Primary CNS lymphoma at first relapse/progression: characteristics, management, and outcome of 256 patients from the French LOC network
Sophie Langner-Lemercier
(1)
,
Caroline Houillier
(2, 3)
,
Carole Soussain
(4)
,
Hervé Ghesquières
(5)
,
Olivier Chinot
(6, 7)
,
Luc Taillandier
(8)
,
Pierre Soubeyran
(9)
,
Thierry Lamy
(1, 10)
,
Franck Morschhauser
(11)
,
Alexandra Benouaich-Amiel
(12)
,
Guido Ahle
(13)
,
Marie-Pierre Moles-Moreau
(14)
,
Cécile Moluçon-Chabrot
(15)
,
Pascal Bourquard
(16)
,
Ghandi Damaj
(17)
,
Fabrice Jardin
(18, 19)
,
Delphine Larrieu
(20)
,
Emmanuel Gyan
(21, 22)
,
Rémy Gressin
(23)
,
Arnaud Jaccard
(24)
,
Sylvain Choquet
(2)
,
Annie Brion
(25)
,
Olivier Casasnovas
(26)
,
Philippe Colin
(27)
,
Oumedaly Reman
(17)
,
Adrian Tempescul
(28)
,
Jean-Pierre Marolleau
(29)
,
Michel Fabbro
(30)
,
Florian Naudet
(31, 1)
,
Khe Hoang-Xuan
(32, 2, 33)
,
Roch Houot
(10, 34)
1
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
2 CHU Pitié-Salpêtrière [AP-HP]
3 ICM - Institut du Cerveau = Paris Brain Institute
4 Hôpital René Huguenin [Saint-Cloud]
5 Centre Léon Bérard [Lyon]
6 CRO2 - Centre de Recherches en Oncologie biologique et Oncopharmacologie
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 Service de Neuro-Oncologie [CHRU Nancy]
9 Institut Bergonié [Bordeaux]
10 MiCa - Microenvironnement et cancer
11 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 Hôpitaux Civils de Colmar
14 CHU Angers - Centre Hospitalier Universitaire d'Angers
15 Service Hématologie Biologique [CHU Clermont-Ferrand]
16 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
17 CHU Caen
18 GPL - Groupe d'étude des proliférations lymphoïdes
19 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
20 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
21 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
22 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
23 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
24 Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges]
25 Service d'hématologie
26 CHU Dijon
27 Service de radiothérapie [Reims]
28 CHU-Brest-Hemato - CHRU Brest - Service d'Hématologie
29 CHU Amiens-Picardie
30 ICM - Institut régional de Cancérologie de Montpellier
31 CIC - Centre d'Investigation Clinique [Rennes]
32 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
33 OncoNeuroTek [ICM Paris]
34 Service d'hématologie clinique
2 CHU Pitié-Salpêtrière [AP-HP]
3 ICM - Institut du Cerveau = Paris Brain Institute
4 Hôpital René Huguenin [Saint-Cloud]
5 Centre Léon Bérard [Lyon]
6 CRO2 - Centre de Recherches en Oncologie biologique et Oncopharmacologie
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 Service de Neuro-Oncologie [CHRU Nancy]
9 Institut Bergonié [Bordeaux]
10 MiCa - Microenvironnement et cancer
11 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 Hôpitaux Civils de Colmar
14 CHU Angers - Centre Hospitalier Universitaire d'Angers
15 Service Hématologie Biologique [CHU Clermont-Ferrand]
16 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
17 CHU Caen
18 GPL - Groupe d'étude des proliférations lymphoïdes
19 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
20 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
21 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
22 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
23 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
24 Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges]
25 Service d'hématologie
26 CHU Dijon
27 Service de radiothérapie [Reims]
28 CHU-Brest-Hemato - CHRU Brest - Service d'Hématologie
29 CHU Amiens-Picardie
30 ICM - Institut régional de Cancérologie de Montpellier
31 CIC - Centre d'Investigation Clinique [Rennes]
32 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
33 OncoNeuroTek [ICM Paris]
34 Service d'hématologie clinique
Caroline Houillier
- Fonction : Auteur
- PersonId : 893167
Olivier Chinot
- Fonction : Auteur
- PersonId : 172185
- IdHAL : olivier-chinot
- IdRef : 034791205
Pierre Soubeyran
