Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial

Tabouret, Émeline; Houillier, Caroline; Martin-Duverneuil, N; Blonski, Marie; Soussain, Carole; Ghesquières, Hervé; Houot, Roch; Larrieu, Delphine; Soubeyran, Pierre; Gressin, Rémy; Gyan, Emmanuel; Chinot, Olivier; Taillandier, Luc; Choquet, Sylvain; Alentorn, Agustí; Leclercq, Delphine; Omuro, Antonio; Tanguy, Marie‐Laure; Hoang-Xuân, Khê

doi:10.1093/neuonc/now238

Cited by 40 publications

(51 citation statements)

References 25 publications

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“…9 This observation is consistent with the fact that lymphomatous dissemination in the brain may occur in the absence of contrast enhancement on MRI (Figure 2). …”

Section: Diagnosis Pathogenesis and Radiographic Assessmentsupporting

confidence: 89%

Biology of CNS lymphoma and the potential of novel agents

Rubenstein

2017

Hematology

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Primary and secondary CNS lymphomas are aggressive brain tumors that pose an immense challenge to define in terms of molecular pathogenesis, as well as to effectively treat. During the past 10 years improvements in survival have been achieved with the implementation of anti-CD20 immunotherapy and optimization of dose-intensive consolidation strategies. The applications of whole-exome sequencing, comparative genomic hybridization, transcriptional profiling, and examination of the tumor microenvironment, particularly in the context of clinical investigation, provide insights that create a roadmap for the development and implementation of novel targeted agents for this disease. A body of genetic evidence strongly suggested that primary CNS lymphomas (PCNSLs) are likely largely dependent on NF-κB prosurvival signals, with enrichment of mutations involving the B-cell receptor pathway, in particular myeloid differentiation primary response 88 and cluster of differentiation 79B. The first set of early-phase investigations that target NF-κB in PCNSL have now been completed and support the NF-κB hypothesis but at the same time reveal that much work needs to be done to translate these results into meaningful advances in survival for a large fraction of patients. Insights into secondary prosurvival pathways that mediate drug resistance is a priority for investigation. Similarly, further evaluation of the immune-suppressive mechanisms in the CNS lymphoma tumor microenvironment is requisite for progress. Combinatorial interventions that promote the antitumor immune response have significant potential. With increasing availability of targeted agents, there is also a need to develop more sensitive imaging tools, not only to detect this highly invasive brain neoplasm but also potentially to define an evolving molecular phenotype to facilitate precision medicine.

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“…9 This observation is consistent with the fact that lymphomatous dissemination in the brain may occur in the absence of contrast enhancement on MRI (Figure 2). …”

Section: Diagnosis Pathogenesis and Radiographic Assessmentsupporting

confidence: 89%

Biology of CNS lymphoma and the potential of novel agents

Rubenstein

2017

Hematology

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“…This dynamic change indicated that these white matter non-enhancing T2-FLAIR hyperintensity lesions had neoplastic nature. It has been reported that the prevalence of this phenomenon was about 23% [13]. In our research, the most frequently involved locations of non-enhancing T2-FLAIR hyperintensity lesions were deep and juxtacortical white matter.…”

Section: Discussionsupporting

confidence: 55%

“…It has been observed that the non-enhancing T2-FLAIR hyperintensity lesions at a distance from the enhancing tumor site at baseline have the neoplastic nature [13]. However, the incidence, location, and shape of these non-enhancing T2-FLAIR hyperintensity lesions in PCNSL are still poorly characterized.…”

Section: Introductionsmentioning

confidence: 99%

MRI Patterns of Non-Enhancing T2-FLAIR Hyperintensity Lesions in Primary CNS Lymphoma

Liu

Hou

Liu

et al. 2020

Preprint

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Purpose: The non-enhancing T2-FLAIR hyperintensity lesions at a distance from the enhancing tumor site at baseline have been observed of neoplastic nature in primary central nervous system lymphomas (PCNSL). Our aim was to explore the incidence, location, and morphology of the non-enhancing T2-FLAIR hyperintensity lesions in PCNSL.Methods: We retrospectively reviewed patients diagnosed with immunocompetent PCNSL at our institution. We identified and evaluated the T2-FLAIR hyperintensity lesions without enhancement that markedly decrease or disappear in the MRI after treatment. MRI characteristics of PCNSL at initial presentation were analyzed and compared between patients with non-enhancing T2-FLAIR hyperintensity lesions and patients without these lesions.Results: Among 89 patients, 10 patients (11.2%) were found to have non-enhancing T2-FLAIR hyperintensity lesions at a distance from the enhancing tumor site at baseline, that showed a markedly decrease or disappearance after treatment. The locations of these lesions were as follows: the juxtacortical and deep white matter in 7 lesions, periventricular white matter in 2 lesions, basal ganglia in 1 lesion, and infratentorial aera in 1 lesion. Baseline MRI characteristics in patients with non-enhancing T2-FLAIR hyperintensity lesions exhibited a higher rate of multiple enhancing lesions (P = 0.027), and bilateral enhancing lesions (P = 0.001), compared to patients without non-enhancing T2-FLAIR hyperintensity lesions.Conclusion: Non-enhancing T2-FLAIR hyperintensity lesions at a distance from the enhancing tumor lesions in patients with PCNSL, which indicated of neoplastic nature, was not rare. Those non-enhancing lesions should be incorporated in the initial evaluation of tumor burden and response in the follow up.

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“…An impressive example of such a T2-FLAIR lesion and its shrinkage under therapy is depicted in Figure 2 of this paper. 5 Now, of those 16 patients 10 relapsed, five among those showing relapse within the non-enhancing (tumorous) shrinking lesions under therapy. This is in contrast to our usual perception of this disease.…”

Section: See the Article By Tabouret Et Al Pp 422-429mentioning

confidence: 97%

“…10 For practical reasons, however, such an extension of response criteria to these T2-FLAIR lesions seems unnecessary since no case with only nonenhancing relapse has been identified in the series by Tabouret and coworkers. 5 Nevertheless, their observation is of clinical relevance, and we should closely monitor suspicious foci of nonenhancing lesions that increase in size at regular MRI follow-up, particular;y if those lesions had shown shrinkage under first-line therapy.…”

Section: See the Article By Tabouret Et Al Pp 422-429mentioning

confidence: 99%