Original Article
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Blood Res 2015; 50(4):
Published online December 31, 2015
https://doi.org/10.5045/br.2015.50.4.242
© The Korean Society of Hematology
Intraocular lymphoma in Korea: the Consortium for Improving Survival of Lymphoma (CISL) study
1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
2Division of Hematology-Oncology, Department of Medicine, Seonam University of Medicine Myongji Hospital, Goyang, Korea.
3Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
4Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea.
6Department of Ophthalmology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.
7Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
8Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
9Department of Hemato-Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
10Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Correspondence to : Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul 05535, Korea. Tel: +82-2-3010-3209, csuh@amc.seoul.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background
Intraocular lymphoma (IOL) is a rare malignant lymphoma that most closely resembles a diffuse large B-cell lymphoma, and it is a subtype of primary central nervous system lymphoma (PCNSL). IOL is located inside the eye in the retina, uvea, and/or optic nerve. We retrospectively analyzed IOL patient data to identify treatment patterns and survival rates in Korea.
Methods
Cytological confirmation for a diagnosis of IOL was performed for all patients. The clinical data collected from medical records included Ann Arbor stage, International Prognostic Index, performance status, date of diagnosis, treatment modality and response, date of relapse, and date of last follow-up.
Results
Twenty patients who were diagnosed with IOL, between December 2007 and June 2014 at multiple centers in Korea, were included in the analysis. Four patients were diagnosed with IOL alone, not involving the CNS. Two patients with isolated IOL later developed PCNSL. Nine patients developed CNS lesions before the onset of ocular lymphoma. Five patients had simultaneous onset in the eye and CNS. Twelve patients were treated by intravitreal injection of methotrexate for IOL. The median progression-free survival (PFS) for patients was 19.7 months (95% CI, 8.7-30.7 mo). The estimated 3-year overall survival (OS) for all patients was 75.1%.
Conclusion
Treatment for IOL patients included radiotherapy and intraocular chemotherapy. IOL patients showed favorable PFS and OS. These patients would require long-term follow-up to identify relapse and adverse effects of radiotherapy or intraocular chemotherapy.
Keywords Intraocular, Lymphoma, Chemotherapy, Radiotherapy
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Original Article
Blood Res 2015; 50(4): 242-247
Published online December 31, 2015 https://doi.org/10.5045/br.2015.50.4.242
Copyright © The Korean Society of Hematology.
Intraocular lymphoma in Korea: the Consortium for Improving Survival of Lymphoma (CISL) study
Seul Lee1,#, Moon Jin Kim2,#, Jin Seok Kim3, Sung Yong Oh1*, Seok Jin Kim4, Yoon Hyung Kwon5, In Young Chung6, Jung Hun Kang7, Deok-Hwan Yang8, Hye Jin Kang9, Dok Hyun Yoon10, Won Seog Kim4, Hyo-Jin Kim1, and Cheolwon Suh10*
1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
2Division of Hematology-Oncology, Department of Medicine, Seonam University of Medicine Myongji Hospital, Goyang, Korea.
3Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
4Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea.
6Department of Ophthalmology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.
7Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
8Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
9Department of Hemato-Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
10Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Correspondence to:Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul 05535, Korea. Tel: +82-2-3010-3209, csuh@amc.seoul.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Intraocular lymphoma (IOL) is a rare malignant lymphoma that most closely resembles a diffuse large B-cell lymphoma, and it is a subtype of primary central nervous system lymphoma (PCNSL). IOL is located inside the eye in the retina, uvea, and/or optic nerve. We retrospectively analyzed IOL patient data to identify treatment patterns and survival rates in Korea.
Methods
Cytological confirmation for a diagnosis of IOL was performed for all patients. The clinical data collected from medical records included Ann Arbor stage, International Prognostic Index, performance status, date of diagnosis, treatment modality and response, date of relapse, and date of last follow-up.
Results
Twenty patients who were diagnosed with IOL, between December 2007 and June 2014 at multiple centers in Korea, were included in the analysis. Four patients were diagnosed with IOL alone, not involving the CNS. Two patients with isolated IOL later developed PCNSL. Nine patients developed CNS lesions before the onset of ocular lymphoma. Five patients had simultaneous onset in the eye and CNS. Twelve patients were treated by intravitreal injection of methotrexate for IOL. The median progression-free survival (PFS) for patients was 19.7 months (95% CI, 8.7-30.7 mo). The estimated 3-year overall survival (OS) for all patients was 75.1%.
Conclusion
Treatment for IOL patients included radiotherapy and intraocular chemotherapy. IOL patients showed favorable PFS and OS. These patients would require long-term follow-up to identify relapse and adverse effects of radiotherapy or intraocular chemotherapy.
Keywords: Intraocular, Lymphoma, Chemotherapy, Radiotherapy
Fig 1.
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Progression-free survival (PFS) and overall survival (OS) curves of patients with intraocular lymphoma. The median PFS of a patient was 19.7 months (95% CI, 8.7-30.7 mo). The estimated 3-year OS of all patients was 75.1%.
Fig 2.
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Survival of primary intraocular lymphoma (IOL) patients, including those with primary IOL alone or that simultaneously detected with primary central nervous system lymphoma (PCNSL). Patients with primary IOL that were subsequently diagnosed with PCNSL had a median progression-free survival (PFS) of 25.4 months (95% CI, 18.0-48.3 mo) and a 3-year overall survival (OS) rate of 90%.
Fig 3.
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Survival of patients with primary central nervous system lymphoma (PCNSL) that were subsequently diagnosed with intraocular lymphoma (IOL) had a median progression-free survival (PFS) of 12.5 months (95% CI, 6.0-19.0 mo) and a 3-year overall survival (OS) rate of 53.3%.
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Table 1 . Clinical characteristics of intraocular lymphoma patients in Korea..
Abbreviations: IOL, intraocular lymphoma; CNSL, central nervous system lymphoma; BG, basal ganglia; LMS, leptomeningeal seeding; IO MTX, intraocular methotrexate injection; HD MTX, high dose methotrexate; Ara-C, cytarabine; CYVE, high-dose cytarabine and etoposide; ORT, ocular radiotherapy; WBRT, whole brain radiotherapy; IT, intrathecal chemotherapy; procar, procarbazine; vinc, vincristine; HSCT, hematopoietic stem cell transplantation..
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