- Fonction : Auteur
- PersonId : 752156
- IdHAL : plsoubhal2022
- ORCID : 0000-0003-3244-7299
- IdRef : 060718668
Franck Morschhauser
- Fonction : Auteur
- PersonId : 762201
- ORCID : 0000-0002-3714-9824
Emmanuel Gyan
- Fonction : Auteur
- PersonId : 1131487
- ORCID : 0000-0002-7651-9189
Arnaud Jaccard
- Fonction : Auteur
- PersonId : 972533
Florian Naudet
- Fonction : Auteur
- PersonId : 14054
- IdHAL : florian-naudet
- ORCID : 0000-0003-3760-3801
- IdRef : 142630837
Roch Houot
- Fonction : Auteur
- PersonId : 767105
- ORCID : 0000-0003-1729-8213
Résumé
Background - Treatment of relapsed/refractory (R/R) primary CNS lymphoma (PCNSL) is poorly defined, because randomized trials and large studies are lacking. The aim of this study was to analyze the characteristics, management, and outcome of R/R PCNSL patients after first-line therapy in a nationwide cohort.
Methods - We analyzed R/R PCNSL patients following first-line treatment who had been prospectively registered in the database of the French network for oculocerebral lymphoma (LOC) between 2011 and 2014.
Results - Among 563 PCNSL patients treated with first-line therapy, we identified 256 with relapsed (n = 93, 16.5%) or refractory (n = 163, 29.0%) disease. Patients who were asymptomatic at relapse/progression (25.5%), mostly diagnosed on routine follow-up neuroimaging, tended to have a better outcome. Patients who received salvage therapy followed by consolidation (mostly intensive chemotherapy plus autologous hematopoietic stem cell transplantation [ICT + AHSCT]) experienced prolonged survival compared with those who did not receive salvage or consolidation therapy. Independent prognostic factors at first relapse/progression were: KPS ≥ 70 vs KPS < 70), sensitivity to first-line therapy (relapsed vs refractory disease), duration of first remission (progression-free survival [PFS] ≥1 y vs <1 y), and management at relapse/progression (palliative care vs salvage therapy). Patients who relapsed early after first-line therapy (ie, PFS < 1 y) had a poor outcome, comparable to that of refractory patients. Conversely, patients experiencing late relapses (PFS ≥ 1 y) and/or undergoing consolidation with ICT + AHSCT experienced prolonged survival.
Conclusions - About a third of PCNSL patients are primary refractory to first line treatment. We identified several independent prognostic factors that can guide the management of R/R PCNSL patients.
Methods - We analyzed R/R PCNSL patients following first-line treatment who had been prospectively registered in the database of the French network for oculocerebral lymphoma (LOC) between 2011 and 2014.
Results - Among 563 PCNSL patients treated with first-line therapy, we identified 256 with relapsed (n = 93, 16.5%) or refractory (n = 163, 29.0%) disease. Patients who were asymptomatic at relapse/progression (25.5%), mostly diagnosed on routine follow-up neuroimaging, tended to have a better outcome. Patients who received salvage therapy followed by consolidation (mostly intensive chemotherapy plus autologous hematopoietic stem cell transplantation [ICT + AHSCT]) experienced prolonged survival compared with those who did not receive salvage or consolidation therapy. Independent prognostic factors at first relapse/progression were: KPS ≥ 70 vs KPS < 70), sensitivity to first-line therapy (relapsed vs refractory disease), duration of first remission (progression-free survival [PFS] ≥1 y vs <1 y), and management at relapse/progression (palliative care vs salvage therapy). Patients who relapsed early after first-line therapy (ie, PFS < 1 y) had a poor outcome, comparable to that of refractory patients. Conversely, patients experiencing late relapses (PFS ≥ 1 y) and/or undergoing consolidation with ICT + AHSCT experienced prolonged survival.
Conclusions - About a third of PCNSL patients are primary refractory to first line treatment. We identified several independent prognostic factors that can guide the management of R/R PCNSL patients.