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Elbert M, Neumann F, Kiefer M, Christofyllakis K, Balensiefer B, Kos I, Carbon G, Kaddu-Mulindwa D, Bittenbring JT, Fadle N, Regitz E, Fend F, Bonzheim I, Thurner L, Bewarder M. Hyper-N-glycosylated SEL1L3 as auto-antigenic B-cell receptor target of primary vitreoretinal lymphomas. Sci Rep 2024; 14:9571. [PMID: 38671086 PMCID: PMC11053041 DOI: 10.1038/s41598-024-60169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is a rare subtype of DLBCL and can progress into primary central nervous system lymphoma (PCNSL). To investigate the role of chronic antigenic stimulation in PVRL, we cloned and expressed B-cell receptors (BCR) from PVRL patients and tested for binding against human auto-antigens. SEL1L3, a protein with multiple glycosylation sites, was identified as the BCR target in 3/20 PVRL cases. SEL1L3 induces proliferation and BCR pathway activation in aggressive lymphoma cell lines. Moreover, SEL1L3 conjugated to a toxin killed exclusively lymphoma cells with respective BCR-reactivity. Western Blot analysis indicates the occurrence of hyper-N-glycosylation of SEL1L3 at aa 527 in PVRL patients with SEL1L3-reactive BCRs. The BCR of a PVRL patient with serum antibodies against SEL1L3 was cloned from a vitreous body biopsy at diagnosis and of a systemic manifestation at relapse. VH4-04*07 was used in both lymphoma manifestations with highly conserved CDR3 regions. Both BCRs showed binding to SEL1L3, suggesting continued dependence of lymphoma cells on antigen stimulation. These results indicate an important role of antigenic stimulation by post-translationally modified auto-antigens in the genesis of PVRL. They also provide the basis for a new treatment approach targeting unique lymphoma BCRs with ultimate specificity.
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MESH Headings
- Humans
- Receptors, Antigen, B-Cell/metabolism
- Glycosylation
- Cell Line, Tumor
- Retinal Neoplasms/genetics
- Retinal Neoplasms/metabolism
- Retinal Neoplasms/pathology
- Retinal Neoplasms/immunology
- Autoantigens/immunology
- Autoantigens/metabolism
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Female
- Male
- Vitreous Body/metabolism
- Vitreous Body/pathology
- Middle Aged
- Aged
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Affiliation(s)
- Michelle Elbert
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Frank Neumann
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Maximilian Kiefer
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | | | | | - Igor Kos
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Gabi Carbon
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | | | | | - Natalie Fadle
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Evi Regitz
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
| | - Irina Bonzheim
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
| | - Lorenz Thurner
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Moritz Bewarder
- Internal Medicine I, Saarland University Medical Center, Homburg, Germany.
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2
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Olukoya O, Osunronbi T, Jesuyajolu DA, Uwaga BC, Vaughan A, Aluko O, Ayantayo TO, Daniel JO, David SO, Jagunmolu HA, Kanu A, Kayode AT, Olajide TN, Thorne L. The prognostic utility of temporalis muscle thickness measured on magnetic resonance scans in patients with intra-axial malignant brain tumours: A systematic review and meta-analysis. World Neurosurg X 2024; 22:100318. [PMID: 38440376 PMCID: PMC10911852 DOI: 10.1016/j.wnsx.2024.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms. Method We searched Medline, Embase, Scopus and Cochrane databases for relevant studies. Event ratios with 95% confidence intervals (CI) were analysed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence. Results Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46-0.76) (GRADE low), progression free survival (PFS) (HR 0.40; 95% CI 0.26-0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168-0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60-1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67-0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19-0.60) (GRADE moderate) and progression free survival (HR 0.23; 95% CI 0.09-0.56) (GRADE high). Conclusion TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision making between patients and clinicians.
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Affiliation(s)
- Olatomiwa Olukoya
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Temidayo Osunronbi
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Blossom C. Uwaga
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Ayomide Vaughan
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Oluwabusayo Aluko
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | | | - Samuel O. David
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Alieu Kanu
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Ayomide T. Kayode
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Tobi N. Olajide
- Neurosurgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Lewis Thorne
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Frosch M, Demerath T, Fung C, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : Headache, Mental Confusion and Mild Hemiparesis in a 68-year-old Patient. Clin Neuroradiol 2023; 33:1159-1164. [PMID: 37872367 PMCID: PMC10654210 DOI: 10.1007/s00062-023-01359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Affiliation(s)
- M Frosch
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C Fung
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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Chuang CH, Kuo MC, Chang H, Wu JH, Hung YS, Ou CW, Lin TL, Su YJ, Ong YC, Shih LY, Kao HW. Different patterns of failure in two treatment regimens for primary central nervous system lymphoma, a retrospective analysis of 124 cases in Taiwan. Clin Exp Med 2023; 23:5327-5336. [PMID: 37679606 PMCID: PMC10725386 DOI: 10.1007/s10238-023-01182-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
To explore prognostic factors and outcomes of primary central nervous system lymphoma (PCNSL) of diffuse large B-cell lymphoma (DLBCL) in Taiwan, 124 PCNSL-DLBCL patients (from 1995 to 2021) were retrospectively analyzed. Mainly, two treatment modalities including sandwich chemoradiotherapy and modified MATRix regimen were employed in these patients. Overall survival (OS) was determined by log-rank test and time-dependent Cox analysis. Median OS of all patients was 27.1 months. 47 (37.9%) patients who underwent sandwich chemoradiotherapy had a complete remission (CR) rate of 87.2%, median OS of 53.9 months, and progression free survival (PFS) of 42.9 months. 11 (8.9%) patients who underwent modified MATRix regimen had CR rate of 72.7%, median OS of 18.9, and PFS of 11.2 months. There are no significant OS differences between treatment groups or addition of Rituximab. Patients treated with the modified MATRix regimen experienced a higher early mortality rate followed by a survival plateau. IELSG low-risk group had significantly improved OS and PFS than IELSG intermediate- or high-risk group. In multivariant analysis, age > 60 years old and bilateral cerebral lesions are associated with significantly inferior OS. Sandwich chemoradiotherapy demonstrated better early survival and reduced treatment-related toxicity for PCNSL patients compared to the modified MATRix regimen. However, the long-term follow-up revealed a higher rate of treatment failure events in the sandwich chemoradiotherapy group. IELSG and MSKCC scores served as reliable risk assessment models. Incorporating bilateral cerebral lesions as a risk factor further improved risk evaluation.
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Affiliation(s)
- Chin-Hsuan Chuang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Ming-Chung Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Hou Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Yu-Shin Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Che-Wei Ou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Yi-Jiun Su
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Yuen-Chin Ong
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
| | - Lee-Yung Shih
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Wen Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 333423, Taiwan, ROC.
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Qian H, Yang Z, Cai L, Chen H. Conditional survival of elderly primary central nervous system lymphoma. J Cancer Res Clin Oncol 2023; 149:13391-13401. [PMID: 37491638 DOI: 10.1007/s00432-023-05200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Recent studies have reported that overall survival of elderly patients with primary central nervous system lymphoma (PCNSL), who have the highest incidence of this disease, had failed to benefit from the advancements in treatment strategies over the past decades. This highlights the necessity for intensified research to guide treatment decisions for this specific patient population. METHODS The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) was used to extract data of elderly PCNSL patients (age ≥ 60) who were divided into training and validation groups at the ratio of 7:3, for our analysis. Conditional survival [CS(y|x)] was defined as the probability at survival additional y years given that the patient had not died of PCNSL at a specified period of time (x years) after initial diagnosis. The CS pattern of elderly PCNSL patients was analyzed. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression analysis were applied to develop a novel CS-based nomogram. RESULTS A total of 3315 elderly patients diagnosed with CNS lymphoma between 2000 and 2019 were extracted from the SEER database, of whom 2320 patients were divided into the training group and 995 into the internal validation group. CS analysis revealed a noteworthy escalation in the 5-year survival rate among elderly PCNSL patients for every additional year of survival. The rates progressed from an initial 21-49%, 63%, and 75%, culminating in an impressive 88% and the survival improvement over time was nonlinear. The LASSO regression identified nine predictors and multivariate Cox regression was used to successfully construct the CS-based nomogram model with favorable prediction performance. CONCLUSION CS of elderly PCNSL patients was dynamic and increased over time. Our newly-established CS-based nomogram can provide a real-time dynamic survival estimation, allowing clinicians to better guide treatment decision for these patients.
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Affiliation(s)
- Hui Qian
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China
| | - Zhihao Yang
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China
| | - Linqiang Cai
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China
| | - Huawei Chen
- Department of Neurosurgery, The Central Hospital Affiliated to Shaoxing University, Zhejiang Province, Shaoxing City, China.
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Chew SH, Achmad Sankala HB, Chew E, Md Arif MHB, Mohd Zain NR, Hashim H, Koya Kutty SB, Chee YC, Mohd Saleh NB, Ong BH, Viswanathan S. Tumefactive demyelinating lesions versus CNS neoplasms, a comparative study. Mult Scler Relat Disord 2023; 79:104992. [PMID: 37717306 DOI: 10.1016/j.msard.2023.104992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Differentiating tumefactive demyelinating lesions (TDL) from neoplasms of the central nervous system continues to be a diagnostic dilemma in many cases. OBJECTIVE Our study aimed to examine and contrast the clinical and radiological characteristics of TDL, high-grade gliomas (HGG) and primary CNS lymphoma (CNSL). METHOD This was a retrospective review of 66 patients (23 TDL, 31 HGG and 12 CNSL). Clinical and laboratory data were obtained. MRI brain at presentation were analyzed by two independent, blinded neuroradiologists. RESULTS Patients with TDLs were younger and predominantly female. Sensorimotor deficits and ataxia were more common amongst TDL whereas headaches and altered mental status were associated with HGG and CNSL. Compared to HGG and CNSL, MRI characteristics supporting TDL included relatively smaller size, lack of or mild mass effect, incomplete peripheral rim enhancement, absence of central enhancement or restricted diffusion, lack of cortical involvement, and presence of remote white matter lesions on the index scan. Paradoxically, some TDLs may present atypically or radiologically mimic CNS lymphomas. CONCLUSION Careful evaluation of clinical and radiological features helps in differentiating TDLs at first presentation from CNS neoplasms.
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Affiliation(s)
- Sin Hong Chew
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
| | | | - Elaine Chew
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | | | | | - Hilwati Hashim
- Department of Radiology, Faculty of Medicine, Universiti Teknologi Mara, Malaysia
| | | | - Yong Chuan Chee
- Department of Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Beng Hooi Ong
- Neurology Unit, Kedah Medical Centre, Alor Setar, Malaysia
| | - Shanthi Viswanathan
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
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Khwaja J, Nayak L, Cwynarski K. Evidence-based management of primary and secondary CNS lymphoma. Semin Hematol 2023; 60:313-321. [PMID: 38135609 DOI: 10.1053/j.seminhematol.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Central nervous system (CNS) lymphoma has traditionally had very poor outcomes however advances in management have resulted in dramatic improvements and long-term survival of patients. We describe the evidence for treatment strategies for these aggressive disorders. In primary CNS lymphoma there are randomized trial data to inform treatment decisions but these are lacking to guide management in secondary CNS lymphoma. Dynamic assessment of patient fitness and frailty is key throughout treatment, alongside delivery of CNS-bioavailable therapy and enrolment in clinical trials, at each stage of the disease. Intensive high-dose methotrexate-containing induction followed by consolidation with autologous stem cell transplantation with thiotepa-based conditioning is recommended for patients who are fit. Less intensive chemoimmunotherapy, novel agents (including Bruton tyrosine kinase inhibitors, cereblon targeting immunomodulatory agents, and checkpoint inhibitors in the context of clinical trials), and whole brain radiotherapy may be reserved for less fit patients or disease which is chemoresistant. Data regarding the efficacy of chimeric antigen receptor T-cells therapy is emerging, and concerns regarding greater toxicity have not been realized. Future areas of prospective studies include the identification of those at high risk of developing CNS lymphoma, management in elderly or frail patients as well as incorporating novel agents into regimens, particularly for those with chemoresistant disease.
