Identification of Leptomeningeal Disease in Aggressive B-Cell Non-Hodgkin's Lymphoma: Improved Sensitivity of Flow Cytometry

Quijano, Sandra; López, Antonio; Sancho, Juan Manuel; Panizo, Carlos; Debén, Guillermo; Castilla, Carolina; García-Vela, José Antonio; Salar, Antonio; Alonso-Vence, Natalia; González‐Barca, Eva; Peñalver, Francisco Javier; Plaza-Villa, Josefa; Morado, Marta; García-Marco, José A.; Arias, Jesús; Briones, Javier; Ferrer, Secundino; Capote, Javier; Nicolás, Concepción; Órfão, Alberto

doi:10.1200/jco.2008.17.7089

Cited by 196 publications

(227 citation statements)

References 39 publications

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“…Sixteen (84%) of these LPs were sent for flow cytometry, which has been shown to be the more sensitive than cell counts or cytology in detecting occult CNS involvement of the CSF. 22 Two of the 16 samples sent for flow cytometry were equivocal for the presence of clonal B cells due to a paucity of cells for analysis; in both of these cases, the cytology was negative. One of the patients with equivocal flow cytometry results at diagnosis subsequently developed a CNS recurrence.…”

Section: Discussionmentioning

confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

210

159

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BACKGROUND:The outcome of patients with systemic diffuse large B-cell lymphoma (DLBCL) had improved over the past decade with the addition of monoclonal antibody therapy. Unfortunately, approximately 5% of these patients still developed a secondary central nervous system (CNS) recurrence followed invariably by rapid death. This rate is substantially increased in patients with certain high-risk features. Although prophylaxis against CNS recurrence with either intrathecal or intravenous methotrexate is commonly used for such patients, to the authors' knowledge, there is no standard of care. Retrospectively evaluated was the role of high-dose systemic methotrexate combined with standard cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (R-CHOP) chemotherapy to decrease CNS recurrence in high-risk patients. METHODS: A total of 65 patients with DLBCL and CNS risk factors were identified at the study institution between 2000 and 2008 who received intravenous methotrexate as CNS prophylaxis concurrent with standard systemic therapy with curative intent. CNS recurrence rate, progression-free survival, and overall survival were calculated. RESULTS: Patients received a median of 3 cycles of methotrexate at a dose of 3.5 gm/m 2 with leucovorin rescue. The complete response rate was 86%, with 6% partial responses. At a median follow-up of 33 months, there were only 2 CNS recurrences (3%) in this high-risk population. The 3-year progression-free and overall survival rates were 76% and 78%, respectively. Complications associated with methotrexate therapy included transient renal dysfunction in 7 patients and a delay in systemic chemotherapy in 8 patients. CONCLUSIONS: Intravenous methotrexate can be safely administered concurrently with R-CHOP and is associated with a low risk of CNS recurrence in high-risk patients. Cancer 2010;116:4283-90.

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Section: Discussionmentioning

confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

210

159

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“…12 However, the use of multiparameter flow cytometry in addition to conventional cytology will improve the identification of leptomeningeal disease in patients with IVL, as reported recently in patients with aggressive nonHodgkin lymphoma. 31,32 The most striking feature of recurrent NL is its timing. It is noteworthy that all 4 of our patients developed NL during or shortly they completed chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

High frequency of neurolymphomatosis as a relapse disease of intravascular large B‐cell lymphoma

Matsue

Hayama

Iwama

et al. 2011

Cancer

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BACKGROUND: Intravascular large B-cell lymphoma (IVL) is characterized by lymphoma cell proliferation in the lumina of small vessels in various organs. A high incidence of neurologic symptoms associated with the central nervous system has been reported, but peripheral nerve involvement (neurolymphomatosis [NL]) rarely has been described. METHODS: The medical records from patients who were diagnosed with IVL over the past 4 years were reviewed. A diagnosis of NL was made based on the combination of neurologic symptoms and their correspondence with imaging studies, such as magnetic resonance imaging (MRI), 18 F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT), and/or the histologic confirmation of lymphoma cells within the peripheral nerves, nerve root/plexuses, or cranial nerves. RESULTS: Four patients with NL were identified among 11 patients who had IVL. All cases of NL occurred as relapsed disease during or shortly after the completion of chemotherapy. Although MRI studies of the brains and whole spines revealed nerve infiltration by gadolinium enhancement in 2 patients, the technology was not sensitive enough to detect such infiltration in the remaining 2 patients. In contrast, FDG-PET/CT studies successfully revealed cranial or peripheral nerve lesions in all 4 patients and was useful for evaluating therapeutic response. Patients received treatment with high-dose methotrexate with or without other systemic chemotherapy, which achieved varied success. Further studies will be needed to determine the optimal treatment. CONCLUSIONS: Considering the rarity of IVL and NL, the current observations suggested that IVL may have a predilection not only for the vessels but also for both the central and peripheral nervous systems. Cancer 2011;117:4512-

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“…Por este motivo, en el servicio de Citometría de la Universidad de Salamanca, se estandarizó un protocolo que optimiza el almacenamiento, transporte, preparación y marcación de las muestras de líquido cefalorraquídeo mediante el empleo de una solución estabilizadora con un efecto de dilución conocido (Transfix R ), que previene la pérdida celular debida a los efectos citotóxicos in vitro del líquido cefalorraquídeo sobre los leucocitos, manteniéndose la eficacia de la estabilización por periodos superiores a las 24 a 48 horas de su obtención (10,16,17).…”

Section: Caracterización De Poblaciones Celulares En La Urticaria Papunclassified

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Dongen¹

2012

biomedica

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Identification of Leptomeningeal Disease in Aggressive B-Cell Non-Hodgkin's Lymphoma: Improved Sensitivity of Flow Cytometry

Abstract: FCM significantly improves the sensitivity of CC for the identification of leptomeningeal disease in aggressive B-NHL at higher risk of CNS disease, particularly in paucicellular samples.

Cited by 196 publications

References 39 publications

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

High frequency of neurolymphomatosis as a relapse disease of intravascular large B‐cell lymphoma

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