scholarly journals NCOG-58. IMPACT OF TIME FROM PRESENTATION TO TREATMENT INITIATION ON CLINICAL OUTCOMES IN CENTRAL NERVOUS SYSTEM LYMPHOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii142-ii142
Author(s):  
Marissa Barbaro ◽  
Peter Pan ◽  
Sara Torres ◽  
Kiran Thakur ◽  
Mary Welch
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Outcomes ◽  
Treatment Initiation ◽  
Statistical Significance ◽  
Central Nervous System Lymphoma ◽  
Complete Response ◽  
Functional Independence ◽  
One Year ◽  
The Impact

Abstract OBJECTIVE To examine impact of time from presentation to treatment initiation (TPT) on clinical outcomes in a cohort of patients with central nervous system lymphoma (CNSL). INTRODUCTION Earlier work in our population found that multifocal disease, cerebrospinal fluid (CSF) sampling, and use of immunomodulatory therapies were associated with longer TPT in CNSL, but impact on clinical outcomes was not assessed. METHODS We retrospectively reviewed records of patients who were diagnosed with CNSL from 2010-2018 and treated at Columbia University Irving Medical Center (CUIMC). Regression models were applied to examine the impact of age, gender, response to methotrexate (MTX), use of radiation, and TPT >/= 30 days on survival 1 year from diagnosis (one-year survival), overall survival (OS), and functional independence (FI, defined as Karnofsky Performance Status (KPS) > 70). RESULTS There were sixty-nine patients (51% men; median age at diagnosis 70 years, range 21-90). Median TPT was 24 days (range 7-372). TPT was < 30 days in 59 (85%) and >/= 30 days in 10 (15%). One-year survival was 77%, and FI rate was 78%. Negative prognostic factors for OS were age > 65 years (HR 5.34, CI 1.20-24.30, p=0.03) and absence of complete response to MTX (HR 2.40, CI 0.87-6.69, p=0.09). Only complete response to MTX predicted both FI (OR 4.71, CI 1.17-19.02, p=0.03) and one-year survival (OR 6.77, CI 1.98-23.13, p=0.002). Notably, OS was numerically improved among patients with TPT >/= 30 days vs. < 30 days (HR 0.31, p=0.27), though this did not meet statistical significance. CONCLUSIONS Longer TPT has been associated with worse outcomes in systemic lymphoma, but such a correlation has not always been observed in brain cancers such as glioblastoma. We found no negative impact of longer TPT on survival or FI.

scholarly journals RARE-29. PRIMARY CENTRAL NERVOUS SYSTEM NON-HODGKIN LYMPHOMA IN AN 11-YEAR-OLD BOY: A CASE REPORT

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii448-iii448
Author(s):  
Jorge Luis Ramírez-Melo ◽  
Regina M Navarro-Martin del Campo ◽  
Manuel D Martinez-Albarran ◽  
Fernando Sánchez-Zubieta ◽  
Ana L Orozco-Alvarado ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hodgkin Lymphoma ◽  
Central Nervous System Lymphoma ◽  
Complete Response ◽  
High Dose ◽  
Illustrative Case ◽  
Tumor Biopsy ◽  
Non Hodgkin Lymphoma ◽  
The Right

Abstract BACKGROUND Primary central nervous system lymphoma (PCNSL) are very rare in children. CLINICAL CASE: An 11-year-old male presented with a 2 months history with myoclonic movements in the upper right limb, and a sudden frontal headache, gait disturbance due to right hemiparesis and an ipsilateral convulsive episode. Upon admission he had critical condition, with hypertensive skull syndrome, Glasgow of 12, Karnofsky 40%, right hemiparesis, swallowing disorder, facial paralysis, and loss of photo motor reflex and unilateral amaurosis. A CT and MRI showed a huge tumor mass in the left tempo-parietal region, infiltrating the white matter and shifting the midline. A Tumor biopsy was done, and reported diffuse small cell non-Hodgkin lymphoma of high-grade, Burkitt type. Systemic lymphoma workup was negative. He received six cycles of chemotherapy based on high dose methotrexate, rituximab and triple intrathecal.After the second cycle an ophthalmologic evaluation was done, and found infiltration to the right retina, for which 6 cycles of intra vitreous chemotherapy with methotrexate were applied, he showed an excellent response, and recovered all his neurological functions except that right hemianopia persist. Control MRI showed partial response at 2nd cycle and complete response after the 4th cycle. No Radiation was performed. CONCLUSION This report highlights the fact that pediatric PCNSL may be effectively treated by a combination of HDMTX and rituximab-based chemoimmunotherapy without irradiation. Lack of awareness of this rare entity may lead to extense resections of brain, and potential permanent secuelae that were avoided in this illustrative case.

