Primary central nervous system lymphoma high incidence and poor survival in Finnish population-based analysis

Puhakka, Inka; Kuitunen, Hanne; Jäkälä, Pekka; Sonkajärvi, Eila; Turpeenniemi‐Hujanen, Taina; Rönkä, Aino; Selander, Tuomas; Korhonen, Miika; Kuittinen, Outi

doi:10.1186/s12885-022-09315-8

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…This study is limited by its retrospective design and the restricted number of patients that could be included, especially in comparison with other biomarker studies. Thus, our results should be confirmed in a larger and ethnically more diverse patient cohort; nevertheless, there was sufficient post‐hoc power of 0.902 and 70 patients is a considerable number, given that CNSL is a rare disease with an incidence number ranging from 0.17 to 0.63/100000 person‐years in epidemiological studies from different continents (Eloranta et al., 2018; Farrall & Smith, 2021; Ostrom et al., 2022; Puhakka et al., 2022; Shin et al., 2015). Also, the comparatively high number of SCNSL in the lymphoma group might reduce the validity of the results for PCNSL patients.…”

Section: Discussionmentioning

confidence: 96%

Intrathecal IgM synthesis as a diagnostic marker in patients with suspected CNS lymphoma

Reinecke,

Jahnke,

Foltyn‐Dumitru

et al. 2024

Journal of Neurochemistry

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For CNS lymphomas (CNSL), there is a high need for minimally invasive and easily obtainable diagnostic markers. Intrathecal IgM synthesis can easily be determined in routine CSF diagnostics. The aim of this study was to systematically investigate the diagnostic potential of intrathecal IgM synthesis in primary and secondary CNSL (PCNSL and SCNSL). In this retrospective study, patients with a biopsy‐proven diagnosis of PCNSL or SCNSL were compared with patients with other neurological diseases in whom CNSL was initially the primary radiological differential diagnosis based on MRI. Sensitivity and specificity of intrathecal IgM synthesis were calculated using receiver operating characteristic curves. Seventy patients with CNSL were included (49 PCNSL and 21 SCNSL) and compared to 70 control patients. The sensitivity and specificity for the diagnosis of CNSL were 49% and 87%, respectively, for the entire patient population and 66% and 91% after selection for cases with tumor access to the CSF system and isolated intrathecal IgM synthesis. In cases with MRI‐based radiological suspicion of CNSL, intrathecal IgM synthesis has good specificity but limited sensitivity. Because of its low‐threshold availability, analysis of intrathecal IgM synthesis has the potential to lead to higher diagnostic accuracy, especially in resource‐limited settings, and deserves further study.

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Section: Discussionmentioning

confidence: 96%

Intrathecal IgM synthesis as a diagnostic marker in patients with suspected CNS lymphoma

Reinecke,

Jahnke,

Foltyn‐Dumitru

et al. 2024

Journal of Neurochemistry

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“…971–977). A study reported that the 2-year age-adjusted relative survival rate of PCNSL was 33%, and the corresponding 5-year survival rate of PCNSL was 26% [ 6 ]. An accurate diagnosis is crucial for the effective treatment of PCNSL.…”

Section: Instructionmentioning

confidence: 99%

Improving the Classification of PCNSL and Brain Metastases by Developing a Machine Learning Model Based on 18F-FDG PET

Cui

Yao

et al. 2023

JPM

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Background: The characteristic magnetic resonance imaging (MRI) and the positron emission tomography (PET) findings of PCNSL often overlap with other intracranial tumors, making definitive diagnosis challenging. PCNSL typically shows iso-hypointense to grey matter on T2-weighted imaging. However, a particular part of PCNSL can demonstrate T2-weighted hyperintensity as other intracranial tumors. Moreover, normal high uptake of FDG in the basal ganglia, thalamus, and grey matter can mask underlying PCNSL in 18F-FDG PET. In order to promote the efficiency of diagnosis, the MRI-based or PET/CT-based radiomics models combining histograms with texture features in diagnosing glioma and brain metastases have been widely established. However, the diagnosing model for PCNSL has not been widely reported. The study was designed to investigate a machine-learning (ML) model based on multiple parameters of 2-deoxy-2-[18F]-floor-D-glucose (18F-FDG) PET for differential diagnosis of PCNSL and metastases in the brain. Methods: Patients who underwent an 18F-FDG PET scan with untreated PCNSL or metastases in the brain were included between May 2016 and May 2022. A total of 126 lesions from 51 patients (43 patients with untreated brain metastases and eight patients with untreated PCNSL), including 14 lesions of PCNSL, and 112 metastatic lesions in the brain, met the inclusion criteria. PCNSL or brain metastasis was confirmed after pathology or clinical history. Principal component analysis (PCA) was used to decompose the datasets. Logistic regression (LR), support vector machine (SVM), and random forest classification (RFC) models were trained by two different groups of datasets, the group of multi-class features and the group of density features, respectively. The model with the highest mean precision score was selected. The testing sets and original data were used to examine the efficacy of models separately by using the weighted average F1 score and area under the curve (AUC) of the receiver operating characteristic curve (ROC). Results: The multi-class features-based RFC and SVM models reached identical weighted-average F1 scores in the testing set, and the score was 0.98. The AUCs of RFC and SVM models calculated from the testing set were 1.00 equally. Evaluated by the original dataset, the RFC model based on multi-class features performs better than the SVM model, whose weighted-average F1 scores of the RFC model calculated from the original data were 0.85 with an AUC of 0.93. Conclusions: The ML based on multi-class features of 18F-FDG PET exhibited the potential to distinguish PCNSL from brain metastases. The RFC models based on multi-class features provided comparatively high efficiency in our study.

