Vassilakopoulos Theodoros P, Panitsas Fotios, Mellios Zois, Apostolidis John, Michael Michalis, Gurion Ronit, Ferhanoglu Burhan, Hatzimichael Eleftheria, Karakatsanis Stamatios, Dimou Maria, Kalpadakis Christina, Katodritou Eirini, Leonidopoulou Theoni, Kotsianidis Ioannis, Giatra Hara, Kanellias Nick, Sayyed Ayman, Tadmor Tamar, Akay Olga Meltem, Angelopoulou Maria K, Horowitz Netanel, Bakiri Maria, Pangalis Gerassimos A, Panayiotidis Panayiotis, Papageorgiou Sotirios G
Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Department of Haematology and Lymphoma, Evangelismos General Hospital, Athens, Greece.
Hematol Oncol. 2023 Feb;41(1):97-107. doi: 10.1002/hon.3096. Epub 2022 Dec 8.
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.
中枢神经系统（CNS）受累在原发性纵隔大B细胞淋巴瘤（PMLBCL）中较为罕见。我们旨在评估564例接受免疫化疗的PMLBCL患者中，中枢神经系统复发作为首次治疗失败事件的发生率，以及诱导化疗方案、中枢神经系统国际预后指数（CNS-IPI）和其他临床及实验室变量对中枢神经系统复发风险的影响。仅有17例患者（3.0%）接受了中枢神经系统预防。在中位随访55个月期间，仅有8例患者出现中枢神经系统复发作为首次事件，均为孤立性复发。中枢神经系统复发的2年累积发生率（CI-CNSR）为1.47%，此后保持不变。CI-CNSR不受化疗方案（R-CHOP或R-da-EPOCH）的影响。侵袭性淋巴瘤既定的国际预后指数因素均不能预测PMLBCL中的中枢神经系统复发。有肾脏受累与无肾脏受累患者的2年CI-CNSR分别为13.3%和0.96%（p<0.001）；有肾上腺受累与无肾上腺受累患者分别为14.3%和1.13%（p<0.001）；有肾脏或肾上腺受累与无肾脏或肾上腺受累患者分别为10.2%和0.97%。CNS-IPI也具有预测性（高危组与中/低危组的2年CI-CNSR：10.37%与0.84%，p<0.001）。然而，这种关联可能主要由肾脏和/或肾上腺受累驱动。总之，在PMLBCL中，中枢神经系统复发罕见，且似乎与肾脏和/或肾上腺受累密切相关。