scholarly journals INNV-21. EFFECTIVE REGIMEN OF HIGH-DOSE METHOTREXATE PLUS TEMOZOLOMIDE FOR PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA: A SINGLE-CENTER RETROSPECTIVE STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii120-ii121
Author(s):  
Jun-ping Zhang ◽  
Jing-jing Ge ◽  
Cheng Li ◽  
Shao-pei Qi ◽  
Feng-jun Xue ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
Complete Response ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Better Than

Abstract OBJECTIVE To evaluate the efficacy and safety of high-dose methotrexate combined with temozolomide in the treatment of newly diagnosed primary central nervous system lymphoma. METHODS A retrospective study was performed to analyze the clinical data of patients with primary central nervous system lymphoma treated with high-dose methotrexate plus temozolomide in the Department of Neuro-oncology, Capital Medical University, Sanbo Brain Hospital from May 2010 to December 2018. RESULTS A total of 41 patients were identified. Median age was 57 years (range, 27–76 years). The maximal extent of surgery was total resection in 6, partial resection in 8, and biopsy in 27 patients. Of the 35 patients with evaluable lesions, 32 achieved complete response (CR) and 3 achieved partial response. CR rate was 91.4%. The median follow-up time was 36.5 months (range, 4.9–115.4 months). After treatment, the median progression-free survival (PFS) was 45.1 months. PFS rate at 1, 2, 5 years were 85.4%, 70.1% and 43.8%, respectively. The OS rate at 1, 2, 5 years were 92.7%, 82.4% and 66.5%, respectively. The median PFS of patients younger than 65 years was better than that of patients ≥65 years (98.8 months vs 27.9 months, p=0.039). There was no association between efficacy and extent of resection (p=0.836). After disease progression, 6 of the 21 patients received radiotherapy. There was no statistical difference in OS between the patients with or without radiotherapy (36.9 months vs 28.4 months). The main severe adverse events were myelosuppression (36.6%) and elevated transaminase (34.1%). Three patients were discontinued due to drug-related toxicities. CONCLUSIONS High-dose methotrexate combined with temozolomide is effective in the treatment of primary central nervous system lymphoma, with a low incidence of severe adverse reactions. This efficacy may be better than the historical control of methotrexate alone or methotrexate plus rituximab.

scholarly journals HOUT-26. FACTORS ASSOCIATED WITH TREATMENT DELAY IN CENTRAL NERVOUS SYSTEM LYMPHOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi117-vi117
Author(s):  
Marissa Barbaro ◽  
Peter Pan ◽  
Sarah Torres ◽  
Kiran Thakur ◽  
Mary Welch
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Treatment Initiation ◽  
Central Nervous System Lymphoma ◽  
Initial Presentation ◽  
Medical Attention ◽  
Single Center ◽  
Delayed Treatment ◽  
Factors Associated ◽  
Multifocal Disease

