Elevated LDH and paranasal sinus involvement are risk factors for central nervous system involvement in patients with peripheral T-cell lymphoma

Yi, Jongyoun; Kim, J. H.; Baek, Kyung Kee; Lim, Tae Woo; Lee, D. J.; Ahn, Yong Chan; Kim, K.; Kim, S. J.; Ko, Young Hyeh; Kim, W. S.

doi:10.1093/annonc/mdq645

Cited by 43 publications

(54 citation statements)

References 22 publications

(29 reference statements)

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“…Extranodal NK/T-cell lymphoma, a disease that often involves the paranasal sinuses, was reported separately, with an incidence of 5.8% among 208 patients with this particular lymphoma. 17 Consistent with studies in aggressive B-cell lymphomas, a poor survival was reported for patients with PTCL with CNS relapse, 16 but several studies have also highlighted the dismal prognosis of relapsed PTCL in general. 15,18,19 In this study, we aimed at analyzing risk factors for CNS involvement in first relapse and the outcome of these patients in a large population-based cohort of patients with PTCL.…”

Section: Introductionsupporting

confidence: 61%

“…14,15 The most extensive study in PTCL included 228 patients, with extranodal NK/T-cell lymphoma excluded, and found an incidence of 8.8% CNS relapses. 16 In that study, the identified risk factors for CNS relapse were elevated lactate dehydrogenase and paranasal sinus involvement. Extranodal NK/T-cell lymphoma, a disease that often involves the paranasal sinuses, was reported separately, with an incidence of 5.8% among 208 patients with this particular lymphoma.…”

Section: Introductionmentioning

confidence: 89%

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Central nervous system relapse in peripheral T-cell lymphomas: a Swedish Lymphoma Registry study

Ellin

Landström

Jerkeman

et al. 2015

Blood

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Key Points• CNS involvement at relapse/ progression in PTCL occurred at a frequency similar to what is seen in aggressive B-cell lymphomas.• Outcome after relapse is generally very poor in patients with PTCL and is not significantly altered by presence of CNS involvement at relapse.Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) carries a very poor prognosis. Risk factors and outcome have been studied in aggressive B-cell lymphomas, but very little is known about the risk in peripheral T-cell lymphoma (PTCL). We aimed at analyzing risk factors for CNS involvement at first relapse or progression, as well as the outcome of these patients, in a large population-based cohort of patients with PTCL. Twenty-eight out of 625 patients (4.5%) developed CNS disease over time. In multivariable analysis, disease characteristics at diagnosis independently associated with an increased risk for later CNS involvement were involvement of more than 1 extranodal site (hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.07-6.29; P 5 .035) and skin (HR, 3.51; 95% CI, 1.26-9.74; P 5 .016) and gastrointestinal involvement (HR, 3.06; 95% CI, 1.30-7.18; P 5 .010). The outcome of relapsed/refractory patients was very poor, and CNS involvement was not associated with a significantly worse outcome compared with relapsed/refractory patients without CNS involvement in multivariable analysis (HR, 1.6; 95% CI, 0.96-2.6; P 5 .074). The results from the present study indicate that CNS relapse in PTCL occurs at a frequency similar to what is seen in aggressive B-cell lymphomas, but the poor outcomes in relapse are largely driven by systemic rather than CNS disease. (Blood. 2015;126(1):36-41)

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Section: Introductionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 89%

Central nervous system relapse in peripheral T-cell lymphomas: a Swedish Lymphoma Registry study

Ellin

Landström

Jerkeman

et al. 2015

Blood

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“…Prior retrospective series suggest that the rate of CNS involvement in PTCL ranges from 2-9% [15][16][17][18]. One series from Korea found that presence of an elevated LDH and sinus involvement as risk factors for CNS involvement in PTCL.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective series report CNS involvement in 5-9% of patients with PTCL [15][16][17]. In a larger series from Korea describing 228 patients with PTCL excluding NK/T-cell lymphoma who did not receive CNS prophylaxis, the incidence of CNS relapse was 8.7%.…”

Section: Introductionmentioning

confidence: 99%

Central Nervous System Involvement in T-cell Lymphoma: A Single Center Experience

Mehta

Gurion

Maragulia

et al. 2015

Clinical Lymphoma Myeloma and Leukemia

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“…28 In a Korean study of 228 patients, Yi et al identified elevated LDH and paranasal sinus involvement as associated with CNS relapse. 65 In both studies, all PTCL subtypes were considered together to derive risk factors. Of specific relevance to this patient, Chihara et al analyzed CNS risk according to PTCL subtype in 616 patients treated at MDACC: among 76 patients with ALK 1 ALCL, the 5-year risk of CNS relapse was 5.3%; however, among ALK 1 ALCL and .1 extranodal site the 1-year CNS relapse was 15%.…”

Section: -62mentioning

confidence: 99%

How I treat patients with aggressive lymphoma at high risk of CNS relapse

Chin

Cheah

2017

Blood

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Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis. (Blood. 2017;130(7):867-874) IntroductionNon-Hodgkin lymphomas are biologically and clinically diverse hematological malignancies. Treatment is influenced by patient fitness, disease biology, and tumor burden. Identifying patients at high risk of central nervous system (CNS) relapse is important as the outcome of secondary CNS lymphoma is poor. [1][2][3][4] Risk of CNS progression is influenced by histologic subtype and subtype-specific clinicopathologic features (eg, site of involvement, protein expression, or gene rearrangements). Patients with highly aggressive lymphomas (eg, lymphoblastic, Burkitt lymphoma) are at high risk and frontline protocols include CNS-directed prophylaxis. In contrast, indolent lymphomas rarely involve the CNS and CNS prophylaxis is not required. Between these extremes fall diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL) with MYC and BCL2 or BCL6 rearrangements, so-called "double-hit" lymphomas (HGBL-DH), and (nodal) peripheral T-cell lymphomas (PTCLs). The addition of rituximab has slightly reduced CNS relapse in DLBCL, probably through superior systemic control as there is negligible CNS penetration of the drug across the intact blood-brain barrier. 1,5 However, ;4% of unselected patients with DLBCL treated with prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (R-CHOP) experience CNS relapse, 6,7 and considerable efforts have been made to identify those at greatest risk. In this review, we will summarize our approach to this problem with case vignettes drawn from our practice. How I identify patients at increased risk for CNS relapseMany investigators have examined risk factors for CNS relapse, but studies have yielded inconsistent results, due to heterogeneity in patient populations, treatment, and/or limited sample size. [8][9][10][11][12][13][14][15][16] To address some of these limitations, Schmitz et al developed a 6-point score from 2164 patients treated on prospective German studies and validated in 1597 patients with DLBCL treated with R-CHOP in the British Columbia Cancer Agency (BCCA) Lymphoid Malignancies Database. 6 The components of the s...

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Elevated LDH and paranasal sinus involvement are risk factors for central nervous system involvement in patients with peripheral T-cell lymphoma

Cited by 43 publications

References 22 publications

Central nervous system relapse in peripheral T-cell lymphomas: a Swedish Lymphoma Registry study

Central nervous system relapse in peripheral T-cell lymphomas: a Swedish Lymphoma Registry study

Central Nervous System Involvement in T-cell Lymphoma: A Single Center Experience

How I treat patients with aggressive lymphoma at high risk of CNS relapse

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