Outcome of a Real-World Patient Cohort with Secondary CNS Lymphoma Treated with High-Intensity Chemoimmunotherapy and Autologous Stem Cell Transplantation

Thiele, Benjamin; Binder, Mascha; Schliffke, Simon; Frenzel, Christian; Dierlamm, Judith; Wass, Maxi; Weisel, Katja; Bokemeyer, Carsten; Janjetovic, Snjezana

doi:10.1159/000517531

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…Less data is presented for prior hematologic/lymphatic cancers. One retrospective cohort study of patients with non‐Hodgkin lymphoma and second primary CNS involvement found a median survival time of 11 months, which differs from the 7 months found here 28 . These findings contextualize the importance of inclusion of patients with second primary brain cancer in ongoing clinical trials.…”

Section: Discussionsupporting

confidence: 51%

“…One retrospective cohort study of patients with non-Hodgkin lymphoma and second primary CNS involvement found a median survival time of 11 months, which differs from the 7 months found here. 28 These findings contextualize the importance of inclusion of patients with second primary brain cancer in ongoing clinical trials. In an analysis of 464 clinical trials, more than one-third excluded this population completely, with another one-third instituting conditional exclusion criteria.…”

Section: Discussionmentioning

confidence: 83%

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Impact of prior cancer history on survival in brain malignancy: A propensity score‐adjusted, population‐based study

Ebad Ur Rehman,

Faraz,

Cheema

et al. 2024

Cancer Reports

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BackgroundIndividuals with a Prior Cancer History (PCH) are often excluded from clinical trials. However, a growing body of evidence suggests that prior cancer history does not present adverse outcomes on cancer patients. The evidence on the survival of brain cancer patients in this regard remains widely unknown.MethodsWe conducted a retrospective cohort study to estimate the prevalence and impact of prior cancer on survival of patients diagnosed with brain cancer. Data of patients who were diagnosed with brain cancer as their first or second primary malignancy between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity Score Matching (PSM) was used to ensure comparable baseline characteristics among the patients. Survival analysis was conducted using the Kaplan–Meier method, as well as multivariate Cox proportional hazard and multivariate competing risk models.ResultsOut of 42 726 patients, 1189 (2.78%) had PCH. Genitourinary (40.4%), Breast (13.6%), Hematologic and Lymphatic (11.4%), and Gastrointestinal malignancies (11.3%) were the most common types of prior cancer. PCH served as a significant risk factor for Overall Survival (OS) (Adjusted Hazard Ratio [AHR] 1.26; 95% CI [1.15–1.39]; p < .001) but did not have a statistically significant impact on Brain Cancer‐Specific Survival (BCSS) (AHR 0.97; 95% CI [0.88–1.07]; p = .54). Glioblastoma exhibited the most substantial and statistically significant impact on survival as compared to other histological types. Of all the organs systems, only prior Gastrointestinal and Hematologic and Lymphatic malignancies had a statistically significant impact on OS of patients.ConclusionOur findings indicate that PCH does not exert a substantial impact on the survival of brain cancer patients, except in cases involving gastrointestinal or hematologic and lymphatic PCH, or when the brain cancer is glioblastoma.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 83%

Impact of prior cancer history on survival in brain malignancy: A propensity score‐adjusted, population‐based study

Ebad Ur Rehman,

Faraz,

Cheema

et al. 2024

Cancer Reports

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“…Table 2 shows the results of clinical trials and retrospective studies that included patients with systemic DLBCL or HGBL with synchronous CNS involvement at diagnosis (studies with ⩽15 patients with synchronous CNS involvement at diagnosis were not included). 14,[20][21][22][23][24] The table highlights the paucity of published data and considerable heterogeneity in patients' characteristics and types of treatments received. Furthermore, none of these studies reported on the outcomes of patients with HGBL specifically.…”

Section: Outcomes Based On Receipt Of Hctmentioning

confidence: 99%

Outcomes of patients with diffuse large B-cell and high-grade B-cell lymphomas with synchronous CNS and systemic involvement at diagnosis treated with high-dose methotrexate and R-CHOP: a single-center retrospective study

