Tumor microenviromental reaction would diminish incomparable accuracy and swiftness of flow cytometric diagnosis of primary central nervous system lymphoma

2021 ◽  
Author(s):  
Hayato Takeuchi ◽  
Tohru Inaba ◽  
Yukiko Shishido-Hara ◽  
Taku Tsukamoto ◽  
Shinsuke Mizutani ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Rapid Progression ◽  
Cell Type ◽  
Eligibility Criteria ◽  
Initiation Of Therapy ◽  
Fcm Analysis ◽  
Histological Confirmation ◽  
Pattern Sensitivity

Abstract Background Primary central nervous system lymphoma (PCNSL), a relatively rare brain tumor, bears a dire prognosis. On occasion, rapid progression of the tumor makes immediate diagnosis and initiation of therapy imperative. To achieve swift diagnosis, we adopt flow cytometry (FCM) in addition to conventional histopathology. The aim of this study is to reveal utility and drawbacks of FCM diagnosis for PCNSL. Methods Patients with suspected PCNSL on neuroradiological findings and received both FCM and histological diagnosis between August 2015 and April 2020 were retrospectively enrolled into the study. Tumor samples were collected by craniotomy with either of endoscope or microscope. The patients’ electronic medical records were investigated, and histological findings, results of FCM, and other clinical data were evaluated. Results Twenty seven patients met the eligibility criteria. Twenty three patients (11 males and 12 females) were diagnosed with PCNSL by histological confirmation, and 22 cases were B-cell type lymphoma and 1 was T-cell type. Median age at diagnosis was 65. FCM analysis showed lymphoma pattern in 20 cases, but in the other 3 lymphoma cases (FCM discordant: FCM-D) and 4 non-lymphomatous tumor cases, FCM results did not show lymphoma pattern (sensitivity: 86.4%, specificity: 100%). Analysis of FCM-D cases showed infiltration of T lymphocytes or astrocytes into the tumor tissue, indicating tumor microenvironmental reaction, were observed, and it is assumed that those reactions deceived FCM diagnosis. Conclusions Despite some disadvantages, diagnosis of PCNSL by FCM is rapid and reliable.

MYC, BCL2, and BCL6 rearrangements in primary central nervous system lymphoma of large B cell type

2018 ◽  
Vol 98 (1) ◽  
pp. 169-173 ◽  
Author(s):  
Anahita Nosrati ◽  
Ahmad Monabati ◽  
Alireza Sadeghipour ◽  
Fatemeh Radmanesh ◽  
Akbar Safaei ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Central Nervous System Lymphoma ◽  
Cell Type ◽  
Large B Cell

scholarly journals Ifosphamide and Carboplatin Based (R-DeVIC) Salvage Therapy in Patients with Relapsed/Refractory PCNSL - a Multicentre Retrospective Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1705-1705
Author(s):  
Hans-Guido Holl ◽  
Elisabeth Schorb ◽  
Jürgen Finke ◽  
Nikolaos Vassiliadis ◽  
Benjamin Kasenda ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Research Funding ◽  
Progressive Disease ◽  
Response Rate ◽  
Brain Mri ◽  
Central Nervous System Lymphoma ◽  
Common Adverse Event ◽  
High Dose ◽  
Eligibility Criteria

Abstract Background Primary central nervous system lymphoma (PCNSL) is rare and aggressive Non-Hodgkin lymphoma of the central nervous system (CNS).High-dose methotrexate (HD-MTX) based chemotherapy is standard first-line treatment in newly diagnosed disease. Although remissions can be achieved in most patients, at least a third relapses and therapeutic options in relapsed/refractory PCNSL (r/r PCNSL) are still limited. Aim of this study was to investigate efficacy and safety in of the R-DeVIC protocol consisting of: rituximab, ifosfamide, dexamethason, carboplatin and etoposide. Methods This was a retrospective study based on routinely collected health data from two sites in Germany (Stuttgart and Freiburg). Patient eligibility criteria were: r/r PCNSL confirmed by local pathology treated with at least one prior therapy. The R-DeVIC protocol was applied according to the following schedule: Rituximab 375 mg/m2/d (d0), dexamethasone 40 mg/d (d1-3), etoposide 100 mg/m2/d (d1-3), ifosfamide 1500 mg/m2/d (d1-3), carboplatin 300 mg/m2/ (d1) and repeated after 21 days. Feasibility endpoints included: toxicity, dose density, and treatment related death. Efficacy endpoints included: response as evaluated on brain MRI, progression free survival (PFS) and overall survival (OS). We used descriptive statistics for summarizing patient characteristics and outcomes; including the Kaplan-Meier estimator to plot time-to-event endpoints. Results We identified 19 eligible patients with r/r PCNSL being treated with R-DeVIC between 2010 and 2018. All patients received prior HD-MTX based chemotherapy (58% (11/19) treated with R-MTX/AraC/Thiotepa, 11% (2/19) treated with R-MTX/AraC and 26% (5/19) treated with R-MTX). All, but 2 patients received R-DeVIC at first progression after 1stline treatment. In 52% (10/19), treatment was discontinued after the first cycle. In 3 patients R-DeVIC was discontinued due to severe infections or renal injury and in 2 patients due to ifosfamide induced neuro-toxicity, as well as progressive disease in 2 patients. 2 patients already achieved complete remission and in one case reasons for discontinuance were not recorded. A 2ndcycle was administered in 47% (9/19) and 3 patients received a 3rdcycles of R-DeVIC. Observed overall response rate after R-DeVIC was 79% (15/19): Five patients with complete and 10 with partial remission, respectively. Three (26%) patients had progressive disease and one patient achieved disease stabilization. Neutropenic fever requiring intravenous antibiotic treatment was the most common adverse event (21% of administered cycles), followed by neurological disturbances, mainly associated with ifosfamide. After a median follow-up of 5 months, 6- month and 12 -month PFS were both 47% (95% CI 24-67); 6 month and 12-month was OS 59% (95% CI 32-78). Conclusions R-DeVIC is a feasible therapeutic salvage option in r/r PCNSL associated with a response rate of 79%. However, substantial toxicity was also observed leading to discontinuation of treatment in about a quarter of patients. Further data will be presented at the meeting. Disclosures Finke: Novartis: Consultancy, Honoraria, Other: travel grants, Research Funding; Medac: Consultancy, Honoraria, Other: travel grants, Research Funding; Neovii: Consultancy, Honoraria, Other: travel grants, Research Funding; Riemser: Consultancy, Honoraria, Research Funding. Illerhaus:Riemser: Consultancy, Honoraria.