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Affiliation(s)
- Jahanzaib Khwaja
- Department of Haematology, University College London Hospital, London, United Kingdom.
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kate Cwynarski
- Department of Haematology, University College London Hospital, London, United Kingdom
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Arcuri PP, Aiello V, Antonelli S, Cascini GL, Rossi M, Laganà D. Primary large B-cell lymphoma involving the cerebellopontine angle mimic acoustic schwannoma: Role of MR Spectroscopy in differential diagnosis. A case report. Radiol Case Rep 2023; 18:3729-3734. [PMID: 37636538 PMCID: PMC10447925 DOI: 10.1016/j.radcr.2023.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Primary central nervous system (CNS) lymphoma is a very rare aggressive non-Hodgkin disease that originates in CNS (brain, leptomeninges, spinal cord, or eyes). It seems to have increased over the last two decades in both immunocompromised and immunocompetent patients. Primary large B-cell lymphoma involving the cerebellopontine angle (CPA) is extremely rare: only 15 cases of large B-cell lymphoma of the CPA have been reported worldwide; based on our knowledge, no cases studied with MR Spectroscopy. Primary large B-cell lymphoma of the CPA must be differentiated from other cerebellopontine angle diseases, such as acoustic neuroma and meningioma. An early and accurate diagnosis of this neoplasm is necessary for the best management because it is a radiosensitive and chemosensitive tumor. Herein, we report a rare case of B-cell lymphoma involving the left CPA in a 65-year-old man who presented with 3 months of hearing loss on the left, illustrated by MR and TC imaging, highlighting how the MR Spectroscopy, thanks to their greater specificity, is decisive in achieving the correct diagnosis of primary lymphoma and differentiating it from acoustic schwannoma or meningioma. Therefore, in the suspicion of a malignant heteroplastic lesion of the CPA, we suggest including Spectroscopy in the MR study protocol.
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Affiliation(s)
- Pier Paolo Arcuri
- Radiology Unit “De Lellis”, Department of Radiology, Dulbecco University Hospital, 88100, Catanzaro, Italy
| | - Vincenzo Aiello
- Rheumatology Clinic “Madonna dello Scoglio” Cotronei, Crotone, Italy
| | - Simonetta Antonelli
- Radiology Unit “De Lellis”, Department of Radiology, Dulbecco University Hospital, 88100, Catanzaro, Italy
| | - Giuseppe Lucio Cascini
- Nuclear Medicine Unit, Dulbecco University Hospital, 88100, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | - Marco Rossi
- Department of Hematology-Oncology, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
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9
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Mesbah-Oskui L, Alabkal J, Alduaij W, Dhawan PS. A unique case of a fulminant clonal CD8-positive T-cell lymphoproliferative disorder with CNS involvement. BMC Neurol 2023; 23:329. [PMID: 37715128 PMCID: PMC10503065 DOI: 10.1186/s12883-023-03371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND This is a unique case that describes the presentation, investigations, and disease trajectory of a fatal, clonal CD8-positive T-cell lymphoproliferative disorder in an otherwise healthy and immunocompetent patient with Epstein-Barr virus seronegative status. Central nervous system involving T-cell lymphoproliferative disorders are rare and typically encountered in the setting of immunocompromise. These disorders are often associated with aggressive cytomorphological features and characteristic magnetic resonance imaging patterns, which were not seen in this case. CASE PRESENTATION Here we describe a case of a 65 year-old male presenting with neuropsychiatric symptoms, truncal ataxia, and falls who's bone marrow, cerebrospinal fluid, and brain biopsy were consistent with a clonal CD8-positive T-cell lymphoproliferative disorder that did not meet existing World Health Organization criteria for classification as T-cell lymphoma. The patient was treated with intrathecal methotrexate resulting in transient improvement of his symptoms followed by disease progression and death related to aspiration. CONCLUSIONS This case highlights the importance of urgent and comprehensive work-up in patients with clinical features suggestive of lymphoma with central nervous system involvement, despite atypical imaging features and lack of cytomorphological features satisfying current World Health Organization classification criteria.
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Affiliation(s)
- Lia Mesbah-Oskui
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Jarrah Alabkal
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Waleed Alduaij
- Division of Medical Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Priya S Dhawan
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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10
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Kaulen LD, Denisova E, Hinz F, Hai L, Friedel D, Henegariu O, Hoffmann DC, Ito J, Kourtesakis A, Lehnert P, Doubrovinskaia S, Karschnia P, von Baumgarten L, Kessler T, Baehring JM, Brors B, Sahm F, Wick W. Integrated genetic analyses of immunodeficiency-associated Epstein-Barr virus- (EBV) positive primary CNS lymphomas. Acta Neuropathol 2023; 146:499-514. [PMID: 37495858 PMCID: PMC10412493 DOI: 10.1007/s00401-023-02613-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
Immunodeficiency-associated primary CNS lymphoma (PCNSL) represents a distinct clinicopathological entity, which is typically Epstein-Barr virus-positive (EBV+) and carries an inferior prognosis. Genetic alterations that characterize EBV-related CNS lymphomagenesis remain unclear precluding molecular classification and targeted therapies. In this study, a comprehensive genetic analysis of 22 EBV+ PCNSL, therefore, integrated clinical and pathological information with exome and RNA sequencing (RNASeq) data. EBV+ PCNSL with germline controls carried a median of 55 protein-coding single nucleotide variants (SNVs; range 24-217) and 2 insertions/deletions (range 0-22). Genetic landscape was largely shaped by aberrant somatic hypermutation with a median of 41.01% (range 31.79-53.49%) of SNVs mapping to its target motifs. Tumors lacked established SNVs (MYD88, CD79B, PIM1) and copy number variants (CDKN2A, HLA loss) driving EBV- PCNSL. Instead, EBV+ PCNSL were characterized by SOCS1 mutations (26%), predicted to disinhibit JAK/STAT signaling, and mutually exclusive gain-of-function NOTCH pathway SNVs (26%). Copy number gains were enriched on 11q23.3, a locus directly targeted for chromosomal aberrations by EBV, that includes SIK3 known to protect from cytotoxic T-cell responses. Losses covered 5q31.2 (STING), critical for sensing viral DNA, and 17q11 (NF1). Unsupervised clustering of RNASeq data revealed two distinct transcriptional groups, that shared strong expression of CD70 and IL1R2, previously linked to tolerogenic tumor microenvironments. Correspondingly, deconvolution of bulk RNASeq data revealed elevated M2-macrophage, T-regulatory cell, mast cell and monocyte fractions in EBV+ PCNSL. In addition to novel insights into the pathobiology of EBV+ PCNSL, the data provide the rationale for the exploration of targeted therapies including JAK-, NOTCH- and CD70-directed approaches.
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Affiliation(s)
- Leon D Kaulen
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Evgeniya Denisova
- Division of Applied Bioinformatics, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Felix Hinz
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Neuropathology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Ling Hai
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Dennis Friedel
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Octavian Henegariu
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
- Department of Genetics, Yale School of Medicine, New Haven, USA
| | - Dirk C Hoffmann
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Jakob Ito
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexandros Kourtesakis
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Pascal Lehnert
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sofia Doubrovinskaia
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, Munich University Hospital, Ludwig Maximilians University (LMU) Munich, and German Cancer Consortium (DKTK) Partner Site, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Munich University Hospital, Ludwig Maximilians University (LMU) Munich, and German Cancer Consortium (DKTK) Partner Site, Munich, Germany
| | - Tobias Kessler
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Joachim M Baehring
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
- Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Benedikt Brors
- Division of Applied Bioinformatics, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.
- Clinical Cooperation Unit (CCU) Neuropathology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
- Clinical Cooperation Unit (CCU) Neuro-Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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11
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Rachdi A, Hernandez-Tost H, Herzi D, Morales-Martinez A, Hernández-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Recent advances in the diagnosis and the treatment of primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:481-489. [PMID: 37045615 DOI: 10.1016/j.neurol.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
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Affiliation(s)
- A Rachdi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Institut Mongi Ben Hamida de neurologie de Tunis, Tunis, Tunisia
| | - H Hernandez-Tost
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - D Herzi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - A Morales-Martinez
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | | | - C Houillier
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; LOC network, France
| | - A Alentorn
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France
| | - K Hoang-Xuan
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France.
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12
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Dufour J, Choquet S, Hoang-Xuan K, Schmitt A, Ahle G, Houot R, Taillandier L, Gressin R, Casasnovas O, Marolleau JP, Tamburini J, Serrier C, Perez E, Paillassa J, Gyan E, Chauchet A, Ursu R, Kas A, Soussain C, Houillier C. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 2023; 102:1159-1169. [PMID: 36991231 DOI: 10.1007/s00277-023-05108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtrière, Service d'Hématologie clinique, Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - A Schmitt
- Institut de Bergonie, Service d'Hématologie, Bordeaux, France
| | - G Ahle
- Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Service d'Hématologie, Rennes, France
| | - L Taillandier
- Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France
| | - R Gressin
- Hôpital Universitaire de Grenoble, Service d'Hématologie, Grenoble, France
| | - O Casasnovas
- Hôpital Universitaire de Dijon, Service d'hematologie clinique, Dijon, France
| | - J P Marolleau
- Hôpital Universitaire d'Amiens, Service d'Hematologie clinique, Amiens, France
| | - J Tamburini
- Hôpital Cochin, Service d'Hématologie, Paris, France
| | - C Serrier
- Centre Hospitalier de Perpignan, Service d'Hématologie, Perpignan, France
| | - E Perez
- Hôpital Universitaire de la Réunion, Service d'oncologie-hématologie, Paris, La Réunion, France
| | - J Paillassa
- Hôpital Universitaire d'Angers, Service d'Hématologie, Angers, France
| | - E Gyan
- Hôpital Universitaire de Tours, Service d'Hématologie, Tours, France
| | - A Chauchet
- Hôpital Universitaire de Besançon, Service d'Hématologie, Besançon, France
| | - R Ursu
- Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France
| | - A Kas
- Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - C Soussain
- Institut Curie, Service d'Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - C Houillier
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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13
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Nguyen-Them L, Alentorn A, Ahle G, Soussain C, Mathon B, Le Garff Tavernier M, Houillier C, Hoang-Xuan K. CSF biomarkers in primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:141-149. [PMID: 36336490 DOI: 10.1016/j.neurol.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
PCNSL is a non-Hodgkin lymphoma (NHL) affecting brain, spinal cord, eyes and leptomeninges. In the past two decades, its prognosis significantly improved due to therapeutic advances but it remains a highly aggressive tumor and early diagnosis is necessary for optimal management. Diagnosis relies on the identification of lymphoma cells in brain tissue obtained by stereotactic biopsy. Alternatively, lymphoma cells may be found in CSF through lumbar puncture (LP) or by a vitrectomy. For several reasons, the diagnosis of PCNSL may be challenging. Misleading radiological presentations are frequent. Dramatic response to steroids may bias histological analysis and deep brain location or frail health status can contraindicate brain biopsy. In the follow-up of patients who have been previously treated, differential diagnosis between tumor relapse and post-treatment may be also difficult. Therefore, the development of complementary reliable diagnostic tools is needed. This review will summarize several diagnostic or prognostic CSF biomarkers which have been proposed in PCNSL, their interests and limits.
