Objective: To study the clinical characteristics, prognostic factors and treatment outcomes in patients with primary central nervous system lymphoma (PCNSL).Materials and Methods: The data of total 5166 PCNSL patients diagnosed between 2000 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database was obtained.Results: The mean age was 63.1±14.9 years, with a male to female of 1.1:1.0. The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL) (84.6%). The 1-, 3-, and 5-year OS were 50.1, 36.0 and 27.2% and corresponding to DSS were 54.4, 41.3 and 33.5%, respectively. Multivariate analysis with Cox regression showed that race, sex, age, marital status, surgery, chemotherapy and radiotherapy were independent prognostic factors for OS, but radiotherapy no longer for DSS. Nomograms specially for DLBCL were established to predict the possibility of OS and DSS. The concordance index (C-index) of OS and DSS were 0.704 (95% CI 0.687-0.721) and 0.698 (95% CI 0.679-0.717), suggesting the high discrimination ability of the nomograms.Conclusion: Surgery or/and chemotherapy was favourably associated with better OS and DSS. However, radiotherapy did not benefit to OS and DSS in the long-term. A new predictive nomogram and a web-based survival rate calculator we developed showed favorable applicability and accuracy to predict the long-term OS for DLBCL patients specifically.
Introduction: Diffuse large B cell lymphoma (DLBCL) is a highly heterogeneous tumor mainly occuring in the elderly, with approximately 40% of cases occurring in patients over 70 years old and this proportion will increase in the future. High grade B cell lymphomas (HGBL) with MYC and BCL2 and BCL6 rearrangements, so called triple-hit lymphomas (HGBL-THL), which usually presents a high-aggressive clinical behavior as well as to be associated with a very poor outcome. However, there are no standard treatment strategies for very elderly HGBL-DHL/THL patients, it still remains a challenge for clinicians. Case Presentaion: we report a case of a 95-year-old patient diagnosed with diffuse large B-cell lymphoma (HGBL-THL, non-germinal central type, stage IV group A, IPI 5 points, high risk group), coronary atherosclerotic heart disease (paroxysmal atrial fibrillation, cardiac insufficiency), hypertension, treated with chemotherapy, radiotherapy and targeted drug therapy obtained better outcome of keeping alive for 1 year. Conclusion: For very elderly HGBL-THL patients, a careful assessment of performance, nutritional status and comorbidities are needed before treatment. Novel therapies including immunotherapy, targeted therapy and chimeric antigen receptor T (CAR-T) cell therapy may provide benefit.
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