A single-center retrospective analysis of outcome measures and consolidation strategies for relapsed and refractory primary CNS lymphoma

Bonm, Alipi; Gibson, Alec W; Holmberg, Leona; Mielcarek, Marco; McGranahan, Tresa; Taylor, Lynne; Graber, Jerome

doi:10.1007/s11060-020-03648-9

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…This study was approved by the University of Washington institutional review board. A database of all PCNSL patients treated at the University of Washington between 2000-2021 was created combining an unbiased screen for ICD9/10 codes as previously reported [4]. We retrospectively reviewed the presenting brain MRIs for all patients diagnosed from 2010 through 2021.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore intensive, and frequently in-hospital treatment regimens are justi ed by the potential for long-term remission. On the other hand, approximately 10-20% of patients will be refractory to initial induction with high-dose methotrexate (HDMTX) based regimens [4,5] with a median survival of 2.1 months after progression [6]. Additionally, patients who relapse within the rst year had a one-year survival of about 20%, whereas patients who relapsed more than a year after diagnosis had a one-year post-relapse survival of greater than 70% [6].…”

Section: Introductionmentioning

confidence: 99%

“…[6]. Importantly, even patients with refractory disease or early relapse can achieve longterm progression-free survival if a second remission can be achieved [7], and we previously reported that there is no correlation between the durability of successive responses [4]. Overall, the one-year mortality of PCNSL is approximately 21-24% [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Sarcopenia Measured by Temporalis Muscle Thickness Independently Predicts Early Relapse and Short Survival in Primary CNS Lymphoma

Bonm¹,

Menghini²,

Graber³

2021

Preprint

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Introduction: Primary CNS lymphoma (PCNSL) outcomes diverge between a majority of patients who achieve long term remission and a smaller minority who have aggressive disease course and die in the first year. Sarcopenia is increasingly recognized as a powerful predictor of mortality in brain and systemic cancers. Temporalis muscle thickness (TMT) is a validated radiographic measure of sarcopenia. We hypothesized that patients with TMT less than one standard deviation below the mean (“very thin TMT”) would go on to have shorter survival. Methods: Two blinded operators retrospectively measured TMT in 99 consecutive pretreatment brain MRIs from patients that were subsequently diagnosed with PCNSL. Results: On univariate analysis TMT predicted early progression (HR 4.25, 95% CI 1.95 – 9.29, p<0.001) and early mortality (HR 4.38, 95% CI 2.25 – 8.53, p<0.001), and these effects were maintained in subgroups of patients both <65 and ³65 years of age. Very thin TMT predicted mortality more robustly than IELSG or MSKCC scores. Patients with very thin TMT received fewer cycles of high-dose methotrexate (HD-MTX) and were less likely to receive consolidation. On multivariate analysis which included the covariates age, sex, TMT, ECOG, BMI, lifetime doses of HD-MTX, and consolidation, very thin TMT was independently associated with both early progression (HR = 7.87, 95% CI = 3.55 – 17.45, p<0.001) and short survival (HR 4.49, 95% CI = 1.94 – 10.40, p<0.001). Conclusions: We conclude that PCNSL patients with very thin TMT are at high risk for relapse and early mortality. Future trials should stratify patients by TMT to avoid potential confounding.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sarcopenia Measured by Temporalis Muscle Thickness Independently Predicts Early Relapse and Short Survival in Primary CNS Lymphoma

Bonm¹,

Menghini²,

Graber³

2021

Preprint

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“…Although new therapeutic regimes have improved outcomes especially in younger patients, elderly patients with PCNSL still have a very poor prognosis, especially when relapsing after first-line therapy [ 1 ]. The survival after relapse is usually <1 year and currently no optimal treatment regimen exists for those patients [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Sustained Complete Remission in Multi-Relapsed Primary CNS Lymphoma Treated with Ibrutinib Monotherapy: A Case Report

et al. 2021

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Primary CNS lymphoma (PCNSL) is a highly aggressive malignant disease with a high recurrence rate and a poor prognosis. We present the case of a 71-year-old woman diagnosed with PCNSL in June 2010. After 3 relapses and intensive treatment with multiple chemotherapy regimens and whole-brain radiotherapy, she received off-label treatment with the Bruton tyrosine kinase inhibitor ibrutinib, responded well, achieved a complete remission, and is progression-free for now >3 years.

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Impact of Thiotepa-Based Autologous Hematopoietic Cell Transplantation in Primary Central Nervous System Lymphoma in First Complete Remission: A University of California Hematologic Malignancies Consortium Retrospective Analysis

Othman¹,

Quan²,

Zhang³

et al. 2023

Clinical Lymphoma Myeloma and Leukemia

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A single-center retrospective analysis of outcome measures and consolidation strategies for relapsed and refractory primary CNS lymphoma

Cited by 6 publications

References 23 publications

Sarcopenia Measured by Temporalis Muscle Thickness Independently Predicts Early Relapse and Short Survival in Primary CNS Lymphoma

Sarcopenia Measured by Temporalis Muscle Thickness Independently Predicts Early Relapse and Short Survival in Primary CNS Lymphoma

Sustained Complete Remission in Multi-Relapsed Primary CNS Lymphoma Treated with Ibrutinib Monotherapy: A Case Report

Impact of Thiotepa-Based Autologous Hematopoietic Cell Transplantation in Primary Central Nervous System Lymphoma in First Complete Remission: A University of California Hematologic Malignancies Consortium Retrospective Analysis

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