scholarly journals What Is on Your Mind? Impaired Social Cognition in Primary Central Nervous System Lymphoma Patients Despite Ongoing Complete Remission

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 943
Author(s):  
Milena Pertz ◽  
Thomas Kowalski ◽  
Patrizia Thoma ◽  
Uwe Schlegel
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Social Cognition ◽  
Complete Remission ◽  
Central Nervous System Lymphoma ◽  
Well Being ◽  
Mental States ◽  
Self Report ◽  
Social Situations ◽  
Term Survival

Within the past decades, long-term survival was achieved in a substantial fraction of primary central nervous system lymphoma (PCNSL) patients, expanding the focus of research to their quality of life (QoL). Social relationships crucially contribute to well-being in the context of adversity. Therefore, abilities that facilitate social interactions essentially determine QoL. The present study specifically targeted those sociocognitive abilities. Forty-three PCNSL patients with ongoing complete remission to therapy for at least one year and 43 healthy controls matched for age, gender and education were examined with standardized self-report and behavioral measures of social cognition. An impaired ability to comprehend others´ feelings was found in patients for both positive and negative mental states. Patients had difficulties in identifying the awkward element in challenging social situations, whereas the degree of discomfort experienced in those situations was comparable between groups. Both the production of optimal solutions for social situations and the mere recognition of these among less optimal strategies were impaired in patients. Clinicians should be aware of possible sociocognitive impairment and ought to address this in additional supportive interventions. Impaired sociocognitive abilities may entail social conflicts at a time when patients rely on social support. This, in turn, could detrimentally affect QoL.

Targeting the PI3K/AKT/mTOR Signaling Pathway in Primary Central Nervous System Lymphoma: Current Status and Future Prospects

2020 ◽  
Vol 19 (3) ◽  
pp. 165-173
Author(s):  
Xiaowei Zhang ◽  
Yuanbo Liu
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Signaling Pathway ◽  
Central Nervous System Lymphoma ◽  
B Cell Lymphoma ◽  
Mtor Signaling ◽  
Mtor Signaling Pathway ◽  
Antitumor Effects ◽  
Term Survival

Primary Central Nervous System Lymphoma (PCNSL) is a rare invasive extranodal non- Hodgkin lymphoma, a vast majority of which is Diffuse Large B-Cell Lymphoma (DLBCL). Although high-dose methotrexate-based immunochemotherapy achieves a high remission rate, the risk of relapse and related death remains a crucial obstruction to long-term survival. Novel agents for the treatment of lymphatic malignancies have significantly broadened the horizons of therapeutic options for PCNSL. The PI3K/AKT/mTOR signaling pathway is one of the most important pathways for Bcell malignancy growth and survival. Novel therapies that target key components of this pathway have shown antitumor effects in many B-cell malignancies, including DLBCL. This review will discuss the aberrant status of the PI3K/AKT/mTOR signaling pathways in PCNSL and the application prospects of inhibitors in hopes of providing alternative clinical therapeutic strategies and improving prognosis.

scholarly journals Central nervous system leukemia in children with acute nonlymphoblastic leukemia

Blood ◽  
1985 ◽  
Vol 66 (5) ◽  
pp. 1062-1067
Author(s):  
CH Pui ◽  
GV Dahl ◽  
DK Kalwinsky ◽  
AT Look ◽  
J Mirro ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Complete Remission ◽  
Leukocyte Count ◽  
Intrathecal Methotrexate ◽  
Remission Induction ◽  
Term Survival ◽  
Cns Relapse ◽  
Acute Nonlymphoblastic Leukemia ◽  
The Impact

Factors contributing to the development of central nervous system (CNS) leukemia, and the impact of leukemic involvement of this site on subsequent remission length, were determined in 184 children with acute nonlymphoblastic leukemia who had been treated in two successive clinical trials. Preventive CNS therapy in both studies consisted of intrathecal methotrexate (12 mg/m2) given monthly during the first six months of therapy and then every three months until all treatment was stopped. Children with CNS leukemia at diagnosis or relapse were given intrathecal chemotherapy weekly for four weeks and then monthly throughout the remainder of the treatment course. Those continuing in complete remission received 2,400 rad cranial irradiation plus five doses of intrathecal methotrexate before cessation of therapy. The 38 children (20.7%) with CNS leukemia at diagnosis were more likely to have an initial leukocyte count greater than or equal to 25 X 10(9)/L (P = .01) and age less than 2 years (P = .03). The presence of CNS leukemia at diagnosis did not adversely affect the remission induction rate (P = .13) or the length of complete remissions (P = .73). CNS relapse ended initial remissions in 11 patients only and did not preclude subsequent long-term survival, as four of these children are off therapy and in second complete remission for 33+ to 78+ months. Three features at diagnosis were predictive of CNS relapse: monocytic or myelomonocytic leukemia (P = .002); age less than 2 years (P = .0001); and leukocyte count greater than or equal to 25 X 10(9)/L (P = .012). By stepwise Cox regression analysis, each factor was found to have independent predictive value. Despite the apparent effectiveness of intrathecal methotrexate as preventive CNS treatment, our findings indicate that more effective prophylaxis is needed for patients with features predisposing to CNS relapse.