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Affiliation(s)
- L Nguyen-Them
- Centre Hospitalier Saint Jean, 20 Avenue du Languedoc, 66000 Perpignan, France; Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - A Alentorn
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - G Ahle
- Hôpitaux Civils de Colmar, 39 Avenue Liberté, 68024 Colmar, France
| | - C Soussain
- Institut Curie - site de Saint Cloud, 35 Rue Dailly, 92210 Saint-Cloud, France
| | - B Mathon
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - M Le Garff Tavernier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Houillier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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Seidel S, Kowalski T, Nilius-Eliliwi V, Schroers R, Schlegel U. Survival, prognostic factors, hospitalization time and clinical performance status after first cerebral relapse or progression in 54 patients with primary CNS lymphoma not eligible for high dose chemotherapy: a retrospective analysis. Neurol Res Pract 2023; 5:8. [PMID: 36814351 PMCID: PMC9948364 DOI: 10.1186/s42466-023-00234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Treatment of relapsed or refractory primary CNS lymphoma (r/r PCNSL) is difficult, particularly in patients not eligible for high dose chemotherapy with autologous stem cell transplantation (HDC-ASCT). No standard treatment has been defined for these patients yet. METHODS We retrospectively analyzed survival, prognostic factors, hospitalization time and Karnofsky performance score (KPS) before and after treatment in 54 r/r PCNSL patients with isolated cerebral relapse or progression (n = 23 refractory, n = 31 relapsed) not eligible for HDC-ASCT, who received heterogenous salvage treatments. RESULTS Treatments were temozolomide (+ rituximab) (n = 21), high dose methotrexate (HD-MTX)-based therapy (n = 11), whole brain radiotherapy (WBRT)/focal radiotherapy (n = 11), other systemic treatments (n = 2) and best supportive care (BSC, n = 9). Median progression free survival (PFS) and overall survival (OS) were 2.6 months (95% CI 1.0-4.2 months) and 4.8 months (95% CI 3.3-6.3 months), respectively. Eight patients survived for ≥ 3 years (13.1%, n = 3 received temozolomide, n = 3 WBRT, n = 2 HD-MTX-based treatment). Application of any salvage treatment (vs. BSC), younger age at relapse and asymptomatic (vs. symptomatic) relapse were positive prognostic factors. No significant differences in OS were found for the different salvage treatments. Median hospitalization time for treatment was 15/13 days for temozolomide (+ rituximab)/radiotherapy compared to 55 days for HD-MTX-based therapy. Median KPS in assessable patients (n = 41) was 60 (range 30-100) before treatment and 50 (range 20-90) after treatment. In patients with response to treatment (n = 16) KPS improved from 60 (range 40-90) before treatment to 70 (range 50-90) after treatment, while patients with PD (n = 25) deteriorated from 60 (range 30-100) to 40 (range 20-70). CONCLUSION Survival for this cohort of r/r PCNSL patients with isolated cerebral relapse or progression was poor. Considering long hospital stays associated with HD-MTX-based chemotherapy and neurotoxicity associated with WBRT, temozolomide might be worth considering with a chance of prolonged survival and avoidance of long hospitalization. Novel therapeutic agents are urgently needed to improve survival in r/r PCNSL patients.
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Affiliation(s)
- Sabine Seidel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| | - Thomas Kowalski
- grid.5570.70000 0004 0490 981XDepartment of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - Verena Nilius-Eliliwi
- grid.5570.70000 0004 0490 981XDepartment of Hematology and Oncology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - Roland Schroers
- grid.5570.70000 0004 0490 981XDepartment of Hematology and Oncology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - Uwe Schlegel
- grid.5570.70000 0004 0490 981XDepartment of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
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15
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Li C, Zhou F, Wang J, Chang Q, Du M, Luo W, Zhang Y, Xu J, Tang L, Jiang H, Liu L, Kou H, Lu C, Liao D, Wu J, Wei Q, Ke S, Deng J, Liu C, Mei H, Hu Y. Novel CD19-specific γ/δ TCR-T cells in relapsed or refractory diffuse large B-cell lymphoma. J Hematol Oncol 2023; 16:5. [PMID: 36681817 PMCID: PMC9862812 DOI: 10.1186/s13045-023-01402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/15/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND T cell receptor (TCR)-T cells possess similar effector function, but milder and more durable signal activation compared with chimeric antigen receptor-T cells. TCR-T cell therapy is another active field of cellular immunotherapy for cancer. METHODS We previously developed a human anti-CD19 antibody (ET190L1) and generated novel CD19-specific γ/δ TCR-T cells, ET019003, by fusing the Fab fragment of ET190L1 with γ/δ TCR constant chain plus adding an ET190L1-scFv/CD28 co-stimulatory molecule. ET019003 cells were tested in preclinical studies followed by a phase 1 clinical trial. RESULTS ET019003 cells produced less cytokines but retained comparable antitumor potency than ET190L1-CAR-T cells in vivo and in vitro. In the first-in-human trial, eight patients with relapsed or refractory DLBCL were treated. CRS of grade 1 was observed in three (37.5%) patients; ICANS of grade 3 was noted in one (12.5%) patient. Elevation of serum cytokines after ET019003 infusion was almost modest. With a median follow-up of 34 (range 6-38) months, seven (87.5%) patients attained clinical responses and six (75%) achieved complete responses (CR). OS, PFS and DOR at 3 years were 75.0%, 62.5%, and 71.4%, respectively. Notably, patient 1 with primary CNS lymphoma did not experience CRS or ICANS and got an ongoing CR for over 3 years after infusion, with detectable ET019003 cells in CSF. ET019003 showed striking in vivo expansion and persisted in 50% of patients at 12 months. Three patients received a second infusion, one for consolidation therapy after CR and two for salvage therapy after disease progression, but no response was observed. ET019003 expansion was striking in the first infusion, but poor in the second infusion. CONCLUSIONS CD19-specific γ/δ TCR-T cells, ET019003, had a good safety profile and could induce rapid responses and durable CR in patients with relapsed or refractory DLBCL, even primary CNS lymphoma, presenting a novel and potent therapeutic option for these patients. TRIAL REGISTRATION NCT04014894.
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Affiliation(s)
- Chenggong Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Fen Zhou
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
- Department of Pediatrics, Union Hospital, Tongji Medical College,, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qi Chang
- Eureka Therapeutics, Inc, Emeryville, CA, 94608, USA
| | - Mengyi Du
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Wenjing Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Yinqiang Zhang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Jia Xu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Lu Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Huiwen Jiang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Lin Liu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Haiming Kou
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Cong Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Danying Liao
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Jianghua Wu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Qiuzhe Wei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Sha Ke
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Cheng Liu
- Eureka Therapeutics, Inc, Emeryville, CA, 94608, USA
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China.
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16
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Mo SS, Cleveland J, Rubenstein JL. Primary CNS lymphoma: update on molecular pathogenesis and therapy. Leuk Lymphoma 2023; 64:57-65. [PMID: 36286546 DOI: 10.1080/10428194.2022.2133541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of extra-nodal non-Hodgkin lymphoma that as a brain tumor poses a unique set of challenges in diagnosis and management. With the advent of next-generation sequencing, we review updates in the understanding of its molecular and genomic pathogenesis. We also highlight key issues in management, with a focus on emerging technologies and new biological therapies including monoclonal antibodies, IMiDs, BTK inhibitors, PD-1 inhibitors, and CAR-T therapy. Integration of these approaches will likely enhance induction and consolidation strategies to suppress NF-κB activation and the anti-tumor immune response, while minimizing the often noxious effects of genotoxic approaches.
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Affiliation(s)
- Shirley S Mo
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Joseph Cleveland
- Department of Medicine, University of California, San Francisco, CA, USA
| | - James L Rubenstein
- Department of Medicine, University of California, San Francisco, CA, USA.,Hematology/Oncology, University of California, San Francisco, CA, USA.,Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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17
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Asghar N, Masood A, Dhaliwal A, Khurana S, Davis J, Hashmi H, Husnain M. Chimeric Antigen Receptor T-Cell (CAR T-Cell) Therapy for Primary and Secondary Central Nervous System Lymphoma: A Systematic Review of Literature. Clin Lymphoma Myeloma Leuk 2023; 23:15-21. [PMID: 36328891 DOI: 10.1016/j.clml.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
Relapsed/refractory central nervous system (CNS) lymphoma, whether primary or secondary, is associated with poor prognosis with currently available treatment modalities, including high-dose chemotherapy-autologous stem cell transplantation. The pivotal ZUMA-1 and JULIET trials that led to FDA approval of Axicabtagene ciloleucel and Tisagenlecleucel for relapsed refractory large cell lymphoma excluded patients with CNS involvement due to concerns of increased toxicity. However, TRANSCEND study for Lisocabtagene maraleucel in relapsed refractory large cell lymphoma allowed patients with CNS involvement and reported manageable CNS toxicities in these patients. In the real-world experience, chimeric antigen receptor T-cell (CAR T) therapy has been deemed safe and effective for these patients with poor prognosis. In this systematic review, we analyzed available literature to evaluate the role of CAR T-cell therapy in both primary and secondary CNS lymphoma using Embase, Cochrane, and PubMed databases. A total of 14 studies, including 8 retrospective analyses and 6 prospective studies/clinical trials, were included in the qualitative synthesis to study the safety and efficacy of CAR T. Based on our analysis, CAR T-cell therapy appears to be associated with reasonable efficacy and a manageable safety for primary and secondary CNS lymphoma.