scholarly journals Primary Central Nervous System Lymphoma Presenting as Parkinsonism with Atypical MRI Findings and Elevated 14-3-3 Protein

2020 ◽  
Vol 11 (03) ◽  
pp. 492-494
Author(s):  
Elanagan Nagarajan ◽  
Sushma Y. Yerram ◽  
Lakshmi P. Digala ◽  
Pradeep C. Bollu
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Movement Disorders ◽  
Central Nervous System Lymphoma ◽  
Mass Effect ◽  
High Dose ◽  
Rapid Progression ◽  
Mri Findings ◽  
Atypical Presentations ◽  
The Right

AbstractPrimary central nervous system lymphoma (PCNSL) is a rare neoplasm with an incidence of 2 to 3% of all CNS malignancies. The diagnosis can be challenging, especially with atypical presentations. Movement disorders can be one of the rare presentations of PCNSL. Here, we present an unusual case of gradually progressing Parkinsonism with an elevation of cerebrospinal fluid (CSF) 14–3-3 protein and atypical imaging findings found to have PCNSL. A 76-year-old female patient presented with gait and intermittent speech difficulty. Initial workup revealed a contrast-enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed over 6 months and presented with mild dysarthria, bradykinesia, mild rigidity, and reduced left arm swinging. These features were consistent with Parkinsonism. The repeat imaging showed the progression of hyperintensities in the bilateral putamen. The patient underwent a stereotypic biopsy of the right caudate nucleus, which revealed PCNSL. She was treated with high-dose methotrexate and is currently in remission. Diagnosis of movement disorders remains clinical and rapid progression of symptoms, and atypical presentation must warrant further imaging and workup.

scholarly journals HOUT-16. A RETROSPECTIVE ANALYSIS OF SURVIVAL OUTCOMES BASED ON CONSOLIDATION REGIMENS IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi115-vi115
Author(s):  
Savannah Gelhard ◽  
Amiee Maxwell ◽  
Adam Cohen ◽  
Joe Mendez
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Induction Therapy ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
Autologous Stem Cell Transplant ◽  
High Dose ◽  
Cell Transplant ◽  
Consolidation Therapy ◽  
Eligibility Criteria

Abstract BACKGROUND Currently, Primary Central Nervous System Lymphoma (PCNSL) is treated with induction therapy consisting of polychemotherapy followed by consolidation therapy. Besides the incorporation of high-dose methotrexate as the backbone of induction therapy, there is no accepted standard induction or consolidation regimen for patients with PCNSL in the US. In this study, we compared three consolidation techniques by analyzing overall survival (OS) and progression free survival (PFS) in patients treated for PCNSL. METHODS Patients treated for newly diagnosed PCNSL at Huntsman Cancer Institute after July 1, 2012 with induction followed by consolidation therapy were retrospectively reviewed. Patients who completed one of the following regimens were included: rituximab/methotrexate/vincristine/procarbazine (R-MVP), rituximab/methotrexate/temozolomide (R-MT), or rituximab/methotrexate (R-M) for induction followed by consolidation with etoposide/cytarabine (EA), high-dose cytarabine (HIDAC), or autologous stem cell transplant (ASCT). Patients were excluded if there was evidence of systemic lymphoma on PET/CT or if the patient received radiation as consolidation therapy. Survival was calculated from the date of diagnosis and last date of known survival. RESULTS Twenty-three patients met eligibility criteria and received the following four treatment regimens: R-MT+EA (12), R-MT+ASCT (4), R-M+ASCT (1), and R-MVP+HIDAC (6). The median age of diagnosis was 61. Patients receiving ASCT (5) had a trend towards a more favorable OS (p=0.0675) compared to the other two consolidation therapies with no recurrence or death in those patients treated with ASCT. When comparing non-transplanted patients, R-MVP-HIDAC had a trend towards better OS and PFS compared to R-MT-EA. CONCLUSION This small retrospective review provides evidence that ASCT may be a superior treatment consolidation strategy in patients with PCNSL compared to EA and HIDAC, and that R-MT-EA may be less successful in practice than in published trials. These findings suggest that consolidation with ASCT should be strongly considered in all patients with PCSNL despite which induction therapy was received.

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