Long-Term Survival Following Radiotherapy and Cytarabine Chemotherapy for Sporadic Primary Central Nervous System Lymphoma

2003 ◽  
Vol 179 (9) ◽  
pp. 626-632 ◽  
Author(s):  
Christoph Pöttgen ◽  
Martin Stuschke ◽  
Georg Stüben ◽  
Armin Schmitz ◽  
Karl Schwechheimer ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Term Survival ◽  
Long Term Survival

Sequential High Dose Immuno-Chemotherapy Followed by Autologous Peripheral Blood Stem Cell Transplantation for Patients with Untreated Primary Central Nervous System Lymphoma - a Multicentre Study by the Collaborative PCNSL Study Group Freiburg

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 302-302 ◽  
Author(s):  
Gerald Illerhaus ◽  
Kristina Fritsch ◽  
Gerlinde Egerer ◽  
Monika Lamprecht ◽  
Nikolas von Bubnoff ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Stem Cell ◽  
Complete Remission ◽  
Performance Status ◽  
Central Nervous System Lymphoma ◽  
Infectious Complications ◽  
Induction Treatment ◽  
High Dose ◽  
Grade 3

Abstract Abstract 302 Background: Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin′s lymphoma with poor prognosis. Addition of methotrexate (MTX) to whole brain radiotherapy (WBRT) has improved the prognosis of patients (pts) with PCNSL, but a significant proportion are still not cured. Preliminary reports suggested that dose-intensified chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) are highly effective in the treatment of newly-diagnosed PCNSL in younger pts. To strengthen the evidence of this approach, we initiated a prospective multicenter phase II study with early HDT and ASCT to investigate efficacy, safety and survival. This trial is registered at ClinicalTrials.gov (NCT 00647049). Methods: Immunocompetent pts <65 years with untreated biopsy proven PCNSL were eligible. Induction treatment consisted of 4 repetitive cycles of MTX (8g/m2) and 2 cycles cytarabine (2×3g/m2) and thiotepa (TT, 40mg/m2). Rituximab (375mg/m2) was added by amendmend after 2 included patients; it was given on day −7 before induction treatment and before each chemotherapy cycle. After the 2nd cycle cytarabine/TT stem-cells were collected after mobilisation with rG-CSF. The HDT regimen included carmustine (400mg/m2) and TT (4×5mg/kgBW) prior ASCT. Primary endpoint was complete remission (CR) 30 days after ASCT. Secondary end-points were overall-survival (OS), duration of response and toxicity. Patients not in complete remission after HDT and ASCT received WBRT. Results: From 2007 to 2011 79 pts (44 female, 35 male) were enrolled from 18 German centers and evaluable for analysis (median age 55 years, range 20–66). Seventy eight pts had aggressive B-cell lymphomas and one T-cell-lymphoma. Median Karnofsky performance status at diagnosis was 90% (range 30–100). After induction treatment, 73 of 76 (96%) evaluable pts responded, (26,9% CR, 55,7 PR). Seventy-three pts (96%) received HDT and ASCT according to protocol. Six pts were treated off-protocol due to low performance status (n=1), progressive disease (n=1) and infectious complications (n=4). Regarding the primary endpoint, CR was achieved in 77% and partial remission (PR) in 14% of patients (overall response rate 91%) after HDT and ASCT. Ten pts in PR after HDT and ASCT received consolidating WBRT. After a median follow-up of 28.8 months (range 1–63 mo) 1 and 2 years OS was 92% and 87%, respectively. Myelotoxicity was the most frequent CTC grade 3–4 toxicity with grade 3–4 infections in 41/73 pts (56,2%) during the transplant-phase. Two patients had lethal infectious complications during induction treatment with cytarabine/TT, three further pts died after HDT and ASCT due to severe infection (n=1), renal failure (n=1) and pneumonitis (n=1). Further results will be presented. Conclusion: Sequential MTX-based immuno-chemotherapy followed by carmustine/TT containing HDT and ASCT is highly effective and feasible in younger patients. Treatment related toxicity is of concern and comparable to non-high-dose protocols. Further randomised trials to compare HDT with conventional CT are needed. Disclosures: Illerhaus: Riemser: Honoraria.