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18
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Curry LD, Munker R, Li N, Yan D, Pryor P, Nozad S, Keller P, Monohan GP, Iragavarapu C, Krem MM. Performance status, comorbidities, and cycles of methotrexate exert the greatest influence on outcomes of primary and secondary CNS lymphomas: the Lexington experience. Ann Hematol 2023; 102:141-54. [PMID: 36367559 DOI: 10.1007/s00277-022-05018-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) occurs primarily in older patients and has a worse prognosis than other extranodal lymphomas. Contemporary treatment is based on high-dose methotrexate (HD-MTX), which crosses the blood-brain barrier. Secondary CNS lymphoma (SCNSL) can occur concomitantly with systemic lymphoma or later at relapse and generally has a dismal outcome. We reviewed disease characteristics and outcomes of 103 patients (44 PCNSL and 59 SCNSL) treated at our center between 2015 and 2020. Median ages at diagnosis were 64 and 62 years, respectively. In both groups, diffuse large B cell lymphoma (DLBCL) was the major histologic type; in SCNSL, other types were also seen. SCNSL, in contrast with PCNSL, manifested with smaller tumors or cerebrospinal fluid positivity. For SCNSL the mean interval to brain involvement was 18 months (0-138). The overall survival had a trend to worse in SCNSL; median survival 11 months versus 61 months in PCNSL (p = 0.089). Progression-free survival was similar in both groups. A significant proportion of SCNSL patients with poor performance status could not obtain CNS-directed treatments. The strongest predictor of poor outcome was ECOG performance status 2 + at diagnosis for both groups. Charlson comorbidity index was predictive only for the PCNSL cohort. Tumor size was not prognostic for survival. The number of HD-MTX cycles correlated with survival, whereas the regimen itself and average cumulative dose of methotrexate did not play a role. Our study is in line with the recent literature and confirms ongoing challenges. We discuss how the outcomes of CNS lymphomas can be improved.
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19
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Seidel S, Kowalski T, Nilius-Eliliwi V, Schroers R, Schlegel U. Outcome and prognostic factors of very old patients with primary CNS lymphoma: a retrospective analysis of patients ≥80 years treated with high-dose methotrexate-based chemotherapy. Leuk Lymphoma 2022; 63:2905-2911. [PMID: 35856480 DOI: 10.1080/10428194.2022.2100371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although >10% of primary CNS lymphoma (PCNSL) patients are ≥80 years, data on this population are limited. We analyzed 19 consecutive octogenarians with PCNSL treated with high-dose methotrexate (HD-MTX)-based chemotherapy at our institution concerning outcome, prognostic factors and living conditions at six-month follow-up for 11 patients alive and in remission. Seven patients received intracerebroventricular (ICV) treatment additional to systemic therapy. Median follow-up was 27.3 months. Median overall survival was 16.3 months. Positive prognosticators of survival were application of ICV treatment (p = 0.033) and female gender (p = 0.015). All 11 patients alive and in remission at 6-month follow-up were living at home with a median Karnofsky performance score of 60 (range 50-90) and a median instrumental activities of daily living score of 3 (range 1-8). HD-MTX-based polychemotherapy including ICV treatment was feasible in this population, patients in remission needed moderate support in everyday live.
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Affiliation(s)
- Sabine Seidel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Thomas Kowalski
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Verena Nilius-Eliliwi
- Department of Hematology and Oncology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Roland Schroers
- Department of Hematology and Oncology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
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20
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Kaulen LD, Baehring JM. Treatment Options for Recurrent Primary CNS Lymphoma. Curr Treat Options Oncol 2022; 23:1548-65. [PMID: 36205806 DOI: 10.1007/s11864-022-01016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/30/2023]
Abstract
OPINION STATEMENT Primary CNS lymphoma (PCNSL) constitutes a rare extranodal variant of non-Hodgkin lymphoma (NHL) with an annual incidence of 0.45/100,000. Given the paucity of large prospective clinical trials, there is no consensus treatment for refractory or relapsed (r/r) PCNSL, and available strategies are largely based on retrospective analyses. Patient age, performance status, previously administered treatment, duration of response, and molecular characteristics guide selection of salvage therapy. Patients with a good performance status (KPS >70), particularly ≤65 years, and adequate organ function should be considered for salvage polychemotherapy. Based on its high overall response rate even in the relapsed setting, we choose high-dose (≥ 3.5g/m2) methotrexate (HD-MTX) based regimens, e.g., R-MPV (rituximab, HD-MTX, procarbazine, and vincristine), for remission re-induction as long as patients were sensitive to first line HD-MTX-based regimens, especially when duration of previous response was ≥ 1 year. Following successful remission induction, we choose myeloablative chemotherapy (e.g., thiotepa, busulfan, cyclophosphamide) and subsequent autologous stem cell transplant in curative intent whenever feasible. Alternatively, conventional chemotherapy regimens (for example, monthly HD-MTX) or low-dose whole-brain radiation therapy (WBRT) are selected for consolidation in non-transplant candidates in complete remission. In cases of HD-MTX refractory disease or contraindications, we use pemetrexed; temozolomide/rituximab; high-dose cytarabine; or whole brain radiation for remission induction. Clinical trial participation is considered as well. Emerging therapies for upfront or salvage therapy under ongoing investigation include bruton tyrosine kinase inhibition (e.g., ibrutinib), immunomodulatory drugs (e.g., lenalidomide), immune checkpoint inhibitors (ICI, e.g., nivolumab), and chimeric antigen receptor T (CAR-T) cell therapy.
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21
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Belachew NF, Diebold M, Reinacher PC, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 51-year-old Patient Presenting with Transient Speech Disorder and a Mass Lesion in the Right Parietal White Matter. Clin Neuroradiol 2022; 32:875-881. [PMID: 35881163 PMCID: PMC9424149 DOI: 10.1007/s00062-022-01195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- N F Belachew
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Diebold
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - P C Reinacher
- Stereotactic & Functional Neurosurgery, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology, Aachen, Germany
| | - M Prinz
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Erny
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany. .,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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22
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Joshi A, Deshpande S, Bayaskar M. Primary CNS lymphoma in Immunocompetent patients: Appearances on Conventional and Advanced Imaging with Review of literature. J Radiol Case Rep 2022; 16:1-17. [PMID: 36051362 PMCID: PMC9354935 DOI: 10.3941/jrcr.v16i7.4562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) constitutes about 3% of all primary brain tumors and nearly 1 to 3% of all Non Hodgkin Lymphomas. In the recent years the incidence of primary CNS lymphoma is increasing in immunocompetent patients. As PCNSL are chemosensitive as well as radiosensitive, its early and accurate diagnosis is imperative for optimal management. Contrast enhanced Magnetic Resonance Imaging (MRI) is the recommended imaging modality for PCNSL; however, contrast enhanced Computed Tomography (CE-CT) is done in cases where MRI is contraindicated. Advanced imaging techniques like DWI (diffusion weighted imaging), MRS (MR Spectroscopy), MR perfusion, DTI (Diffusion tensor imaging) are important in diagnosis and help in its differentiation from other tumors.
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Affiliation(s)
- Anagha Joshi
- Department of radiodiagnosis, Lokmanya Tilak Municipal Medical College and General hospital, Sion, Mumbai, India
| | - Sneha Deshpande
- Department of radiodiagnosis, Lokmanya Tilak Municipal Medical College and General hospital, Sion, Mumbai, India
| | - Madhura Bayaskar
- Department of radiodiagnosis, Lokmanya Tilak Municipal Medical College and General hospital, Sion, Mumbai, India
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23
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Oishi M, Hayashi Y, Sasagawa Y, Oikawa N, Nakada M. Syndrome of inappropriate secretion of antidiuretic hormone as an initial sign of primary central nervous system lymphomas in the hypothalamus. Acta Neurol Belg 2022; 123:415-422. [PMID: 35716313 DOI: 10.1007/s13760-022-01985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) rarely originates in the hypothalamus. Hypothalamic PCNSL can present with various symptoms specific to dysfunction of the hypothalamus, including consciousness disturbance, cognitive impairment, hypopituitarism, and diabetes insipidus (DI). However, it remains unclear whether syndrome of inappropriate secretion of antidiuretic hormone (SIADH) can present as an initial sign of hypothalamic PCNSL. METHODS Ninety-nine patients with PCNSL were diagnosed between January 2006 and December 2020 at our institutes. The initial symptoms and signs, hypothalamic-pituitary functions, serum sodium (Na) value, Karnofsky Performance Status (KPS) score on admission, and duration from onset to diagnosis were retrospectively investigated from the medical charts. RESULTS Eight and 91 patients had hypothalamic PCNSL (hypothalamic group) and PCNSL located in other regions (control group), respectively. Patients' pathological diagnoses were diffuse large B-cell lymphoma (97 patients) and intravascular lymphoma (two patients). Six patients presented with hyponatremia derived from SIADH or suspected SIADH, and one presented with DI. Statistically significant differences between the hypothalamic and control groups were detected only in the preoperative serum Na values and KPS scores. CONCLUSION SIADH can be an initial presentation of hypothalamic PCNSL. Early detection of hypothalamic PCNSL from SIADH may lead to proper management and improved prognosis.
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Affiliation(s)
- Masahiro Oishi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku, Ishikawa, 920-0293, Japan
| | - Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Nozomu Oikawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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24
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Nilles C, Delgadillo D, Sarazin M, Nichelli L, Mokhtari K, Mathon B, Choquet S, Feuvret L, Alentorn A, Ribeiro M, Hoang-Xuan K, Houillier C. Primary CNS lymphoma of the corpus callosum: presentation and neurocognitive outcomes. J Neurooncol 2022. [PMID: 35445956 DOI: 10.1007/s11060-022-04014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The corpus callosum (CC) is frequently involved in primary central nervous system lymphomas (PCNSLs). In this cohort study, we described the neurocognition of patients with PCNSL-CC and its posttherapeutic evolution. METHODS Immunocompetent patients with PCNSL-CC were identified retrospectively at the Pitié-Salpêtrière Hospital. We described their clinical presentation. Neuropsychological test scores (MMSE; digit spans; Free and Cued Selective Reminding Test; Image Oral Naming Test; Frontal Assessment Battery; Trail Making Test; Stroop and verbal fluency tests; Rey's Complex Figure test) and factors impacting them were analyzed. RESULTS Twenty-seven patients were included (median age: 67 years, median Karnofsky Performance Status: 70); cognitive impairment and balance disorders were present in 74% and 59%, respectively. At diagnosis, neuropsychological test results were abnormal for global cognitive efficiency (63% of patients), memory (33-80% depending on the test) and executive functions (44-100%). Results for visuospatial and language tests were normal. All patients received high-dose methotrexate-based polychemotherapy, followed in one patient by whole-brain radiotherapy; 67% of patients achieved complete response (CR). With a median follow-up of 48 months (range 6-156), patients in CR had persistent abnormal test results for global cognitive efficiency in 17%, executive function in 18-60%, depending on the test, and memory in 40-60%. Splenium location and age ≥ 60 years were significantly associated with worse episodic memory scores throughout the follow-up. CONCLUSIONS PCNSL-CC is associated with frequent cognitive dysfunctions, especially memory impairment, which may recover only partially despite CR and warrant specific rehabilitation. Older age (≥ 60) and splenium location are associated with worse neurocognitive outcomes.
