D Chihara1, N Asano2, K Ohmachi3, M Nishikori4, M Okamoto5, M Sawa6, R Sakai7, Y Okoshi8, N Tsukamoto9, Y Yakushijin10, S Nakamura2, T Kinoshita11, M Ogura12, R Suzuki13. 1. Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, USA Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya dchihara-kob@umin.ac.jp. 2. Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya. 3. Department of Hematology and Oncology, Tokai University School of Medicine, Isehara. 4. Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto. 5. Department of Hematology and Medical Oncology, Fujita Health University School of Medicine, Toyoake. 6. Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo. 7. Department of Medical Oncology, Kanagawa Cancer Center, Yokohama. 8. Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba. 9. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma. 10. Department of Clinical Oncology, Ehime University Graduate School of Medicine, Ehime. 11. Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya. 12. Department of Hematology and Laboratory Medicine, Suzuka National Hospital, Suzuka. 13. Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Abstract
BACKGROUND: Central nervous system (CNS) relapse is an uncommon but challenging complication in patients with mantle cell lymphoma (MCL). Survival after CNS relapse is extremely poor. Identification of high-risk populations is therefore critical in determining patients who might be candidates for a prophylactic approach. PATIENTS AND METHODS: A total of 608 patients (median age, 67 years; range 22-92) with MCL newly diagnosed between 1994 and 2012 were evaluated. Pretreatment characteristics and treatment regimens were evaluated for their association with CNS relapse by competing risk regression analysis. RESULTS: None of the patients received intrathecal prophylaxis. Overall, 33 patients (5.4%) experienced CNS relapse during a median follow-up of 42.7 months. Median time from diagnosis to CNS relapse was 20.3 months (range: 2.2-141.3 months). Three-year cumulative incidence of CNS relapse was 5.6% [95% confidence interval (95% CI) 3.7% to 8.0%]. Univariate analysis revealed several risk factors including blastoid variant, leukemic presentation, high-risk MCL International Prognostic Index and high Ki-67 (proliferation marker). Multivariate analyses revealed that Ki-67 ≥ 30 was the only significant risk factor for CNS relapse (hazard ratio: 6.0, 95% CI 1.9-19.4, P = 0.003). Two-year cumulative incidence of CNS relapse in patients with Ki-67 ≥ 30 was 25.4% (95% CI 13.5-39.1), while that in the patients with Ki-67 < 30 was 1.6% (95% CI 0.4-4.2). None of the treatment modalities, including rituximab, high-dose cytarabine, high-dose methotrexate or consolidative autologous stem-cell transplant, were associated with a lower incidence of CNS relapse. Survival after CNS relapse was poor, with median survival time of 8.3 months. There was no significant difference in the survival by the site of CNS involvement.
BACKGROUND: Central nervous system (CNS) relapse is an uncommon but challenging complication in patients with mantle cell lymphoma (MCL). Survival after CNS relapse is extremely poor. Identification of high-risk populations is therefore critical in determining patients who might be candidates for a prophylactic approach. PATIENTS AND METHODS: A total of 608 patients (median age, 67 years; range 22-92) with MCL newly diagnosed between 1994 and 2012 were evaluated. Pretreatment characteristics and treatment regimens were evaluated for their association with CNS relapse by competing risk regression analysis. RESULTS: None of the patients received intrathecal prophylaxis. Overall, 33 patients (5.4%) experienced CNS relapse during a median follow-up of 42.7 months. Median time from diagnosis to CNS relapse was 20.3 months (range: 2.2-141.3 months). Three-year cumulative incidence of CNS relapse was 5.6% [95% confidence interval (95% CI) 3.7% to 8.0%]. Univariate analysis revealed several risk factors including blastoid variant, leukemic presentation, high-risk MCL International Prognostic Index and high Ki-67 (proliferation marker). Multivariate analyses revealed that Ki-67 ≥ 30 was the only significant risk factor for CNS relapse (hazard ratio: 6.0, 95% CI 1.9-19.4, P = 0.003). Two-year cumulative incidence of CNS relapse in patients with Ki-67 ≥ 30 was 25.4% (95% CI 13.5-39.1), while that in the patients with Ki-67 < 30 was 1.6% (95% CI 0.4-4.2). None of the treatment modalities, including rituximab, high-dose cytarabine, high-dose methotrexate or consolidative autologous stem-cell transplant, were associated with a lower incidence of CNS relapse. Survival after CNS relapse was poor, with median survival time of 8.3 months. There was no significant difference in the survival by the site of CNS involvement.
Authors: Dai Chihara; Michelle A Fanale; Roberto N Miranda; Mansoor Noorani; Jason R Westin; Loretta J Nastoupil; Fredrick B Hagemeister; Luis E Fayad; Jorge E Romaguera; Felipe Samaniego; Francesco Turturro; Hun J Lee; Sattva S Neelapu; M Alma Rodriguez; Michael Wang; Nathan H Fowler; Richard E Davis; L Jeffrey Medeiros; Yasuhiro Oki Journal: PLoS One Date: 2018-03-14 Impact factor: 3.240
Authors: Furqaan Ahmed Kaji; Nicolás Martinez-Calle; Vishakha Sovani; Christopher Paul Fox Journal: Br J Haematol Date: 2022-03-16 Impact factor: 8.615