Relapse pattern and prognostic factors for patients with primary central nervous system lymphoma

Jeong Eun Kim; Dok Hyun Yoon; Shin Kim; Dae Ho Lee; Jeong Hoon Kim; Young Hee Yoon; Hyun Sook Chi; Sang Wook Lee; Chan-Sik Park; Jooryung Huh; Cheolwon Suh

doi:10.5045/kjh.2012.47.1.60

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Original Article

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Korean J Hematol 2012; 47(1):

Published online March 31, 2012

https://doi.org/10.5045/kjh.2012.47.1.60

Relapse pattern and prognostic factors for patients with primary central nervous system lymphoma

Jeong Eun Kim¹, Dok Hyun Yoon¹, Shin Kim¹, Dae Ho Lee¹, Jeong Hoon Kim², Young Hee Yoon³, Hyun Sook Chi⁴, Sang Wook Lee⁵, Chan-Sik Park⁶, Jooryung Huh⁶, and Cheolwon Suh^1*

Author Info. +

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁴Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁵Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁶Department of Pathology, 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 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: February 17, 2012; Revised: March 13, 2012; Accepted: March 14, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

Primary central nervous system lymphoma (PCNSL) rarely relapses in extracranial sites, and no specialized guidelines for follow-up evaluation have been proposed.

Methods

We analyzed 65 patients with newly diagnosed PNCSL to evaluate the pattern of relapse and prognostic factors.

Results

Of the 65 patients analyzed, 55 had only parenchymal brain disease, and 10 had both intracranial and extracranial lesions. As a first-line treatment, 29 patients received chemotherapy only (CTx), 13 received chemotherapy followed by whole brain radiotherapy (CTx-WBRT), 18 received chemotherapy followed by autologous stem cell transplantation (CTx-ASCT), 2 received palliative WBRT, and 3 received best supportive care. The overall response rate to the initial treatment was 75.8%, with specific response rates of 62.1% to CTx, 84.6% to CTx-WBRT, and 100% to CTx-ASCT. The complete response (CR) rate was higher with CTx-ASCT than in the absence of ASCT (77.8% vs. 43.2%; P=0.025). After a median follow-up of 18.8 months, the median failure-free survival (FFS) and overall survival (OS) were 13.0 and 36.1 months, respectively. No systemic relapse without a CNS lesion was noted. Multivariate analysis showed that ASCT was predictive of better FFS but not of OS. Age and the Memorial-Sloan Kettering Cancer Center prognostic score were predictive of survival.

Conclusion

We observed no systemic relapse without a CNS lesion, suggesting that regular systematic evaluation of extracranial sites may not always be necessary. Age was prognostic of survival irrespective of treatment scheme. ASCT may improve CR rate and FFS.

Keywords Primary CNS lymphoma, Relapse, Prognostic factor

Article

Original Article

Korean J Hematol 2012; 47(1): 60-66

Published online March 31, 2012 https://doi.org/10.5045/kjh.2012.47.1.60

Relapse pattern and prognostic factors for patients with primary central nervous system lymphoma

Jeong Eun Kim¹, Dok Hyun Yoon¹, Shin Kim¹, Dae Ho Lee¹, Jeong Hoon Kim², Young Hee Yoon³, Hyun Sook Chi⁴, Sang Wook Lee⁵, Chan-Sik Park⁶, Jooryung Huh⁶, and Cheolwon Suh^1*

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁴Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁵Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁶Department of Pathology, 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 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: February 17, 2012; Revised: March 13, 2012; Accepted: March 14, 2012

Abstract

Background

Primary central nervous system lymphoma (PCNSL) rarely relapses in extracranial sites, and no specialized guidelines for follow-up evaluation have been proposed.

Methods

We analyzed 65 patients with newly diagnosed PNCSL to evaluate the pattern of relapse and prognostic factors.

Results

Conclusion

Keywords: Primary CNS lymphoma, Relapse, Prognostic factor

Abstract

Fig 1.

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Figure 1.

Failure free survival (A) and overall survival (B) in all patients.

Blood Research 2012; 47: 60-66https://doi.org/10.5045/kjh.2012.47.1.60

Fig 2.

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Figure 2.

Failure free survival and overall survival according to age (A, B), Eastern Cooperative Oncology Group performance status (ECOG PS) (C, D), serum lactate dehydrogenase (LD) level (E, F), and MSKCC, Memorial-Sloan Kettering Cancer Center (MSKCC) prognostic group (G, H).

Blood Research 2012; 47: 60-66https://doi.org/10.5045/kjh.2012.47.1.60

Fig 3.

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Figure 3.

Failure free survival (A) and overall survival (B) in patients treated with and without autologous stem cell transplantation.

Blood Research 2012; 47: 60-66https://doi.org/10.5045/kjh.2012.47.1.60

Table 1 . Baseline characteristics (N=65)..

^a)T-lymphoblastic lymphoma (1), peripheral T-cell lymphoma (1), ^b)All were HIV-associated lymphoma..

Abbreviations: ECOG PS, Eastern Cooperative Oncology Group performance status; IPI, international prognostic index; WBRT, whole brain radiotherapy; ASCT, autologous stem cell transplantation..

Table 2 . Responses to first-line treatment (N=62)..

^a)P-value indicates comparison between non-ASCT and CTx-ASCT groups..

Abbreviations: CR, complete response; PR, partial response; ORR, overall response rate (CR+PR); SD, stable disease; PD, progressive disease; NE, not evaluable; CTx, chemotherapy; WBRT, whole brain radiotherapy; ASCT, autologous stem cell transplantation..

Table 3 . Failure pattern of disease (N=65)..

^a)Chemotherapy only (4), Whole brain radiotherapy [WBRT] (3), ^b)Chemotherapy only (12), Chemotherapy followed by autologous stem cell transplantation (8), Chemotherapy followed by WBRT (7)..

Table 4 . Univariate analysis for overall survival and failure-free survival..

Abbreviations: ECOG PS, Eastern Cooperative Oncology Group performance status; KPS, Karnofsky performance status; ASCT, autologous stem cell transplantation; FFS, failure-free survival; OS, overall survival; MSKCC, Memorial-Sloan Kettering Cancer Center..

Table 5 . Multivariate analysis for overall survival and failure-free survival..

Abbreviations: FFS, failure-free survival; OS, overall survival; ECOG PS, Eastern Cooperative Oncology Group performance status; MSKCC, Memorial-Sloan Kettering Cancer Center group..

1: Age≤50 years. 2: Age>50 years and KPS≥70%. 3: Age>50 years and KPS<70%..