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25
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Nagane M. [Molecular pathogenesis and therapeutic development of primary central nervous system lymphoma: update and future perspectives]. Rinsho Ketsueki 2022; 63:1145-1156. [PMID: 36198540 DOI: 10.11406/rinketsu.63.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin's lymphoma confined to the central nervous system with a diffuse large B-cell lymphoma (DLBCL) histology and is highly prevelant in elderly patients. Whole brain radiotherapy (WBRT) does not provide considerable remission; rather it is highly involved in the development of leukoencephalopathy with delayed neurotoxicity, notably in elderly patients. Standard care for newly diagnosed patients with PCNSL comprised induction with high-dose methotrexate (HD-MTX)-based multi-agent immunochemotherapy, such as R-MPV (rituximab, MTX, procarbazine, vincristine) yielding 70-75% complete response rate, followed by HD-cytarabine consolidation. Consolidation high-dose chemotherapy with the key drug thiotepa supported by autologous stem cell transplant has recently been investigated to replace WBRT in multiple randomized trials, demonstrating non-inferiority to WBRT with less neurotoxicity. Comprehensive genetic analyses have revealed high rates of oncogenic mutations in CD79B and MYD88 genes, the hallmarks for MCD/C5 subtype of DLBCL, leading to constitutive activation of NF-κB signaling pathways in PCNSL. Bruton's tyrosine kinase (BTK), an intermediate kinase downstream to CD79B/MYD88, has emerged as a promising therapeutic target. Furthermore, tirabrutinib, a second-generation BTK inhibitor, has shown substantial activity against relapsed/refractory PCNSL, resulting in its approval in 2020 in Japan. Additionally, other new agents against PI3-kinase and immunotherapies including immunomodulatory agents, immune checkpoint blockade, and CAR-T have been actively tested in clinical trials.
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Affiliation(s)
- Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
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26
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Lee JY, Paik JH, Suh KJ, Kim JW, Kim SH, Kim JW, Kim YJ, Lee KW, Kim JH, Bang SM, Lee JS, Lee JO. R-MPV followed by high-dose chemotherapy with thiotepa-based and autologous stem cell transplantation for newly diagnosed primary central nervous system lymphoma: a single-center experience. Blood Res 2021; 56:285-292. [PMID: 34801986 PMCID: PMC8721461 DOI: 10.5045/br.2021.2021073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/27/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background High-dose chemotherapy followed by autologous stem cell transplantation (HDC-ASCT) as a consolidation treatment is a promising approach for eligible patients with newly diagnosed primary central nervous system lymphoma (PCNSL). Methods In this retrospective analysis, 22 patients with newly diagnosed PCNSL received chemotherapy with rituximab, methotrexate, procarbazine, and vincristine. Those who showed complete or partial response subsequently received consolidation HDC-ASCT with a thiotepa-based conditioning regimen but did not undergo radiotherapy. Results The PCNSL patients had a median age of 57 years (range, 49‒67 yr); of the total patients, 9.1% had a performance status of 2 or higher, and 72.1% had multiple lesions. Approximately 82% of patients received six cycles of induction chemotherapy, which was well tolerated with excellent disease control. The rate of confirmed or unconfirmed complete response increased from 45.5% at the period of interim analysis to 81.8% prior to the initiation of HDC-ASCT. With a median follow-up of 19.6 months (range, 7.5‒56.5 mo), the 2-year progression-free survival and overall survival estimates were 84% and 88%, respectively. No treatment-related deaths occurred. Grade 3 toxicity was recorded in 90.9% of the patients after undergoing the HDC-ASCT, and the most common grade 3 adverse event was febrile neutropenia without sepsis. Conclusion The discussed treatment approach is feasible in patients with newly diagnosed PCNSL, yielding encouraging results.
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Affiliation(s)
- Ji Yun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Ho Paik
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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27
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Mair A, Muigg A, Stockhammer G, Mangesius S, Wolf D, Gunsilius E. Sustained Complete Remission in Multi-Relapsed Primary CNS Lymphoma Treated with Ibrutinib Monotherapy: A Case Report. Case Rep Oncol 2021; 14:1337-1341. [PMID: 34720938 PMCID: PMC8525268 DOI: 10.1159/000518528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
Primary CNS lymphoma (PCNSL) is a highly aggressive malignant disease with a high recurrence rate and a poor prognosis. We present the case of a 71-year-old woman diagnosed with PCNSL in June 2010. After 3 relapses and intensive treatment with multiple chemotherapy regimens and whole-brain radiotherapy, she received off-label treatment with the Bruton tyrosine kinase inhibitor ibrutinib, responded well, achieved a complete remission, and is progression-free for now >3 years.
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Affiliation(s)
- Anna Mair
- Department of Hematology & Medical Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Armin Muigg
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Stephanie Mangesius
- Department of Neuroradiology, Neuroimaging core facility, Medical University Innsbruck, Innsbruck, Austria
| | - Dominik Wolf
- Department of Hematology & Medical Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Eberhard Gunsilius
- Department of Hematology & Medical Oncology, Medical University Innsbruck, Innsbruck, Austria
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28
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Khanna G, Ahlawat S, Garg N, Gupta R, Patir R. A Rare Case of Isolated Intraventricular Primary Central Nervous System Lymphoma in an 85-Year-Old Man. Asian J Neurosurg 2021; 16:623-625. [PMID: 34660383 PMCID: PMC8477809 DOI: 10.4103/ajns.ajns_551_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/22/2021] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
Primary CNS lymphoma (PCNSL) is rare malignant B cell lymphoid tumor of brain which predominantly occurs in supratentorial region in periventricular location. Majority of PCNSL are of DLBCL type and idiopathic in etiology. Here we are reporting a case of primary CNS lymphoma, DLBCL involving extremely uncommon intraventricular location. Central neurocytoma, subependymal giant cell astrocytoma, choroid plexus tumors and meningiomas are the common diagnosis at this site. Aim of reporting this case is to bring awareness of unusual intraventricular location of primary CNS lymphoma which should be kept in mind before considering gross total excision of lesion.
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Affiliation(s)
- Gaurav Khanna
- SRL Diagnostics, Department of Pathology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Sunita Ahlawat
- SRL Diagnostics, Department of Pathology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Neeraj Garg
- SRL Diagnostics, Department of Pathology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Rakesh Gupta
- Department of Radiology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Rana Patir
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurgaon, Haryana, India
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Calimeri T, Steffanoni S, Foppoli M, Ponzoni M, Ferreri AJM. Implications of recent molecular achievements in early diagnosis and precision treatments for primary CNS lymphoma. Expert Opin Ther Targets 2021; 25:749-760. [PMID: 34606736 DOI: 10.1080/14728222.2021.1988927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system (PCNSL) represents a relevant challenge in onco-hematology. PCNSL has specific molecular profile and biological characteristics that distinguish it from systemic DLBCL. Several translational studies have allowed for significant improvement in the knowledge about its genomic and molecular profile. High-dose-methotrexate-based chemotherapy followed whole-brain irradiation or autologous stem cell transplantation is the most commonly used therapeutic approach in PCNSL patients.Areas covered: This work provides an overview of the new biomarkers of PCNSL, focusing on their potential diagnostic, predictive and prognostic role. Publications in English language, peer-reviewed, high-quality international journals, were identified on PubMed.Expert opinion: Early diagnosis, a better antitumor response definition and recognition of new effective treatments are important research fields aiming to improve PCNSL outcome and management. The acquisition of new molecular and genomic knowledge in PCNSL has allowed for the attainment of promising diagnostic and prognostic tools as well as the development of clinical trials with new therapeutic approaches beyond chemotherapy agents, which have demonstrated activity in refractory/relapsed PCNSL and deserve to be investigated in first-line therapy.
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Affiliation(s)
- Teresa Calimeri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Steffanoni
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Foppoli
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurilio Ponzoni
- Universita' di Medicina e Chirurgia, Vita -Salute San Raffaele, Milano, Italy.,Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Shao L, Xu C, Wu H, Jamal M, Pan S, Li S, Chen F, Yu D, Liu K, Wei Y. Recent Progress on Primary Central Nervous System Lymphoma-From Bench to Bedside. Front Oncol 2021; 11:689843. [PMID: 34485125 PMCID: PMC8416460 DOI: 10.3389/fonc.2021.689843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare subtype of extra-nodal lymphoma. The high relapse rate of PCNSL remains a major challenge to the hematologists, even though patients exhibit high sensitivity to the methotrexate-based chemotherapeutic regimens. Recently, the advent of Bruton's tyrosine kinase inhibitor (BTKi) and CAR T treatment has made more treatment options available to a proportion of patients. However, whether BTKi monotherapy should be given alone or in combination with conventional chemotherapy is still a clinical question. The status of CAR T therapy for PCNSLs also needs to be elucidated. In this review, we summarized the latest progress on the epidemiology, pathology, clinical manifestation, diagnosis, and treatment options for PCNSLs.
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Affiliation(s)
- Liang Shao
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chengshi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huijing Wu
- Department of Lymphoma Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Muhammad Jamal
- Department of Immunology, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Shan Pan
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Sirui Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fei Chen
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ding Yu
- Department of Lymphoma Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kui Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Sugita Y, Hashimoto G, Fukuda K, Takahashi K, Shioga T, Furuta T, Arakawa F, Ohshima K, Nakamura H, Miyata H, Watanabe M, Kakita A. Primary Nondural Central Nervous System Marginal ZoneB-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue Type Mimicking CNS Inflammatory Diseases. J Neuropathol Exp Neurol 2021; 80:789-799. [PMID: 34383910 DOI: 10.1093/jnen/nlab058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Marginal zone B-cell lymphomas (MZBCLs) are non-Hodgkin lymphomas arising from postgerminal center marginal zone B cells. MZBCLs are subclassified into extranodal, nodal, and splenic MZBCLs. Primary nondural central nervous system (CNS) MZBCLs of the mucosa-associated lymphoid tissue (MALT) type are among the extranodal examples. Their clinicopathological features are not well characterized. Therefore, the clinicopathological features of 8 primary nondural CNS MZBCLs of the MALT type were assessed to establish their pathological diagnostic criteria. Histologically, all cases of primary nondural CNS MZBCLs of the MALT type showed perivascular expansive monotonous proliferation of small atypical B lymphoid cells with plasma cell differentiation, low Ki-67 labeling index, and minimal invasion from the perivascular space. In addition, no vascular changes such as glomeruloid changes, obliterative fibrointimal proliferation, and intramural lymphocytic infiltration were seen. These key histological characteristics should be considered when diagnosing cases that are suspected to be primary nondural CNS MZBCLs of the MALT type. Additionally, regarding PCR for the detection of immunoglobulin heavy variable gene and T-cell receptor γ gene rearrangements, the former is detected, but the latter is not detected in all cases. Therefore, PCR detection including sequence analysis should be added when diagnosing difficult cases based on the key histological characteristics.
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Affiliation(s)
- Yasuo Sugita
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Go Hashimoto
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Kenji Fukuda
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Kenji Takahashi
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Taro Shioga
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Takuya Furuta
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Fumiko Arakawa
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Koichi Ohshima
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Hideo Nakamura
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Hajime Miyata
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Masashi Watanabe
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Akiyoshi Kakita
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
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Yoon SE, Kim YJ, Shim JH, Park D, Cho J, Ko YH, Park WY, Mun YC, Lee KE, Cho D, Kim WS, Kim SJ. Plasma Circulating Tumor DNA in Patients with Primary Central Nervous System Lymphoma. Cancer Res Treat 2021; 54:597-612. [PMID: 34325497 PMCID: PMC9016302 DOI: 10.4143/crt.2021.752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Analysis of circulating tumor DNA (ctDNA) in blood could allow noninvasive genetic analysis of primary tumors. Although there have been unmet needs for noninvasive methods in patients with primary central nervous system lymphoma (PCNSL), it is still not determined whether plasma ctDNA analysis could be useful for patients with PCNSL. Materials and Methods Targeted deep sequencing of 54 genes was performed in cell-free DNA isolated from plasma samples collected pretreatment, during treatment, and at the end of treatment in 42 consecutively diagnosed PCNSL patients between January 2017 and December 2018. Results Targeted sequencing of plasma cell-free DNA detected somatic mutations representing ctDNA in 11 cases (11/41, 27%). The detection of ctDNA was not related to the concentration of cell-free DNA or tumor volume. The mutation profiles of these 11 cases varied between patients. The most frequently mutated gene was PIM1 (4/11, 36.4%), whereas KMT2D, PIK3CA, and MYD88 were each observed in three patients (3/11, 27%). The mutations of 13 genes were concordantly found in primary tumor tissue and plasma ctDNA, giving a detection sensitivity of 45%. During the serial tracking of seven patients with complete response, the disappearance of ctDNA mutations was found in four patients, whereas three patients had detected ctDNA mutation at the end of treatment. Conclusion The plasma ctDNA mutation analysis still has limited value for surveillance and predicting treatment outcomes of PCNSL because the detection efficiency was lower than other systemic lymphomas. Thus, analytical platforms should be improved to overcome anatomical hurdles associated with PCNSL.
