Primary central nervous system lymphoma: a new prognostic model for patients with diffuse large B-cell histology

Yongchel Ahn; Heui June Ahn; Dok Hyun Yoon; Jung Yong Hong; Changhoon Yoo; Shin Kim; Jooryung Huh; Cheolwon Suh

doi:10.5045/br.2017.52.4.285

Quick links

Most Cited Most Read Ahead of Print Archives Go to E-submission

Original Article

Split Viewer

Blood Res 2017; 52(4):

Published online December 31, 2017

https://doi.org/10.5045/br.2017.52.4.285

Primary central nervous system lymphoma: a new prognostic model for patients with diffuse large B-cell histology

Yongchel Ahn¹, Heui June Ahn¹, Dok Hyun Yoon², Jung Yong Hong², Changhoon Yoo², Shin Kim², Jooryung Huh³, and Cheolwon Suh^2*

Author Info. +

¹Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

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

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

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 05505, Korea. csuh@amc.seoul.kr

Received: March 29, 2017; Revised: June 28, 2017; Accepted: July 20, 2017

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

Go to

Abstract

Background

Age and performance status are important prognostic factors in primary central nervous system (CNS) lymphoma. Although several prognostic models have been proposed, there is no consensus on the optimal model for patients with diffuse large B-cell histology.

Methods

Seventy-seven patients with primary CNS diffuse large B-cell lymphoma were retrospectively analyzed to determine factors affecting survival. Three Western models were applied to our eligible patients; we devised a novel model based on our findings.

Results

The median patient age was 59 years (range, 29?77); the median event-free and overall survival (OS) durations were 35.9 and 12.6 months, respectively. Nottingham/Barcelona and Memorial Sloan Kettering Cancer Center models were applicable to our cohorts. Multivariate analysis showed that advanced age, multifocal lesions, and high cerebrospinal fluid (CSF) protein concentrations were correlated significantly. A novel model for predicting prognosis was then developed based on these variables. Each variable was assigned 1 point; patients with a total score of 0, 1, 2, and 3 were categorized into the low- (N=17), moderate- (N=26), high- (N=14), and very high-risk groups (N=4), respectively. Sixty-one patients were eligible considering our model; the median OS was 58.2, 34.8, 9.0, and 1.8 months in the low-, moderate-, high-, and very high-risk groups, respectively (P<0.01).

Conclusion

Advanced age, multifocal lesions, and high CSF protein concentration were adversely related with prognosis. Our model can be helpful in pre-treatment risk stratification for patients with primary CNS lymphoma with diffuse large B-cell histology.

Keywords Central nervous system, Lymphoma, Prognosis, Survival

Article

Original Article

Blood Res 2017; 52(4): 285-292

Published online December 31, 2017 https://doi.org/10.5045/br.2017.52.4.285

Primary central nervous system lymphoma: a new prognostic model for patients with diffuse large B-cell histology

Yongchel Ahn¹, Heui June Ahn¹, Dok Hyun Yoon², Jung Yong Hong², Changhoon Yoo², Shin Kim², Jooryung Huh³, and Cheolwon Suh^2*

¹Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

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

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

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 05505, Korea. csuh@amc.seoul.kr

Received: March 29, 2017; Revised: June 28, 2017; Accepted: July 20, 2017

Abstract

Background

Methods

Results

Conclusion

Keywords: Central nervous system, Lymphoma, Prognosis, Survival

Abstract

Fig 1.

Download

Figure 1.

International Extranodal Lymphoma Study Group (IELSG) model in our cohort.

Blood Research 2017; 52: 285-292https://doi.org/10.5045/br.2017.52.4.285

Fig 2.

Download

Figure 2.

Nottingham/Barcelona model in our cohort.

Blood Research 2017; 52: 285-292https://doi.org/10.5045/br.2017.52.4.285

Fig 3.

Download

Figure 3.

Memorial Sloan-Kettering Cancer Center (MSKCC) model in our cohort.

Blood Research 2017; 52: 285-292https://doi.org/10.5045/br.2017.52.4.285

Fig 4.

Download

Figure 4.

Newly proposed Asan Medical Center (AMC) prognostic model.

Blood Research 2017; 52: 285-292https://doi.org/10.5045/br.2017.52.4.285

Table 1 Patient characteristics.

Abbreviations: ASCT, autologous stem cell transplantation; CR, complete response; CSF, cerebrospinal fluid; ECOG, Eastern Cooperative Oncology Group; IELSG, International Extranodal Lymphoma Study Group; KPS, Karnofsky Performance Status; LDH, lactate dehydrogenase; MSKCC, Memorial Sloan-Kettering Cancer Center; NE, not evaluable; PD, progressive disease; PR, partial response; RT, radiotherapy; SD, stable disease; WBRT, whole brain radiotherapy..

Table 2 Responses to first-line treatment.

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

Table 3 Results of univariate analysis.

Abbreviations: ASCT, autologous stem cell transplantation; β₂-MG, β₂-microglobulin; CR, complete response; CSF, cerebrospinal fluid; ECOG PS, Eastern Cooperative Oncology Group Performance Status; LDH, lactate dehydrogenase; N/A, not applicable; NE, not evaluable; PD, progressive disease; PR, partial response; SD, stable disease..

Table 4 Multivariate analysis.

Abbreviations: CI, confidence interval; CSF, cerebrospinal fluid; ECOG PS, Eastern Cooperative Oncology Group Performance Status; LDH, lactate dehydrogenase..

Table 5 Comparison of prognostic models.

Abbreviations: AMC, Asan Medical Center; CSF, cerebrospinal fluid; ECOG PS, Eastern Cooperative Oncology Group Performance Status; IELSG, International Extranodal Lymphoma Study Group; LDH, lactate dehydrogenase; MSKCC, Memorial Sloan-Kettering Cancer Center..