scholarly journals Favorable Treatment Alternative for Primary Central Nervous System Lymphoma: Combined Chemotherapy Regimen Consisting of High-Dose Methotrexate, Rituximab and Cytosine-Arabinoside

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5462-5462
Author(s):  
Pinar Ataca ◽  
Selami Kocak Toprak ◽  
Erden Atilla ◽  
Pervin Topcuoglu ◽  
Meltem Kurt Yuksel ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Complete Remission ◽  
Cytosine Arabinoside ◽  
Central Nervous System Lymphoma ◽  
Successful Outcome ◽  
Serum Lactate Dehydrogenase ◽  
Treatment Alternative ◽  
Hematopoietic Stem ◽  
University Department

Abstract Introduction: Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin lymphoma that is limited to the brain parenchyma, intraocular compartment, cranial nerves, leptomeninges and spinal cord. New treatment strategies have improved prognosis. Methods: We present 10 PCNSL patients diagnosed at Ankara University Department of Hematology between 2006 and 2014 and treated at both Ankara University Department of Hematology and Ankara Medicana Hospital. Survival data was analyzed using Kaplan Meier method and Log-Rank. Results: Five of the 10 patients were male. The average age of the group was 53.40 ± 14.45 years (range: 29-72 years); the average age was 60 ± 9.8 years (range: 48-72) for the female patients and 46.8 ± 16.2 years (range: 29-67) for the male patients. The patients’ performance statuses based on Eastern Cooperative Oncology Group (ECOG) scores were distributed as follows: score 0, 2 patients; score 1, 5 patients; score 2, 1 patient; and score 3, 2 patients. The most common symptoms at diagnosis was headache in 6 patients followed by dizziness in 2 patients, memory loss in 1 patient and lumbar pain in 1 patient. Diagnoses were established by craniotomy in 5 patients, stereotactic biopsy in 4 patients and cerebro-spinal fluid analysis in 1 patient. Four patients had total resection, and 1 patient had debulking surgery after diagnosis. The cerebral/spinal parenchyma was involved in 5 patients, whereas 5 patients exhibited deep brain involvement. Eight patients had brain edema, whereas 7 patients had mass effect. Multiple lesions were detected in 7 patients. The mean serum lactate dehydrogenase level was 354 U/L (range 102-555). All of our patients were HIV and EBV negative. Eight patients were treated every 28 days with rituximab (R; 375 mg/m2/day) on the first day, methotrexate (MTX; 3.5 gr/m2/day) and cytosine-arabinoside (ARA-C; 4.4 gr/m2/day) on the second day and ARA-C (4.4 gr/m2/day) on the third day. Of the 8 patients, 3 patients received 4 cycles. One patient received 3 cycles and displayed a complete remission response. This patient received autologous hematopoietic stem cell transplantation (AHSCT) with cyclophosphamide (4x1.5 g/m2), etoposide (4x250-400 mg/m2) and carmustine (4x150-200 mg/m2) conditioning regimen as consolidation treatment. One patient received 2 courses of R-MTX-ARA-C and exhibited progressive disease; AHSCT was applied. All 5 patients ultimately experienced complete remission. The remaining 3 patients are still in their first and second courses of R-MTX-ARA-C -with a successful outcome in interim analysis-. Two of the initial 10 patients had high ECOG performance scores, received 1 course of MTX and radiotherapy (RT; 36-45 Gy) and died. The median overall survival (OS) in the R-MTX-ARA-C group was 18.3 ± 8.5 months, whereas the OS was 4.5 ± 2.1 months in the MTX-RT group (p<0.05). The event-free survival (EFS) was 12 ± 6.3 months in the R-MTX-ARA-C group and 1.5 ± 0.7 months in the MTX-RT group (p<0.05). Conclusion: R-MTX-ARA-C -followed by AHSCT- can serve as a favorable treatment alternative in highly aggressive lymphoma like PCNSL. Disclosures No relevant conflicts of interest to declare.

Long-term survival with favorable cognitive outcome after chemotherapy in primary central nervous system lymphoma

2010 ◽  
Vol 67 (2) ◽  
pp. 182-189 ◽  
Author(s):  
Annika Juergens ◽  
Hendrik Pels ◽  
Sabine Rogowski ◽  
Klaus Fliessbach ◽  
Axel Glasmacher ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Cognitive Outcome ◽  
Term Survival ◽  
Long Term Survival
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