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Affiliation(s)
- Sang Eun Yoon
- Division of Hematology-oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Jeong Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Joon Ho Shim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Donghyun Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,GENINUS Inc., Seoul, Korea
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yeung-Chul Mun
- Division of Hematology-Oncology, Department of Internal Medicine, Ewha Medical Research Center, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyoung Eun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Ewha Medical Research Center, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
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Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Tantiworawit A, Norasetthada L. Outcome of patients with newly diagnosed primary CNS lymphoma after high-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine: an 8-year cohort study. Int J Clin Oncol 2021; 26:1805-1811. [PMID: 34236556 DOI: 10.1007/s10147-021-01982-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Addition of cytarabine to high-dose methotrexate (HD-MTX) chemotherapy improves outcome of primary CNS lymphoma (PCNSL); however, the combination therapy increases toxicity. Sequential chemotherapy and cranial radiation may decrease toxicity without altering efficacy. METHODS This was a single-center, retrospective cohort study of consecutive newly diagnosed immunocompetent PCNSL patients treated with HD-MTX (5 cycles of 3 g/m2 every 2 weeks) followed by consolidation whole-brain radiotherapy (WBRT) and cytarabine (2 cycles of 3 g/m2/d for 2 days every 3 weeks) from January 2013 to December 2020. Initial WBRT before HD-MTX was allowed in patients with significant disability or brain edema at presentation. Primary outcome was progression-free survival (PFS). Key secondary outcomes were response rate, treatment-related toxicity, and overall survival (OS). RESULTS Of 41 patients, 25 patients had a complete response (CR) and ten patients had a partial response, inferring an overall response rate (ORR) of 85.4% and a CR rate of 60.9%. More than 90% of patients were able to tolerate and complete the HD-MTX. The incidence of ≥ grade 3 hematologic and non-hematologic toxicities were 4.8% and 17.1%, respectively. Treatment-related mortality rate was 2.4%. There was no difference in toxicity between patients with age < 60 and ≥ 60 years. At the median follow-up duration of 39.8 months, the median PFS was 35.2 months (95% CI 12.4-69.3) and median OS was 46.5 months (95% CI 21.8-NR). CONCLUSION High-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine has acceptable efficacy, great tolerability, and low toxicity in newly diagnosed PCNSL patients.
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Affiliation(s)
- Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
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Barbaro M, Fine HA, Magge RS. Foundations of Neuro-Oncology: A Multidisciplinary Approach. World Neurosurg 2021; 151:392-401. [PMID: 33618043 DOI: 10.1016/j.wneu.2021.02.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Neuro-oncology is a branch of medicine focused on the diagnosis and treatment of primary and secondary tumors of the nervous system as well as the neurologic complications of cancer and cancer treatments. In practice, neuro-oncologists require an intimate knowledge of the neurologic presentation and management of central nervous system tumors, including gliomas, meningiomas, primary central nervous system lymphoma, metastases to the nervous system, and others. The mainstays of treatment for most nervous system tumors include surgical intervention, radiation therapy, and medical treatment with chemotherapy, immunotherapy, and/or targeted therapy. Interdisciplinary collaboration is thus critical to neuro-oncology. The prognosis for many central nervous system tumors, including gliomas and brain metastases, is often poor despite the advent of novel medical therapies. Efforts to develop more effective therapies are ongoing, and patient enrollment in clinical trials assessing the efficacy of new treatments is crucial to improve outcomes.
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Bonm AV, Gibson AW, Holmberg LA, Mielcarek M, McGranahan T, Taylor LP, Graber JJ. A single-center retrospective analysis of outcome measures and consolidation strategies for relapsed and refractory primary CNS lymphoma. J Neurooncol 2021; 151:193-200. [PMID: 33398532 DOI: 10.1007/s11060-020-03648-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relapsed or refractory primary CNS lymphoma (rrPCNSL) is a rare and challenging malignancy for which better evidence is needed to guide management. METHODS We present a retrospective cohort of 66 consecutive patients with rrPCNSL treated at the University of Washington between 2000 and 2020. Immunosuppressed and secondary CNS lymphoma patients were excluded. RESULTS During a median follow-up of 40.5 months from initial diagnosis, median OS for relapsed disease was 14.1 (0.2-88.5) months and median PFS was 11.0 (0.2-73.9) months. At diagnosis (r2 = 0.85, p < 0.001), first relapse (r2 = 0.69, p < 0.001), multiple relapses (r2 = 0.97, p < 0.001) PFS was highly correlated with OS. In contrast, there was no correlation between the duration of subsequent progression-free intervals. No difference in PFS or OS was seen between CSF or intraocular relapse and parenchymal relapse. Patients reinduced with high-dose methotrexate-based (HD-MTX) regimens had an overall response rate (ORR) of 86.7%. Consolidation with autologous stem cell transplant (ASCT) was associated with longer PFS compared to either no consolidation (p = 0.01) and trended to longer PFS when compared to other consolidation strategies (p = 0.06). OS was similarly improved in patients consolidated with ASCT compared with no consolidation (p = 0.04), but not compared with other consolidation (p = 0.22). Although patients receiving ASCT were younger, KPS, sex, and number of recurrences were similar between consolidation groups. A multivariate analysis confirmed an independent effect of consolidation group on PFS (p = 0.01), but not OS. CONCLUSIONS PFS may be a useful surrogate endpoint which predicts OS in PCNSL. Consolidation with ASCT was associated with improved PFS in rrPCNSL.
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Affiliation(s)
- Alipi V Bonm
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Alec W Gibson
- Medical Scientist Training Program, University of Washington, Seattle, WA, USA
| | - Leona A Holmberg
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marco Mielcarek
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tresa McGranahan
- Departments of Neurology and Neurosurgery, Alvord Brain Tumor Center, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Lynne P Taylor
- Departments of Neurology and Neurosurgery, Alvord Brain Tumor Center, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Jerome J Graber
- Departments of Neurology and Neurosurgery, Alvord Brain Tumor Center, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, 98195, USA.
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Alvarez-Pinzon AM, Wolf A, Valerio JE, Borro M, Herrera D, Alonso JR. Gamma knife stereotactic radiosurgery as an effective tool in primary CNS lymphoma: Evaluation of stereotactic radiosurgery and methotrexate treatment in a prospective and observational clinical research study. Clin Neurol Neurosurg 2020; 201:106457. [PMID: 33418336 DOI: 10.1016/j.clineuro.2020.106457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the progression of Primary Central Nervous System Lymphoma (PCNSL) in patients treated with methotrexate (MTX) versus those treated with a combination of Stereotactic Radiosurgery (SRS) and MTX. Progression was measured via brain lesion count and tumor volume. METHODS This observational and prospective cohort study evaluated the outcome of SRS treatment of PCNSL in one hundred twenty-eight subjects. We analyzed baseline, prospective, and retrospective data of patients enrolled in the brain tumor registry between June 2010 and August 2017. Seventy-three patients were treated exclusively with MTX while the remaining fifty-five patients received a combination of SRS and MTX. Strict inclusion and exclusion criteria were established. RESULTS Mean survival rate for patients receiving combined SRS and MTX treatment was significantly higher (52.6 months) compared to the MTX group (19.8 months); p = 0.0029. At the 36 months follow-up, patients treated with SRS and MTX also had a lower rate of tumor progression (32.7 %) than the MTX group (95.9 %); p = 0.00192. Local tumor control was achieved in all patients treated with SRS. No clinical toxicity was observed in this group. CONCLUSIONS Clinical results obtained from this observational study highlight the potential effectiveness of SRS in the treatment of PCNSL. Although treatment outcomes have improved in the past years, additional evidence in the clinical design of randomized trials is needed to evaluate the strength of this treatment in specific situations.
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Affiliation(s)
- Andres M Alvarez-Pinzon
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States; The Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca (USAL), Salamanca, Spain; University California, San Francisco, Department of Neurological Surgery, Skull Base and Cerebrovascular Laboratory, CA, United States.
| | - Aizik Wolf
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States
| | - Jose E Valerio
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States
| | - Matteo Borro
- Neurosurgery Oncology Department, Miami Neurosciences Center at Larkin, South Miami, FL, United States
| | - Daniela Herrera
- Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jose Ramon Alonso
- The Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca (USAL), Salamanca, Spain
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Gazal S, Lebel E, Kalish Y, Makranz C, Gatt ME, Goldschmidt N, Nachmias B. Venous Thromboembolism Prophylaxis with Low-Molecular-Weight Heparin in Primary Central Nervous System Lymphoma. Oncol Res Treat 2020; 44:52-57. [PMID: 33296909 DOI: 10.1159/000512241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a frequent, potentially lethal complication in individuals with cancer. Patients with brain tumors are at particularly high risk for VTE. Primary central nervous system lymphoma (PCNSL) is a rare subtype of diffuse large B cell lymphoma, involving the craniospinal axis. The incidence of VTE in patients with PCNSL was reported as very high, occurring mostly in the early period of therapy. OBJECTIVES We aimed to evaluate the efficacy and safety of prophylactic low-molecular-weight heparin (LMWH) throughout the treatment of PCNSL. PATIENTS All patients >18 years of age diagnosed and treated for PCNSL at our institution in 2005-2017 were included. RESULTS There were 44 patients; mean age at diagnosis was 61.5 years. Three patients (6.8%) had a personal history of thrombosis, 11 (25%) had a history of diabetes or smoking, and 32 (72%) had an Eastern Cooperative Oncology Group performance status of 0-1 at diagnosis. During treatment with LMWH, no VTE events were recorded; 2 (4.5%) patients experienced a minor bleeding event and 1 (2.3%) a major bleeding event. CONCLUSIONS Among our 44 patients with PCNSL treated with prophylactic LMWH, no VTE events were recorded, and only 1 (asymptomatic) intracranial bleed was recorded. Within the limitations of a retrospective nonrandomized study, our findings suggest that VTE prophylaxis may be beneficial for individuals with PCNSL.