Abstract OBJECTIVE To identify clinico-radiographic characteristics associated with delayed treatment initiation in central nervous system lymphoma (CNSL). INTRODUCTION Clinical and radiographic characteristics of CNSL are often varied with a broad differential diagnosis, potentially leading to delays in diagnosis and treatment. METHODS A single-center retrospective review of clinico-radiographic data was performed at Columbia University Irving Medical Center in patients with pathologically confirmed CNSL diagnosed from 1/2010–12/2018. Descriptive statistics and univariate logistic regression were used to identify variables associated with delayed treatment. Using visual binning, delayed treatment time was designated as >33 days from first presentation to medical attention to first chemotherapy for CNSL. Variables of interest included demographic data, presenting symptomatology, radiographic characteristics, location of initial presentation, and diagnostic and therapeutic interventions performed before biopsy. RESULTS Seventy patients (36 men (51%); median age at diagnosis 70 years, IQR 14.75 years; median time from first presentation to treatment 21 days, IQR 41.25 days) were included. Presentation with cognitive deficits suggested a strong, but not statistically significant, association with delayed treatment (OR=1.93, p=0.20), whereas presentation with focal neurologic deficits suggested protection against delayed treatment (OR=0.25, p=0.05). Initial presentation to a hospital suggested a strong, but not statistically significant, trend against delayed treatment (OR=0.41, p=0.08). Multifocal disease on neuroimaging (OR=7.18, p=0.001), pre-biopsy cerebrospinal fluid (CSF) sampling (OR=5.18, p=0.002), and pre-biopsy immunomodulatory treatment (including high-dose intravenous corticosteroids) for suspected neuroinflammatory disease (OR=6.33, p=0.03) had statistically significant associations with delayed treatment. Antimicrobial treatment before biopsy for suspected CNS infection suggested a trend toward delayed treatment, but the association was not statistically significant (OR=5.1, p=0.06). CONCLUSIONS Multifocal disease and pre-biopsy CSF sampling and immunomodulatory therapy were associated with delayed treatment initiation for CNSL in our single-center cohort. Recognizing factors associated with delayed treatment may allow physicians to circumvent these factors and permit more rapid diagnosis through tissue sampling.

The Impact of Primary Central Nervous System Lymphoma in AIDS Patients

1997 ◽  
Vol 14 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Anne K. Goplen ◽  
Oona Dunlop ◽  
Knut Liestøl ◽  
Ole Ch. Lingjærde ◽  
Johan N. Bruun ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Aids Patients ◽  
The Impact

Maintenance immunotherapy for primary central nervous system lymphoma following complete response after first-line chemotherapy.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e13531-e13531
Author(s):  
Nancy Diane Doolittle ◽  
Rochelle Fu ◽  
Prakash Ambady ◽  
Jenny Firkins ◽  
Edward A. Neuwelt
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Complete Response ◽  
First Line ◽  
Line Chemotherapy

scholarly journals The Impact of Early Corticosteroid Pretreatment Before Initiation of Chemotherapy in Patients With Primary Central Nervous System Lymphoma

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 264-272 ◽  
Author(s):  
Florian Gessler ◽  
Joshua D Bernstock ◽  
Bedjan Behmanesh ◽  
Uta Brunnberg ◽  
Patrick Harter ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Chemotherapeutic Agents ◽  
Optimal Timing ◽  
Newly Diagnosed ◽  
Chemotherapeutic Regimen ◽  
P 75 ◽  
Response To Chemotherapy ◽  
The Impact

Abstract BACKGROUND The optimal timing of corticosteroid (CS) treatment in patients with primary central nervous system (CNS) lymphoma (PCNSL) remains controversial. While poor clinical presentation may justify early treatment with CS, this may ultimately result in reduced concentrations of chemotherapeutic agents via perturbations in the permeability of the blood-brain barrier. OBJECTIVE To investigate whether early CS exposure is associated with beneficial outcomes and/or reduced occurrence of adverse events as opposed to delayed/concomitant administration. METHODS Herein we performed a retrospective observational analysis using patients that were prospectively entered into a database. All patients whom were admitted to the University Hospital between 2009 and 2015 with newly diagnosed PCNSL were included within our study. RESULTS Our cohort included 50 consecutive patients diagnosed with PCNSL; of these, in 30 patients CS administration was initiated prior to chemotherapy (early), whilst in the remaining 20 patients CS administration was initiated concomitantly with their chemotherapeutic regimen (concomitant). Within the early vs concomitant CS administration groups, no significant differences were observed with regard to progression-free survival (PFS) (P = .81), overall survival (OS) (P = .75), or remission (P = .68; odds ratio 0.76 and confidence interval [95%] 0.22-2.71). Critically, the timing of CS initiation was not associated with either PFS (P = .81) or PFS (P = .75). CONCLUSION Early CS administration was not associated with a deterioration in response to chemotherapy, PFS, or OS. As such, administration of CS prior to initiation of chemotherapy is both reasonable and safe for patients with newly diagnosed PCNSL.

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