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“…1 It rises with age to reach 2.0/100,000 at age 60 and above, 2 and ascends to 2.93/100,000 among patients aged 75-79 years. 3 Elderly patients, aged 60 and above, comprise up to 65% of all PCNSL patients. 4 The treatment of PCNSL is challenging as the presence of the blood-brain barrier limits the scope of therapeutic agents that can penetrate the brain and attain therapeutic drug concentrations.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of PCNSL is 0.4 per 100,000 person‐years 1 . It rises with age to reach 2.0/100,000 at age 60 and above, 2 and ascends to 2.93/100,000 among patients aged 75–79 years 3 . Elderly patients, aged 60 and above, comprise up to 65% of all PCNSL patients 4 …”

Section: Introductionmentioning

confidence: 99%

A retrospective study of 222 patients with newly diagnosed primary central nervous system lymphoma—Outcomes indicative for improved survival overtime

Bairey

Lebel

Buxbaum

et al. 2023

Hematological Oncology

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Primary central nervous system lymphoma (PCNSL) is a rare disease with an incidence of 0.4/per 100,000 person‐years. As there is a limited number of prospective randomized trials in PCNSL, large retrospective studies on this rare disease may yield information that might prove useful for the future design of randomized clinical trials. We retrospectively analyzed the data of 222 newly diagnosed PCNSL patients treated in five referral centers in Israel between 2001 and 2020. During this period, combination therapy became the treatment of choice, rituximab has been added to the induction therapy, and consolidation with irradiation was largely laid off and was mostly replaced by high‐dose chemotherapy with or without autologous stem cell transplantation (HDC‐ASCT). Patients older than 60 comprised 67.5% of the study population. First‐line treatment included high‐dose methotrexate (HD‐MTX) in 94% of patients with a median MTX dose of 3.5 g/m2 (range 1.14–6 g/m2) and a median cycle number of 5 (range 1–16). Rituximab was given to 136 patients (61%) and consolidation treatment to 124 patients (58%). Patients treated after 2012 received significantly more treatment with HD‐MTX and rituximab, more consolidation treatments, and autologous stem cell transplantation. The overall response rate was 85% and the complete response (CR)/unconfirmed CR rate was 62.1%. After a median follow‐up of 24 months, the median progression‐free survival (PFS) and overall survival (OS) were 21.9 and 43.5 months respectively with a significant improvement since 2012 (PFS: 12.5 vs. 34.2 p = 0.006 and OS: 19.9 vs. 77.3 p = 0.0003). A multivariate analysis found that the most important factors related to OS were obtaining a CR followed by rituximab treatment and Eastern Cooperative Oncology Group performance status. The observed improvement in outcomes may be due to multiple components such as an intention to treat all patients regardless of age with HD‐MTX‐based combination chemotherapy, treatment in dedicated centers, and more aggressive consolidation with the introduction of HDC‐ASCT.

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Primary central nervous system lymphoma high incidence and poor survival in Finnish population-based analysis

Cited by 9 publications

References 35 publications

Intrathecal IgM synthesis as a diagnostic marker in patients with suspected CNS lymphoma

Intrathecal IgM synthesis as a diagnostic marker in patients with suspected CNS lymphoma

Improving the Classification of PCNSL and Brain Metastases by Developing a Machine Learning Model Based on 18F-FDG PET

A retrospective study of 222 patients with newly diagnosed primary central nervous system lymphoma—Outcomes indicative for improved survival overtime

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