Outcomes and relapse patterns in primary central nervous system lymphoma: Longitudinal analysis of 559 patients diagnosed from 1983 to 2020 Journal Article

   

Authors:	Tringale, K. R.; Scordo, M.; Yahalom, J.; White, C.; Zhang, Z.; Vachha, B.; Cederquist, G.; Schaff, L.; Deangelis, L.; Grommes, C.; Imber, B. S.
Article Title:	Outcomes and relapse patterns in primary central nervous system lymphoma: Longitudinal analysis of 559 patients diagnosed from 1983 to 2020
Abstract:	Background: Contemporary outcomes and relapse patterns in primary CNS lymphoma (PCNSL) are lacking. We analyzed factors associated with relapse in a large cohort with extensive follow-up. Methods: T1-post-contrast-enhancing disease was characterized in immunocompetent PCNSL (diffuse large B-cell) patients from 1983 to 2020. Patients were stratified by response to induction and consolidation (complete/unconfirmed [CR/CRu], partial, stable, progression [POD]). Refractory was POD during (or relapse ≤3 months of) induction. Initial relapse site was categorized as local (involving/adjacent to baseline), distant intraparenchymal, leptomeningeal, or other. Progression-free (PFS) and overall survival (OS) were assessed with proportional hazards. Cumulative incidence with competing risks was used to assess local relapse. Results: Median follow-up was 7.4 years (N = 559). Most (321, 57%) were recursive partitioning analysis class 2 (age ≥50, Karnosfky Performance Status [KPS] ≥70). Most had supratentorial (420, 81%), multifocal (274, 53%), bilateral (224, 43%), and deep structure involvement (314, 56%). Nearly all received methotrexate-based induction (532, 95%). There was no difference in PFS or OS from consolidation based on initial response to induction (CR/CRu vs PR) in patients who ultimately achieved a CR/CRu to consolidation. PFS at 1-, 5 years for 351 patients with CR/CRu to consolidation was 80% (95% confidence interval [95% CI]: 76%-84%) and 46% (95% CI: 41%-53%), respectively; 1-year cumulative incidence of local versus nonlocal relapse was 1.8% versus 15%, respectively. For 97 refractory patients, 1-year cumulative incidence of local versus nonlocal relapse was 57% versus 42%, respectively. Deep structure involvement (HR 1.89, 95% CI: 1.10%-3.27%) was associated with local relapse in refractory patients. Conclusions: We report the first comprehensive relapse patterns in a large PCNSL cohort. While relapses post-CR to consolidation are typically distant and unpredictable, refractory patients had a relatively high incidence of local relapse. These findings can help optimize multimodality therapy for this highest-risk population. © 2024 The Author(s).
Keywords:	adolescent; adult; cancer survival; human tissue; aged; aged, 80 and over; middle aged; survival rate; retrospective studies; young adult; major clinical study; overall survival; mortality; cancer recurrence; salvage therapy; primary central nervous system lymphoma; methotrexate; rituximab; nuclear magnetic resonance imaging; follow up; follow-up studies; antineoplastic agent; progression free survival; computer assisted tomography; neoplasm recurrence, local; tumor volume; antineoplastic combined chemotherapy protocols; vincristine; autologous stem cell transplantation; pathology; retrospective study; histology; procarbazine; central nervous system tumor; central nervous system; central nervous system neoplasms; t cell lymphoma; longitudinal studies; tumor recurrence; chimeric antigen receptor; imaging; radiation therapy; lymphoma, large b-cell, diffuse; drug therapy; therapy; patterns of failure; longitudinal study; cerebrospinal fluid cytology; recurrence free survival; consolidation; whole brain radiotherapy; clinical outcome; diffuse large b cell lymphoma; very elderly; humans; prognosis; human; male; female; article; karnosfky performance status; memorial sloan kettering recursive partitioning analysis
Journal Title:	Neuro-Oncology
Volume:	26
Issue:	11
ISSN:	1522-8517
Publisher:	Oxford University Press
Date Published:	2024-11-01
Start Page:	2061
End Page:	2073
Language:	English
DOI:	10.1093/neuonc/noae115
PUBMED:	38915246
PROVIDER:	scopus
PMCID:	PMC11534311
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85208601503&doi=10.1093%2fneuonc%2fnoae115&partnerID=40&md5=ab7d732a7e2044792b5c1e75a66056d6
Notes:	Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Brandon Imber -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/220592