Balancing relapses versus cognitive impairment in primary central nervous system lymphoma: a single<b>-</b>center experience

Chanswangphuwana, Chantiya; Rojnuckarin, Ponlapat; Cherdchoo, Naritsara; Raiyawa, Tassapong; Uaprasert, Noppacharn

doi:10.1080/10245332.2017.1418610

Cited by 6 publications

(10 citation statements)

References 31 publications

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“…Although most patients experience remission after initial treatment, increased relapse can be observed with prolonged follow-up, and consolidation therapy maintains the state after induction therapy; thus, initial consolidation therapy may play an important role in relapsed PCNSL ( 39 , 40 ). Chanswangphuwana et al.…”

Section: Relapse Rate and Relapse-related Factorsmentioning

confidence: 99%

“…Chanswangphuwana et al. ( 40 ) retrospectively analyzed the effect of whole-brain radiation therapy (WBRT) as a consolidation therapy in patients with PCNSL relapse, and some of the 37 patients with newly diagnosed PCNSL underwent WBRT after initial remission. The results showed that among the 22 patients with CR, PFS was significantly lower in patients without WBRT than in patients with WBRT, and the 3-year PFS rates were 35% and 78.75%, respectively.…”

Section: Relapse Rate and Relapse-related Factorsmentioning

confidence: 99%

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Relapsed Primary Central Nervous System Lymphoma: Current Advances

2021

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Primary central nervous system lymphoma is an invasive malignant lymphoma confined to the central nervous system. Although patients undergoing first-line treatment can achieve complete response, most of them still relapse within two years. Relapsed lymphoma is derived from occult lymphoma cells, and B cell receptor pathway activation and immune escape are the key mechanisms for the pathogenesis of PCNSL. Most relapses are in the central nervous system, a small number of relapses are isolated systemic relapses, and clinical symptoms occur early and vary. Current treatments for relapse include high-dose methotrexate rechallenge and other regimens of chemotherapy, whole-brain radiation therapy, hematopoietic stem-cell transplantation, targeted therapy and immunotherapy, which have become promising treatments. The overall prognosis of relapsed PCNSL is very poor, although it is affected by many factors. This article summarizes the mechanisms, related factors, clinical features, follow-up, treatment and prognosis of relapsed primary central nervous system lymphoma.

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Section: Relapse Rate and Relapse-related Factorsmentioning

confidence: 99%

Section: Relapse Rate and Relapse-related Factorsmentioning

confidence: 99%

Relapsed Primary Central Nervous System Lymphoma: Current Advances

2021

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“…Of the 42 included studies on cognitive functioning, 24 measured objective cognitive performance, including digital span, trail-making test, conversion speeds, and complex figure test (Abrey et al, 2003; Correa et al, 2019; Correa et al, 2004; Correa et al, 2009; Correa et al, 2012; Dahlborg et al, 1996; Doolittle, Dósa, et al, 2013; Ferreri et al, 2017; Fliessbach et al, 2005; Fliessbach et al, 2003; Juergens et al, 2010; McAllister et al, 2000; Morris et al, 2013; Neuwelt et al, 1991; Neuwelt et al, 2005; Nilles et al, 2022; Omuro, Chinot, et al, 2015; Omuro, Correa, et al, 2015; Pels et al, 2003; Pertz et al, 2021; Schlegel et al, 2001; Shah et al, 2007; van der Meulen et al, 2021; Wiemann et al, 2020). 14 studies examined only subjective cognitive functioning (Batchelor et al, 2003; Chanswangphuwana et al, 2018; Fisher et al, 2005; Gao et al, 2016; Glass et al, 2016; Herrlinger et al, 2017; Illerhaus et al, 2016; Illerhaus et al, 2008; Kaburaki et al, 2017; Kiefer et al, 2012; Laack, Ballman, Brown, & O'Neill, 2006; Laack et al, 2011; O’Neill et al, 1999; Shan et al, 2014). The effect of treatment on both outcomes was described in 4 articles (Ferreri et al, 2022; Houillier et al, 2019; Ichikawa et al, 2014; Nilles et al, 2022).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Cognitive Function, Anxiety, and Depression in Patients With Newly Diagnosed Primary Central Nervous System Lymphoma

