Isolated central nervous system relapses in primary mediastinal large B‐cell lymphoma after CHOP‐like chemotherapy with or without Rituximab

Abstract

Central nervous system (CNS) involvement in patients with primary mediastinal large Bcell (PMLBCL) lymphoma is a rare event, occurring in approximately 6% of patients, on the basis of the review of the literature prior to induction of Rituximab. The aim of this retrospective study was to describe the incidence of CNS relapse among 100 consecutive patients with PMLBCL who were treated with R-CHOP AE RT in comparison to patients treated with CHOP AE RT (n = 45) in 11 hospitals in Greece. Two patients experienced a CNS relapse, representing an overall frequency of 2.0% in R-CHOP treated patients and a 2-year actuarial incidence of 2.3%. Both patients had isolated CNS relapses. The incidence of CNS relapse after CHOP without Rituximab was 2/45 (4.4%) for a 2-year actuarial incidence of 7.5% (p = 0.29). Again, both patients had isolated CNS relapses. Parenchymal-only localizations accounted for 3/4 cases. Risk factors for CNS involvement could include leukocytosis, poor performance status and higher age-adjusted International Prognostic Index, although their impact was weakened by competing risk survival analysis. Both patients relapsing after R-CHOP required CNS radiotherapy to achieve a complete remission and be forwarded to high-dose therapy and autologous stem cell transplantation: They are both alive and disease-free 18 and 23 months after CNS relapse. Both cases relapsing after CHOP without Rituximab were salvaged by CNS radiotherapy (one also received intrathecal chemotherapy) entering long-term remissions. In conclusion, CNS relapses are rare in PMLBCL tending to be isolated in the CNS, probably reflecting the persistence of latent CNS disease than dissemination of resistant disease. The impact of Rituximab in reducing CNS relapses remains unknown. Established risk factors for CNS involvement in aggressive lymphomas may not be helpful in assessing the risk of CNS recurrence in this disease. Routine CNS prophylaxis is not probably required in PMLBCL.

Central Nervous System Prophylaxis in Non-Hodgkin Lymphoma: Who, What, and When?

“…Prior to rituximab, approximately 5 % of patients with primary mediastinal B cell lymphoma (PMBL) developed CNS relapse, compared to 2.2 % treated with R-CHOP [51]. Clinical risk factors useful in DLBCL overall were not significant predictors of CNS relapse in a series of 145 patients with PMBL [51].…”

“…Clinical risk factors useful in DLBCL overall were not significant predictors of CNS relapse in a series of 145 patients with PMBL [51]. Overall risk appears sufficiently low as to not warrant routine use of CNS prophylaxis in the primary treatment of this subtype, with decisions regarding individual patients made on the basis of the general predictive indices for DLBCL overall as described above.…”

Effect of dietary supplement from mono‐culture fermentation of Moringa oleifera seeds by Rhizopus stolonifer on hematology and markers linked to hypercholesterolemia in rat model

“…This indicates that level of monocytes produced is still within the tolerable limit for mammals. Our finding supports the earlier finding which stated that uncontrollable high content of monocyte counts greater than 0·9 × 10 9 /L was associated with the development of monocytosis, pericarditis, or joint effusions and ascites (Papageorgiou et al., 2013). …”

Primary mediastinal large B-cell lymphoma

“…Approximately a quarter of patients have stage III/IV disease ( Table 2) [29][30][31][32]. Initial presentation can be nodal or extranodal [13]; however, relapse is frequently extranodal and may involve liver, gastrointestinal tract, kidneys, and ovaries [13,18,33]. Bone marrow involvement is uncommon and observed in 1-5% of cases [29,31,34,35].…”

“…Bone marrow involvement is uncommon and observed in 1-5% of cases [29,31,34,35]. Central nervous system (CNS) involvement, in the form of leptomeningeal or intraparenchymal disease, is uncommon and seen particularly with extranodal disease and at relapse [13,33].…”