Outcomes and Relapse Patterns in Primary Central Nervous System Lymphoma: Longitudinal Analysis of 559 Patients Diagnosed From 1983-2020.

Autor:	Tringale KR; Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, USA.; University of California San Diego, Department of Radiation Medicine and Applied Sciences, California, USA., Scordo M; Memorial Sloan Kettering Cancer Center, Department of Medicine, Adult Bone Marrow Transplant Service, New York, USA., Yahalom J; Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, USA., White C; Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, USA., Zhang Z; Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, USA., Vachha B; UMass Chan Medical School, Department of Radiology, Massachusetts, USA., Cederquist G; Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, USA., Schaff L; Memorial Sloan Kettering Cancer Center, Department of Neurology/Neuro-oncology, New York, USA., DeAngelis L; Memorial Sloan Kettering Cancer Center, Department of Neurology/Neuro-oncology, New York, USA., Grommes C; Memorial Sloan Kettering Cancer Center, Department of Neurology/Neuro-oncology, New York, USA., Imber BS; Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, USA.
Jazyk:	angličtina
Zdroj:	Neuro-oncology [Neuro Oncol] 2024 Jun 25. Date of Electronic Publication: 2024 Jun 25.
DOI:	10.1093/neuonc/noae115
Abstrakt:	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 1983-2020. 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, other. Progression-free (PFS) and overall (OS) survival was 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, 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%CI:76-84%) and 46% (95%CI:41-53%), respectively; 1-year cumulative incidence of local vs non-local relapse was 1.8% vs 15%, respectively. For 97 refractory patients, 1-year cumulative incidence of local vs non-local relapse was 57% vs 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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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