Fleming

Huang

Dotson

et al. 2022

Therapeutic Advances in Hematology

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Background: The optimal treatment of patients with systemic diffuse large B-cell (DLBCL) or high-grade B-cell (HGBL) lymphomas with synchronous central nervous system (CNS) involvement at diagnosis is not well defined. High-dose methotrexate administered concurrently with R-CHOP (RM-CHOP) is a commonly used regimen, but data on outcomes achieved with this regimen are limited. Objective: To report our experience with RM-CHOP in patients with systemic DLBCL or HGBL with synchronous CNS involvement at diagnosis. Design: A single-center retrospective analysis. Methods: We identified consecutive patients with systemic DLBCL or HGBL with synchronous CNS involvement at diagnosis who were treated with RM-CHOP from January 2012 to January 2021. Results: Fifty patients were included with a median age of 62 years; 82% had DLBCL ( n = 41) and 18% had HGBL ( n = 9). Treatment with RM-CHOP was followed by consolidative autologous hematopoietic cell transplantation in 14 patients (28%). The complete response (CR) rate following RM-CHOP was 62%. With a median follow-up of 40 months, the median progression-free (PFS) and overall (OS) survivals were 16 and 58 months, and the 2-year PFS and OS were 41% and 57%, respectively. The 2-year cumulative incidence of CNS progression/relapse was 29%. Outcomes were particularly poor in HGBL, with median PFS and OS of 6 and 7 months, compared with median PFS and OS of 22 months and not reached in DLBCL, respectively. The outcomes of patients with relapsed/progressive disease were poor, with only 63% of patients receiving subsequent treatments and only 21% achieving CR to next subsequent treatment. Most patients (58%) with disease relapse/progression had CNS involvement which was associated with very poor outcomes (median OS of 2 months). Conclusion: CNS involvement in aggressive B-cell non-Hodgkin lymphoma at diagnosis dictates clinical outcomes and requires more effective treatment options.

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“…However, there are no such data for patients with secondary CNSL. Only few reports support the use of analogous treatment strategies in secondary CNSL, but the feasibility of HDT/ASCT is limited for these patients due to failure of salvage treatment, toxicity and unsuccessful stem cell harvest (7,8).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of CD19-specific CAR-T cell-based therapy in secondary central nervous system lymphoma

Zhang

Zhang²,

Wang³

et al. 2022

Front. Immunol.

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Encouraging response has been achieved in relapsed/refractory (R/R) B-cell lymphoma treated by chimeric antigen receptor T (CAR-T) cells. The efficacy and safety of CAR-T cells in central nervous system lymphoma (CNSL) are still elusive. Here, we retrospectively analyzed 15 patients with R/R secondary CNSL receiving CD19-specific CAR-T cell-based therapy. The patients were infused with CD19, CD19/CD20 or CD19/CD22 CAR-T cells following a conditioning regimen of cyclophosphamide and fludarabine. The overall response rate was 73.3% (11/15), including 9 (60%) with complete remission (CR) and 2 (13.3%) with partial remission (PR). During a median follow-up of 12 months, the median progression-free survival (PFS) was 4 months, and the median overall survival (OS) was 9 months. Of 12 patients with systemic tumor infiltration, 7 (58.3%) achieved CR in CNS, and 5 (41.7%) achieved CR both systemically and in CNS. Median DOR for CNS and systemic disease were 8 and 4 months, respectively. At the end point of observation, of the 7 patients achieved CNS disease CR, one was still alive with sustained CR of CNS disease and systemic disease. The other 6 died of systemic progression. Of the 15 patients, 11 (73.3%) experienced grades 1-2 CRS, and no patient had grades 3-4 CRS. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 3 (20%) patients, including 1 (6.6%) with grade 4 ICANS. All the CRS or ICANS were manageable. The CD19-specific CAR-T cell-based therapy appeared to be a promising therapeutic approach in secondary CNSL, based on its antitumor effects and an acceptable side effect profile, meanwhile more strategies are needed to maintain the response.

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Outcome of a Real-World Patient Cohort with Secondary CNS Lymphoma Treated with High-Intensity Chemoimmunotherapy and Autologous Stem Cell Transplantation

Cited by 6 publications

References 23 publications

Impact of prior cancer history on survival in brain malignancy: A propensity score‐adjusted, population‐based study

Impact of prior cancer history on survival in brain malignancy: A propensity score‐adjusted, population‐based study

Outcomes of patients with diffuse large B-cell and high-grade B-cell lymphomas with synchronous CNS and systemic involvement at diagnosis treated with high-dose methotrexate and R-CHOP: a single-center retrospective study

Efficacy and safety of CD19-specific CAR-T cell-based therapy in secondary central nervous system lymphoma

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