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. 2023 Feb;41(1):97-107.
doi: 10.1002/hon.3096. Epub 2022 Dec 8.

Incidence and risk factors for central nervous system relapse in patients with primary mediastinal large B-cell lymphoma in the rituximab era

Theodoros P Vassilakopoulos  1 , Fotios Panitsas  1 , Zois Mellios  2 , John Apostolidis  3 , Michalis Michael  4 , Ronit Gurion  5 , Burhan Ferhanoglu  6 , Eleftheria Hatzimichael  7 , Stamatios Karakatsanis  8 , Maria Dimou  1 , Christina Kalpadakis  9 , Eirini Katodritou  10 , Theoni Leonidopoulou  11 , Ioannis Kotsianidis  12 , Hara Giatra  2 , Nick Kanellias  13 , Ayman Sayyed  3 , Tamar Tadmor  14 , Olga Meltem Akay  6 , Maria K Angelopoulou  1 , Netanel Horowitz  15 , Maria Bakiri  2 , Gerassimos A Pangalis  1   16 , Panayiotis Panayiotidis  1 , Sotirios G Papageorgiou  17
Affiliations

Incidence and risk factors for central nervous system relapse in patients with primary mediastinal large B-cell lymphoma in the rituximab era

Theodoros P Vassilakopoulos et al. Hematol Oncol. 2023 Feb.

Abstract

Central nervous system (CNS) involvement is rare in primary mediastinal large B-cell lymphoma (PMLBCL). We aimed to evaluate the incidence of CNS relapse as first treatment failure event and the effect of the induction chemotherapy regimen, central nervous system - international prognostic index (CNS-IPI) and other clinical and laboratory variables on the risk of CNS relapse in 564 PMLBCL patients treated with immunochemotherapy. Only 17 patients (3.0%) received CNS prophylaxis. During a 55-month median follow-up only 8 patients experienced CNS relapse as first event, always isolated. The 2-year cumulative incidence of CNS relapse (CI-CNSR) was 1.47% and remained unchanged thereafter. The CI-CNSR was not affected by the chemotherapy regimen (R-CHOP or R-da-EPOCH). None of the established International Prognostic Index factors for aggressive lymphomas predicted CNS relapse in PMLBCL. The 2-year CI-CNSR in patients with versus without kidney involvement was 13.3% versus 0.96% (p < 0.001); 14.3% versus 1.13% with versus without adrenal involvement (p < 0.001); and 10.2% versus 0.97% with versus without either kidney or adrenal involvement. CNS-IPI was also predictive (2-year CI-CNSR in high-risk vs. intermediate/low-risk: 10.37% vs. 0.84%, p < 0.001). However, this association may be driven mainly by kidney and/or adrenal involvement. In conclusion, in PMLBCL, CNS relapse is rare and appears to be strongly associated with kidney and/or adrenal involvement.

Keywords: aggressive lymphoma; central nervous system; large cell; primary mediastinal; relapse.

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