A Retrospective Analysis of Clinical Characteristics, Treatment, and Outcomes in Large B‐cell Lymphomas with Synchronous Systemic and Central Nervous System Involvement Article Swipe
J. Erika Haydu
,
Robert Redd
,
Matthew Lei
,
Philipp Karschnia
,
Jochen Dietrich
,
Lakshmi Nayak
,
Jeremy S. Abramson
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1002/hon.3164_307
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1002/hon.3164_307
Introduction: Large B-cell lymphoma with synchronous systemic and central nervous system (CNS) involvement at diagnosis is a rare entity with a poor prognosis. Prior data come from small heterogenous retrospective studies, and there is no consensus on optimal treatment. Methods: Using our IRB-approved Research Patient Data Repository, we identified 60 consecutive pts presenting with synchronous systemic/CNS large B-cell lymphoma between 6/2002-6/2021. Results: The median age was 64 years (range: 38–89), and 23 (38%) were female. Most pts (73%) had diffuse large B-cell lymphoma (47% GCB; 53% non-GCB). There were 6 high grade B-cell lymphomas (4/6 double hit). Six cases were intravascular LBCL. The most common CNS site was brain parenchyma (60%), followed by leptomeninges (58%), intraocular (7%), and spinal cord (2%); 23% of pts had >1 CNS site at diagnosis. The median IPI score was 3 (range 2–5) and baseline LDH was elevated in 60%. Almost all pts (93%) had non-CNS extranodal disease, with a median of 2 sites (range 1–7). The most common non-CNS extranodal sites were testis (18%), adrenal/renal (17%), and bone marrow/leukemic (17%). Most pts received R-CHOP-like regimens (85%) and 14% received EPOCH-R or R-CODOX/IVAC. The most common CNS therapy was intravenous (IV) methotrexate (MTX) in 88%. Among MTX-treated pts, the target dose was 8 g/m2 in 53% (median cycles 6, range 2–20) and 3.5 g/m2 in 45% (median cycles 6, range 1–11). Other CNS therapies were intrathecal (IT) MTX (22%) and IT liposomal cytarabine (15%). Fifteen (25%) pts underwent consolidative autologous stem cell transplant (ASCT). The best overall response rate was 91% (95% CI: 81%–97%) and best complete response rate was 79% (95% CI: 66%–89%). With 8.4 years of median follow up, the median progression-free survival (PFS) was 1.2 years (range 0–10) (Figure 1A) and the median overall survival (OS) was 7.9 years (range 0–10). The 2-year PFS and OS were 46% and 61%, and the 6-year PFS and OS were 36% and 52%, respectively. The 2-year PFS by IPI was 78% for IPI 2 and 40% for IPI ≥3 (p = 0.017, Figure 1B). The 2-year PFS by IV MTX dose was 42% for 3.5 g/m2 and 57% for 8 g/m2 (p = 0.13, Figure 1C). The 2-year PFS for pts with IPI < 3 who received 8 g/m2 IV MTX was 88% (p = 0.036, Figure 1D). The 2-year PFS for pts undergoing consolidative ASCT was 73%, compared to 36% for non-transplanted pts (p = 0.0018, Figure 1E). Pts with IPI ≥3 who underwent ASCT had a 2-year PFS of 73% compared to 31% in non-transplanted pts (p < 0.001, Figure 1F). Keyword: Aggressive B-cell non-Hodgkin lymphoma No conflicts of interests pertinent to the abstract.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/hon.3164_307
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/hon.3164_307
- OA Status
- bronze
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4380079274Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1002/hon.3164_307Digital Object Identifier
- Title
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A Retrospective Analysis of Clinical Characteristics, Treatment, and Outcomes in Large B‐cell Lymphomas with Synchronous Systemic and Central Nervous System InvolvementWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2023Year of publication
- Publication date
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2023-06-01Full publication date if available
- Authors
-
J. Erika Haydu, Robert Redd, Matthew Lei, Philipp Karschnia, Jochen Dietrich, Lakshmi Nayak, Jeremy S. AbramsonList of authors in order
- Landing page
-
https://doi.org/10.1002/hon.3164_307Publisher landing page
- PDF URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/hon.3164_307Direct link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
- OA URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/hon.3164_307Direct OA link when available
- Concepts
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Medicine, Lymphoma, Internal medicine, Methotrexate, Diffuse large B-cell lymphoma, Retrospective cohort study, Bone marrow, Gastroenterology, Vincristine, Central nervous system, Pathology, Chemotherapy, CyclophosphamideTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- Related works (count)
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10Other works algorithmically related by OpenAlex
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