Liu

Hou

et al. 2023

Biological Research For Nursing

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Objective To retrospectively analyze the effects of different treatments on cognitive functioning, anxiety, and depression in patients with primary central nervous system lymphoma (PCNSL). Methods A comprehensive literature search was conducted in multiple databases including the Cochrane Library, CINAHL, PubMed, Web of Science, EMBASE, Sino Med, Wei Pu, Wan Fang, CNKI, and Google Scholar. The search included studies published through June 20, 2023, focusing on cognitive function, anxiety, and depression in adult patients newly diagnosed with PCNSL. Various measurement tools and scales were used to assess the primary outcomes. Descriptive systematic reviews were conducted to integrate the literature and summarize the effects of different treatment modalities on cognitive functioning, anxiety, and depression in PCNSL patients. This review was registered with PROSPERO (CRD42022370250). Results A total of 43 studies were included. Induction chemotherapy was associated with improved cognitive function and reduced anxiety and depression in the majority of patients. Whole-brain radiotherapy (WBRT) was found to lead to cognitive impairment, particularly in executive, attention, memory, and motor function. Low-dose WBRT, autologous stem cell transplantation (ASCT), and blood-brain barrier disruption (BBBD) treatments did not result in significant cognitive impairment. Anxiety and depression were observed to decrease over the long term. Conclusions Overall, the cognitive functioning, anxiety, and depression of patients with PCNSL can be improved with appropriate treatments. However, patients treated with WBRT are at a higher risk of cognitive decline compared to those receiving other treatment modalities. Therefore, special attention should be given to patients undergoing WBRT, and a comprehensive analysis should be conducted to reduce neurotoxicity and address early cognitive problems in these patients.

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“…The two-year survival was about 60–70%, and the five-year survival could be increased to 22–40%. Chanswangphuwana et al [ 31 ] retrospectively analyzed the effect of WBRT as consolidation therapy in patients with PCNSL relapse, and some of the 37 patients with newly diagnosed PCNSL underwent WBRT after initial remission. The results showed that among the 22 patients with CR, progression-free survival (PFS) was significantly lower in patients without WBRT than in patients with WBRT, and the 3-year PFS rates were 35% and 78.75%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Key Factors Associated with Response to Salvage High-Dose Methotrexate Rechallenge in Primary Central Nervous System Lymphoma with First Relapse

Chen

Shen³

et al. 2022

Current Oncology

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Background: Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin’s lymphoma that occurs in the central nervous system. Although sensitive to chemotherapy, 35–60% of PCNSL patients still relapse within 2 years after the initial treatment. High-dose methotrexate (HD-MTX) rechallenge is generally used in recurrent PCNSL, especially for patients who have achieved a response after initial methotrexate (MTX) treatment. However, the overall remission rate (ORR) of HD-MTX rechallenge is about 70–80%. Additionally, the side effects of HD-MTX treatment endanger the health of patients and affect their quality of life. Methods: This is a retrospective study of patients with first relapse PCNSL at Huashan Hospital, Fudan University between January 2000 and November 2020. By comparing the clinical characteristics and radiological manifestations of first relapsed PCNSL patients with remission and non-remission after receiving HD-MTX rechallenge, we screened out the key factors associated with HD-MTX rechallenge treatment response, to provide some help for the selection of salvage treatment strategies for patients with recurrent PCNSL. Additionally, patients with remission after HD-MTX rechallenge were followed up to identify the factors related to progression-free survival of the second time (PFS2) (time from the first relapse to second relapse/last follow-up). The Kruskal–Wallis and Pearson chi-square tests were performed to examine the univariate association. Further, multivariable logistic regression analysis was used to study the simultaneous effect of different variables. Results: A total of 207 patients were enrolled in the study based on the inclusion criteria, including 114 patients in the remission group (RG) and 81 patients in the non-remission group (nRG), and 12 patients were judged as having a stable disease. In Kruskal–Wallis and Pearson chi-square tests, progression-free survival rates for first time (PFS1) and whether the initial treatment was combined with consolidated whole brain radiotherapy (WBRT) were related to the response to HD-MTX rechallenge treatment, which was further validated in regression analysis. Further, after univariate analysis and regression analysis, KPS was related to PFS2. Conclusions: For PCNSL patients in their first relapse, HD-MTX rechallenge may be an effective salvage treatment. PFS1 and whether initial treatment was combined with consolidation WBRT were associated with HD-MTX rechallenge treatment response. In addition, patients with higher KPS at the time of the first relapse had a longer PFS2 after HD-MTX rechallenge treatment.

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Balancing relapses versus cognitive impairment in primary central nervous system lymphoma: a single-center experience

Abstract: The low-dose WBRT consolidation is associated with lower PCNSL relapses with only mild neurocognitive toxicity.

Cited by 6 publications

References 31 publications

Relapsed Primary Central Nervous System Lymphoma: Current Advances

Relapsed Primary Central Nervous System Lymphoma: Current Advances

A Systematic Review of Cognitive Function, Anxiety, and Depression in Patients With Newly Diagnosed Primary Central Nervous System Lymphoma

Analysis of Key Factors Associated with Response to Salvage High-Dose Methotrexate Rechallenge in Primary Central Nervous System Lymphoma with First Relapse

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