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Affiliation(s)
- Stav Gazal
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eyal Lebel
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Chen Makranz
- Leslie and Michael Gaffin Center for Neuro-Oncology, Departments of Oncology and Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Moshe E Gatt
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Boaz Nachmias
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel,
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Kam KL, Brooker SM, Mao Q, Barnea Slonim L, Yaseen NR, Brat DJ, Sonabend AM, Lukas RV. Newly diagnosed enhancing lesions: Steroid initiation may impede diagnosis of lymphoma involving the central nervous system. J Clin Neurosci 2020; 81:61-64. [PMID: 33222970 DOI: 10.1016/j.jocn.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/03/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
Establishing the pathologic diagnosis of central nervous system (CNS) lymphoma can be challenging, yet management of this potentially curable disease depends heavily on it. One avoidable impediment to obtaining an accurate and timely diagnosis is the pre-operative administration of steroids, which causes tumor involution and prevents appropriate sampling of viable tissue. We discuss a case of primary CNS lymphoma that highlights the evolution of the disease and the attempts to establish a diagnosis in the setting of prior administration of corticosteroids. Familiarity with these clinical scenarios will help others avoid delays in patient care that results from delayed diagnosis.
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Affiliation(s)
- Kwok-Ling Kam
- Northwestern University, Department of Pathology, United States.
| | - Sarah M Brooker
- Northwestern University, Department of Neurology, United States
| | - Qinwen Mao
- Northwestern University, Department of Pathology, United States; Lou & Jean Malnati Brain Tumor Institute, United States
| | | | - Nabeel R Yaseen
- Northwestern University, Department of Pathology, United States
| | - Daniel J Brat
- Northwestern University, Department of Pathology, United States; Lou & Jean Malnati Brain Tumor Institute, United States
| | - Adam M Sonabend
- Northwestern University, Department of Neurological Surgery, United States; Lou & Jean Malnati Brain Tumor Institute, United States
| | - Rimas V Lukas
- Northwestern University, Department of Neurology, United States; Lou & Jean Malnati Brain Tumor Institute, United States
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AlOhaly N, Nathoo N, Schmitt LM, McCombe JA Dr. Lymphomatosis cerebri masquerading as the Marburg variant of multiple sclerosis. Mult Scler Relat Disord 2020; 46:102488. [PMID: 32911305 DOI: 10.1016/j.msard.2020.102488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022]
Abstract
Lymphomatosis cerebri (LC) is a rare variant of primary central nervous system lymphoma with few cases reported. Here, we describe the case of a patient with clinical presentation, imaging, and biopsy in keeping with aggressive multiple sclerosis (MS) such as that in Marburg variant. He deteriorated clinically over 9 months. Post-mortem examination yielded a diagnosis of LC with B-cell lymphoma. LC is notoriously difficult to diagnose, as it can present in various ways and biopsy of unaffected areas will be non-diagnostic. In our case, diagnosis was made more challenging by the patient's dramatic response to treatment with steroids and cyclophosphamide.
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Khurana A, Micallef IN, LaPlant BR, Patrick O'Neill B, Habermann TM, Ansell SM, Inwards DJ, Porrata LF, Paludo J, Bisneto JCV, Johnston PB. Outcomes of Autologous Stem Cell Transplant Consolidation in Primary Central Nervous System Lymphoma: A Mayo Clinic Experience. Biol Blood Marrow Transplant 2020; 26:2217-2222. [PMID: 32818553 DOI: 10.1016/j.bbmt.2020.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022]
Abstract
A paucity of randomized phase III clinical trials in primary central nervous system lymphoma (PCNSL) has resulted in no uniform consensus on the optimal strategy for consolidation and conditioning regimens for autologous stem cell transplant (ASCT). The past 2 decades have witnessed a preference for thiotepa (TT)-based conditioning regimens due to superior central nervous system penetration. We retrospectively evaluated outcomes of patients with PCNSL who underwent ASCT at Mayo Clinic, Rochester over the past 2 decades, and the impact of TT-based conditioning regimens. Fifty-six patients underwent transplant for PCNSL, with 25 and 31 patients receiving BEAM (non-thiotepa) and carmustine (BCNU)/TT-based conditioning, respectively. All patients received high-dose methotrexate-based induction therapy. While the BCNU/TT group had higher risk disease features such as high International Extranodal Lymphoma Study Group prognostic score, elevated cerebrospinal fluid protein, and older patient population, there was no significant difference at 2 years post-transplant in progression-free survival (BEAM 68.0% [46.1% to 82.5%] versus BCNU/TT, 65.5% [45.2% to 79.8%], P = .99) or overall survival (OS) (84.0% [62.8% to 93.7%] in the BEAM group versus 81.6% [61.3% to 91.9%] in the BCNU/TT group, P = .95). Disease response status before transplant significantly affected the outcomes as those in complete remission had an OS at 2 years post-transplant of 94.7% (68.1% to 99.2%) in the BEAM group and 90.5% (67.0% to 97.5%) in the BCNU/TT group compared with those in partial response, 57.1% (17.2% to 83.7%) in BCNU/TT group and 50.0% (11.1% to 80.4%) in the BEAM group, respectively (P < .0001). Our retrospective cohort adds to the currently available literature and identifies the disease status before transplant as a significant factor affecting survival.
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Affiliation(s)
- Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Betsy R LaPlant
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Luis F Porrata
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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Abstract
OPINION STATEMENT Primary central nervous system lymphoma is a complex disease with no agreed-upon standard-of-care therapy. Induction therapy involves multiagent chemotherapy based on high-dose methotrexate, with several regimens available. We have a preference for a regimen using rituximab, methotrexate (3.5 g/m2), procarbazine, and vincristine (R-MPV) for initial induction therapy, given the favorable balance between toxicities and very high response rates (80-90%), which allow for decreasing disease burden and increasing the effectiveness of consolidation treatments. However, in the absence of consolidation therapies, R-MPV is not an effective regimen to achieve long-term remission.Based on high rates of long-term remission, our first choice for consolidation therapy is high-dose chemotherapy with autologous stem-cell transplant using thiotepa, busulfan, and cyclophosphamide as a myeloablative regimen, with a curative intent. This typically applies to patients with a favorable performance status at the end of induction, typically with ECOG performance status of 2 or better, adequate organ function, and age younger than 70. Patients with a high transplant-related mortality risk may still be considered for milder myeloablative regimens such as carmustine/thiotepa.For patients who are not transplant candidates, we typically offer consolidation with reduced dose whole-brain radiation therapy (WBRT) (23.4 Gy), which seems to be associated with lower risks of neurotoxicity as compared with higher doses of radiation. For patients who are not transplant candidates and that do not accept the risk of cognitive decline from the radiotherapy, we typically offer consolidation high-dose cytarabine, provided the patient understands the high risk of relapse. For these patients, a clinical trial is strongly recommended.
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Kaulen LD, Karschnia P, Dietrich J, Baehring JM. Autoimmune disease-related primary CNS lymphoma: systematic review and meta-analysis. J Neurooncol 2020; 149:153-9. [PMID: 32683530 DOI: 10.1007/s11060-020-03583-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent studies suggest a relatively high prevalence of autoimmune disorders (AD) among primary CNS lymphoma (PCNSL) patients, however, the literature is limited to case reports. To gain a better understanding of AD-PCNSL we reviewed and analyzed all cases described in the literature. METHODS We searched the MEDLINE database using the search terms 'central nervous system lymphoma' or 'CNS lymphoma' along with AD-related terms. We selected 39 records for qualitative synthesis of data and identified 50 AD-PCNSL. Clinical, imaging and outcome data were collected. Overall survival (OS) was analyzed with the Kaplan-Meier method. Univariate and multivariate analyses were performed using log rank test and Cox proportional hazard model. RESULTS Most common AD were systemic lupus erythematosus (24%), multiple sclerosis (16%), and myasthenia gravis (14%). All patients had received immunosuppressants for their AD. Median interval from AD until PCNSL diagnosis was 108 months (range: 11-420). Male-to-female ratio was 0.42 and AD-PCNSL was diagnosed at a median age of 57 years (range: 2-88). On imaging lesions typically localized to the hemispheres (65%) and displayed peripheral enhancement (74%). Pathological evaluation revealed diffuse large-B-cell lymphoma (DLBCL) subtype (80%) and Epstein-Barr virus positivity (75%) in most AD-PCNSL. Median OS was 31 months. Age > 60 years (p = 0.014) was identified as a significant prognostic factor. CONCLUSIONS AD requiring immunosuppression appear over-represented in the population of PCNSL patients. Aggressive polychemotherapy can accomplish long term OS in AD-PCNSL comparable to immunocompetent patients. Age > 60 may serve as a prognostic factor.
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El-Tawab R, Hamada A, Elhagracy R, Pinto K, Alshemmari S. Promising effect of PDL1 inhibitors in the front-line management of primary aggressive central nervous system lymphoma: A case report. Hematol Oncol Stem Cell Ther 2020:S1658-3876(20)30114-X. [PMID: 32649868 DOI: 10.1016/j.hemonc.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare lymphoma that involves the central nervous system. The standard treatment involves chemotherapy with high-dose methotrexate. To the best of our knowledge, this is the first reported case of employing checkpoint inhibitor, nivolumab, alone to treat a patient with PCNSL who could not tolerate the induction therapy. In aggressive cases of PCNSL where chemotherapy may become futile, stand-alone checkpoint inhibitors should be considered as the front-line treatment protocol.
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Affiliation(s)
- Rasha El-Tawab
- Department of Hematology, Kuwait Cancer Control Center, Kuwait
| | | | - Rehab Elhagracy
- Department of Hematology, Kuwait Cancer Control Center, Kuwait
| | - Karen Pinto
- Department of Pathology, Kuwait Cancer Control Center, Kuwait.
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Farah RA, Alduaij A, Ugas C, Navarro R. Primary Central Nervous System Lymphoma in a Patient on Adalimumab Therapy for Chronic Plaque Psoriasis. World Neurosurg 2020; 139:260-263. [PMID: 32247793 DOI: 10.1016/j.wneu.2020.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adalimumab (Humira) is a recombinant human monoclonal antibody against tumor necrosis factor alpha, which works by blocking the interaction of tumor necrosis factor alpha with its cell-surface receptors, thereby limiting the progression of inflammatory pathways. Its use is approved for several autoimmune conditions, including chronic plaque psoriasis, for which it has been prescribed as a first-line biologic treatment. Increased risks of malignancy, particularly nonmelanoma skin cancer and non-central nervous system lymphomas, have been reported with use of this drug; however, there have been no reports of central nervous system lymphomas. CASE DESCRIPTION A 43-year-old man presented for evaluation following recent speech difficulty and a generalized tonic-clonic seizure. His medical history was significant for plaque psoriasis, for which he had been receiving treatment with adalimumab for 4 months. Magnetic resonance imaging scan of the brain with contrast agent showed a well-defined rounded enhancing lesion in the left temporal lobe with circumferential vasogenic edema. Mass effect was noted. Computed tomography scan of the chest, abdomen, and pelvis was unremarkable. He underwent excisional biopsy, and the preliminary intraoperative pathology report revealed a diagnosis of high-grade lymphoma. Subsequent analysis of morphology and immunophenotyping was consistent with primary diffuse large B-cell lymphoma of the central nervous system. Use of adalimumab was discontinued. Following combination therapy with high-dose methotrexate and rituximab along with 20 sessions of cranial radiation therapy, the patient was disease-free at 14-month follow-up. CONCLUSIONS We report the first case to our knowledge showing a possible association of central nervous lymphoma and adalimumab.
