation on computed tomography imaging due to perilesional hypervascularity. Subsequent angiography revealed a developmental venous anomaly (DVA) but no arteriovenous shunting. The patient's clinical history combined with magnetic resonance imaging findings prompted a tissue biopsy, which demonstrated a rare case of central nervous system (CNS) HL. The neoangiogenesis of this CNS HL with an adjacent DVA contributed to the original radiographic misdiagnosis of an arteriovenous malformation. HL's angiogenic potential, coupled with the proangiogenic environment induced around DVAs, may have contributed to this rare CNS HL metastasis to the cerebellum. The potential misdiagnosis of posterior fossa CNS HL has also been seen in several prior cases reviewed herein. LESSONS Hypervascular tumors, especially when associated with an adjacent DVA, should also be considered when first evaluating suspected intracranial vascular lesions. Although rare, CNS HL should be included in the differential diagnosis for patients with a prior history of HL. https://thejns.org/doi/10.3171/CASE24238.
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Affiliation(s)
- Joshua D McBriar
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York
| | | | - Danielle Golub
- Departments of Neurosurgery, Northwell Health, Manhasset, New York
| | - Hayley Donaldson
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jian Y Li
- Departments of Pathology, Northwell Health, Manhasset, New York
| | - Pallavi Khattar
- Departments of Pathology, Northwell Health, Manhasset, New York
| | - Samuel Singer
- Department of Neurology, Zuckerberg Cancer Center, Northwell Health, New Hyde Park, New York
| | - Karen S Black
- Departments of Neuroradiology, Northwell Health, Manhasset, New York
| | - Thomas W Link
- Departments of Neurosurgery, Northwell Health, Manhasset, New York
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Lee H, Ahn S, Cha SH, Cho WH. Intracranial Involvement of Systemic Hodgkin Lymphoma: A Case Report and Literature Review. Brain Tumor Res Treat 2024; 12:63-69. [PMID: 38317490 PMCID: PMC10864131 DOI: 10.14791/btrt.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024] Open
Abstract
A 27-year-old male patient, previously diagnosed with Hodgkin lymphoma (HL), presented with gait disturbance. Brain MRI showed a 4.5 cm mass lesion in the right occipital lobe, suggesting either intracranial involvement of HL or a potential meningioma. Despite high-dose methotrexate and steroid treatment, the patient's symptoms persisted, and imaging showed an enlarging mass, leading to surgical intervention. Histopathological examination confirmed central nervous system (CNS) involvement of HL. Postoperatively, the patient underwent whole-brain radiotherapy and demonstrated marked clinical improvement. Our literature review from 1980 to 2023 identified only 46 cases of intracranial HL (IC-HL), underscoring its rarity. Lymphomas represent 2.2% of brain tumors, with 90%-95% being diffuse large B-cell lymphoma (DLBCL). In contrast, the incidence of CNS-HL patients is a mere 0.02%. Notably, IC-HL and intracranial DLBCL have differences in their typical locations and treatment strategies. Unlike DLBCL, which predominantly appears in the supratentorial region (87%), IC-HL is found there in 61.5% of cases. Additionally, 33.3% of IC-HL cases occur in the cerebellum, with 43.5% associated with posterior circulation regions. Furthermore, while biopsy followed by chemotherapy induction is a common strategy for DLBCL, 81.8% of IC-HL cases underwent surgical resection, and only 18.1% had a biopsy alone. The distinct characteristics of IC-HL tumors, including their larger size, attachment to the dura, and fibrotic nature with clear boundaries, might account for the preference for surgical intervention. The unique features of IC-HL compared to DLBCL highlight the need for distinct considerations in diagnosis and management.
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Affiliation(s)
- Hwanhee Lee
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Sangjun Ahn
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
| | - Seung Heon Cha
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
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Caillet A, Houillier C, Sourdeau E, Gazzano M, Uzunov M, Friser V, Ribeiro M, Nicelli L, Azar N, Baron M, Phina-Ziebin X, Choquet S, Roos-Weil D. Successful treatment by CAR T-cells in multi-refractory mantle cell lymphoma with central nervous system involvement. Ann Hematol 2023; 102:3295-3297. [PMID: 37580574 DOI: 10.1007/s00277-023-05408-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Adrien Caillet
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Caroline Houillier
- IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Elise Sourdeau
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Marianne Gazzano
- Department of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Madalina Uzunov
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Valérie Friser
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Monica Ribeiro
- IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Lucia Nicelli
- Neuroradiology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Nabih Azar
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Marine Baron
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Xavier Phina-Ziebin
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Damien Roos-Weil
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France.
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