Korean J Hematol.  2012 Mar;47(1):60-66. 10.5045/kjh.2012.47.1.60.

Relapse pattern and prognostic factors for patients with primary central nervous system lymphoma

• Kim JE
• Yoon DH
• Kim S
• Lee DH
• Kim JH
• Yoon YH
• Chi HS
• Lee SW
• Park CS
• Huh J
• Suh C

• KMID: 2251972
• DOI: http://doi.org/10.5045/kjh.2012.47.1.60

Abstract

BACKGROUND
Primary central nervous system lymphoma (PCNSL) rarely relapses in extracranial sites, and no specialized guidelines for follow-up evaluation have been proposed.
METHODS
We analyzed 65 patients with newly diagnosed PNCSL to evaluate the pattern of relapse and prognostic factors.
RESULTS
Of the 65 patients analyzed, 55 had only parenchymal brain disease, and 10 had both intracranial and extracranial lesions. As a first-line treatment, 29 patients received chemotherapy only (CTx), 13 received chemotherapy followed by whole brain radiotherapy (CTx-WBRT), 18 received chemotherapy followed by autologous stem cell transplantation (CTx-ASCT), 2 received palliative WBRT, and 3 received best supportive care. The overall response rate to the initial treatment was 75.8%, with specific response rates of 62.1% to CTx, 84.6% to CTx-WBRT, and 100% to CTx-ASCT. The complete response (CR) rate was higher with CTx-ASCT than in the absence of ASCT (77.8% vs. 43.2%; P=0.025). After a median follow-up of 18.8 months, the median failure-free survival (FFS) and overall survival (OS) were 13.0 and 36.1 months, respectively. No systemic relapse without a CNS lesion was noted. Multivariate analysis showed that ASCT was predictive of better FFS but not of OS. Age and the Memorial-Sloan Kettering Cancer Center prognostic score were predictive of survival.
CONCLUSION
We observed no systemic relapse without a CNS lesion, suggesting that regular systematic evaluation of extracranial sites may not always be necessary. Age was prognostic of survival irrespective of treatment scheme. ASCT may improve CR rate and FFS.

Keyword

Primary CNS lymphoma; Relapse; Prognostic factor

MeSH Terms

Brain
Brain Diseases
Central Nervous System
Follow-Up Studies
Humans
Lymphoma
Multivariate Analysis
Recurrence
Stem Cell Transplantation

Figure

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  Fig. 1 Failure free survival (A) and overall survival (B) in all patients.

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  Fig. 2 Failure free survival and overall survival according to age (A, B), Eastern Cooperative Oncology Group performance status (ECOG PS) (C, D), serum lactate dehydrogenase (LD) level (E, F), and MSKCC, Memorial-Sloan Kettering Cancer Center (MSKCC) prognostic group (G, H).

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  Fig. 3 Failure free survival (A) and overall survival (B) in patients treated with and without autologous stem cell transplantation.

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