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Affiliation(s)
| | - Ahmad Alduaij
- Pathology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi
| | - Carlos Ugas
- Neurosurgery Department, Cleveland Clinic Abu Dhabi, Abu Dhabi
| | - Ramon Navarro
- Neurosurgery Department, American Hospital, Dubai, United Arab Emirates.
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Gessler F, Bernstock JD, Behmanesh B, Brunnberg U, Harter P, Ye D, Friedman GK, Hansmann ML, Wagner M, Seifert V, Weise L, Marquardt G. The Impact of Early Corticosteroid Pretreatment Before Initiation of Chemotherapy in Patients With Primary Central Nervous System Lymphoma. Neurosurgery 2020; 85:264-272. [PMID: 30016483 DOI: 10.1093/neuros/nyy272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/27/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The optimal timing of corticosteroid (CS) treatment in patients with primary central nervous system (CNS) lymphoma (PCNSL) remains controversial. While poor clinical presentation may justify early treatment with CS, this may ultimately result in reduced concentrations of chemotherapeutic agents via perturbations in the permeability of the blood-brain barrier. OBJECTIVE To investigate whether early CS exposure is associated with beneficial outcomes and/or reduced occurrence of adverse events as opposed to delayed/concomitant administration. METHODS Herein we performed a retrospective observational analysis using patients that were prospectively entered into a database. All patients whom were admitted to the University Hospital between 2009 and 2015 with newly diagnosed PCNSL were included within our study. RESULTS Our cohort included 50 consecutive patients diagnosed with PCNSL; of these, in 30 patients CS administration was initiated prior to chemotherapy (early), whilst in the remaining 20 patients CS administration was initiated concomitantly with their chemotherapeutic regimen (concomitant). Within the early vs concomitant CS administration groups, no significant differences were observed with regard to progression-free survival (PFS) (P = .81), overall survival (OS) (P = .75), or remission (P = .68; odds ratio 0.76 and confidence interval [95%] 0.22-2.71). Critically, the timing of CS initiation was not associated with either PFS (P = .81) or PFS (P = .75). CONCLUSION Early CS administration was not associated with a deterioration in response to chemotherapy, PFS, or OS. As such, administration of CS prior to initiation of chemotherapy is both reasonable and safe for patients with newly diagnosed PCNSL.
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Affiliation(s)
- Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, Maryland
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Uta Brunnberg
- Department of Internal Medicine II, Hematology/Oncology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Patrick Harter
- Institute of Neurology (Edinger-Institute), Goethe-University Frankfurt, Frankfurt, Germany
| | - Daniel Ye
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, Maryland
| | - Gregory K Friedman
- Neuro-Oncology Program, Department of Pediatrics, University of Alabama, Birmingham, Alabama
| | - Martin-Leo Hansmann
- Dr Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Lutz Weise
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Schleusenweg, Frankfurt, Germany
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Ambady P, Fu R, Szidonya L, Peereboom DM, Doolittle ND, Neuwelt EA. Impact of maintenance rituximab on duration of response in primary central nervous system lymphoma. J Neurooncol 2020; 147:171-6. [PMID: 32026432 DOI: 10.1007/s11060-020-03411-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The role of maintenance immunotherapy with anti-CD20 monoclonal antibody rituximab in primary central nervous system lymphoma (PCNSL) is unclear. We retrospectively reviewed the medical records of all immunocompetent adults with newly diagnosed PCNSL treated at our institution between1996 and 2017. METHODS We identified 66 patients who attained complete response (CR) after completion of first-line regimen; 20 received maintenance therapy (maintenance therapy group) and 46 were observed with serial MRI scans without maintenance therapy (no-maintenance therapy group). RESULTS Compared to the surveillance group, there was a significant increase in duration of survival (HR 0.27, 95% CI 0.08-0.98, P = 0.046) in the maintenance therapy group while the reduction in the risk of progression was not significant (HR: 0.61, 95% CI 0.26-1.43, P = 0.259). CONCLUSION We are evaluating the effectiveness of maintenance immunotherapy in PCNSL in a prospective multicenter randomized clinical trial.
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Bullis CL, Maldonado-Perez A, Bowden SG, Yaghi N, Munger D, Wood MD, Barajas RF, Ambady P, Neuwelt EA, Han SJ. Diagnostic impact of preoperative corticosteroids in primary central nervous system lymphoma. J Clin Neurosci 2020; 72:287-291. [PMID: 31648968 DOI: 10.1016/j.jocn.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE High dose corticosteroids are an effective tool for rapidly alleviating neurologic symptoms caused by intracranial mass lesions. However, there is concern that preoperative corticosteroids limit the ability to obtain a definitive pathologic diagnosis, particularly if imaging features suggest primary central nervous system lymphoma (PCNSL). METHODS To explore the impact of preoperative corticosteroids in newly diagnosed PCNSL patients, from 2009 to 2018 treated at our institution. RESULTS We identified 54 patients; 18 had received corticosteroids prior to biopsy or resection. Only in one case did the patient have a prior non-diagnostic biopsy, requiring a second procedure. The cumulative doses of preoperative dexamethasone ranged from 4 mg to 120 mg (mean 32 mg, median 24 mg), given over 1-14 days (mean 2 days, median 1 day), and the majority had received corticosteroids for only 1-2 days. There was a trend for a larger diameter of lesional T1 contrast enhancement for patients who received steroids (39 mm vs. 34 mm, p = 0.11). In this series of cases with pathologically and clinically proven PCNSL, preoperative corticosteroids had been given in a third of cases, suggesting that they may be given for symptomatic relief without compromising pathologic diagnosis. CONCLUSIONS Despite the commonly held tenet that preoperative corticosteroids can obscure the pathologic diagnosis in PCNSL, this is likely not the case in the majority of patients who receive a short course preoperatively. Obtaining a second stereotactic scan to confirm continued presence of the lesion prior to tissue sampling may also mitigate these concerns.
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Affiliation(s)
- C L Bullis
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - A Maldonado-Perez
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States; Ponce Health Sciences University, Ponce, PR, United States
| | - S G Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - N Yaghi
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - D Munger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - M D Wood
- Department of Pathology (Neuropathology), Oregon Health & Science University, Portland, OR, United States
| | - R F Barajas
- Department of Radiology, Oregon Health & Science University, Portland, OR, United States
| | - P Ambady
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - E A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - S J Han
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States.
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Beca JM, Raza K, Mow E, Keech J, Kouroukis CT. Cost-effectiveness analysis of rituximab with methotrexate, cytarabine and thiotepa for the treatment of patients with primary central nervous system lymphoma. Leuk Lymphoma 2020; 61:1097-1107. [PMID: 31931647 DOI: 10.1080/10428194.2020.1711902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The International Extranodal Lymphoma Study Group-32 (IELSG32) randomized patients with primary central nervous system lymphoma (PCNSL) for induction treatment with methotrexate-cytarabine, methotrexate-cytarabine-rituximab, or methotrexate-cytarabine-thiotepa-rituximab (MATRix) and reported significantly improved complete remission with the MATRix regimen. This study assessed cost-effectiveness among these three induction strategies for PCNSL. A Markov model was developed based on the IELSG32 trial over a 20 year time horizon from the Canadian health care system perspective. Costs for induction, consolidation, inpatient treatment administration, follow-up, adverse events, relapsed disease, and palliative care were included. Methotrexate-cytarabine-rituximab was subject to extended dominance by the other two strategies. The MATRix regimen compared to methotrexate-cytarabine produced 3.05 quality-adjusted life year (QALY) gains at added costs of $75,513, resulting in an incremental cost-effectiveness ratio of $24,758/QALY gained. The MATRix regimen was the optimal strategy in the majority of simulations (98% probability at willingness-to-pay of $50,000/QALY gained) and results appeared robust across sensitivity analyses.
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Affiliation(s)
- Jaclyn M Beca
- Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Kaiwan Raza
- Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Canada
| | - Elena Mow
- Provincial Drug Reimbursement Programs, Cancer Care Ontario, Toronto, Canada
| | - James Keech
- Provincial Drug Reimbursement Programs, Cancer Care Ontario, Toronto, Canada
| | - C Tom Kouroukis
- Provincial Drug Reimbursement Programs, Cancer Care Ontario, Toronto, Canada.,Juravinski Cancer Centre and Hospital, Hamilton, Canada.,Department of Oncology, McMaster University, Hamilton, Canada
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49
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Abstract
Primary CNS lymphoma (PCNSL) is a rare intracranial tumor. Several treatment regimens exist, but there is no one established standard of care regimen. This article reviews the effects of the addition of rituximab to induction chemotherapy for PCNSL patients. The addition of rituximab in phase II trials seems to increase the overall response rates (ORR) of PCNSL patients, especially when they receive consolidation therapy after rituximab-based induction chemotherapy regimens. Upfront rituximab added to MBVP chemotherapy did not improve overall survival in PCNSL patients, but it may benefit specific subpopulations of PCNSL patients. This review highlights the potential benefit of rituximab as part of induction chemotherapy with consolidation treatment.
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Affiliation(s)
| | - Edward Pan
- University of Texas Southwestern Medical Center, USA.
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50
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Correa DD, Braun E, Kryza-Lacombe M, Ho KW, Reiner AS, Panageas KS, Yahalom J, Sauter CS, Abrey LE, DeAngelis LM, Omuro A. Longitudinal cognitive assessment in patients with primary CNS lymphoma treated with induction chemotherapy followed by reduced-dose whole-brain radiotherapy or autologous stem cell transplantation. J Neurooncol 2019; 144:553-62. [PMID: 31377920 DOI: 10.1007/s11060-019-03257-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The standard treatment for primary central nervous system lymphoma (PCNSL) involves induction methotrexate-based chemotherapy with or without consolidation whole brain radiotherapy (WBRT). As WBRT carries a substantial risk for cognitive impairment, alternative consolidation treatments have been used to reduce neurotoxicity, including reduced-dose WBRT (rdWBRT) or high-dose chemotherapy with autologous stem cell transplant (HDC-ASCT). In this study, we characterized cognitive functions in PCNSL patients achieving long-term remission following rdWBRT or HDC-ASCT. METHODS PCNSL patients completed cognitive evaluations at diagnosis, post-induction chemotherapy, and yearly up to 5 years following rdWBRT or HDC-ASCT. Quality of life (QoL), white matter (WM) disease, and cortical atrophy (CA) on MRI were assessed at similar intervals. RESULTS Performance was impaired on most cognitive tests at diagnosis. Linear mixed model analyses in each group showed statistically significant improvement from baseline up to year 3 in attention/executive functions, graphomotor speed, and memory; however, there was a decline in attention/executive functions and memory after year 3 in both groups. WM abnormalities increased over time in both groups, but more patients treated with rdWBRT developed CA and WM changes. There were no significant longitudinal group differences in cognitive performance or QoL. CONCLUSIONS Results indicated improvement in cognitive function up to 3 years post-treatment, but a decline at later time points and an increase in brain structure abnormalities in both groups. The findings suggest that rdWBRT and HDC-ASCT may be associated with delayed neurotoxicity in progression-free patients and underscore the need for long-term follow-up to characterize cognitive dysfunction in PCNSL patients.
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