Display options
Cite
Asano K, Yamashita Y, Ono T, et al. The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group. Int J Clin Oncol. 2021;27(1):77-94doi: 10.1007/s10147-021-02042-3.
Asano, K., Yamashita, Y., Ono, T., Natsumeda, M., Beppu, T., Matsuda, K., Ichikawa, M., Kanamori, M., Matsuzaka, M., Kurose, A., Saito, K., Sonoda, Y., Ogasawara, K., Fujii, Y., Shimizu, H., Ohkuma, H., Kitanaka, C., Kayama, T., & Tominaga, T. (2022). The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group. International journal of clinical oncology, 27(1), 77-94. https://doi.org/10.1007/s10147-021-02042-3
Asano, Kenichiro, et al. "The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group." International journal of clinical oncology vol. 27,1 (2022): 77-94. doi: https://doi.org/10.1007/s10147-021-02042-3
Asano K, Yamashita Y, Ono T, Natsumeda M, Beppu T, Matsuda K, Ichikawa M, Kanamori M, Matsuzaka M, Kurose A, Saito K, Sonoda Y, Ogasawara K, Fujii Y, Shimizu H, Ohkuma H, Kitanaka C, Kayama T, Tominaga T. The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group. Int J Clin Oncol. 2022 Jan;27(1):77-94. doi: 10.1007/s10147-021-02042-3. Epub 2021 Oct 12. PMID: 34637053.
Copy Download .nbib Format: NLM
Share it on

Int J Clin Oncol. 2022 Jan;27(1):77-94. doi: 10.1007/s10147-021-02042-3. Epub 2021 Oct 12.

The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group.

International journal of clinical oncology

Kenichiro Asano, Yoji Yamashita, Takahiro Ono, Manabu Natsumeda, Takaaki Beppu, Kenichiro Matsuda, Masahiro Ichikawa, Masayuki Kanamori, Masashi Matsuzaka, Akira Kurose, Kiyoshi Saito, Yukihiko Sonoda, Kuniaki Ogasawara, Yukihiko Fujii, Hiroaki Shimizu, Hiroki Ohkuma, Chifumi Kitanaka, Takamasa Kayama, Teiji Tominaga

Affiliations

  1. Department of Neurosurgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. [email protected].
  2. Department of Neurosurgery, Miyagi Cancer Center, Natori, Japan.
  3. Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan.
  4. Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan.
  5. Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
  6. Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.
  7. Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan.
  8. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
  9. Department of Medical Informatics, Hirosaki University Hospital, Hirosaki, Japan.
  10. Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
  11. Department of Neurosurgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
  12. Department of Molecular Cancer Science, Faculty of Medicine, Yamagata University, Yamagata, Japan.
  13. Department of Advanced Cancer Medicine, Yamagata University Graduate School of Medical Science, Yamagata, Japan.

PMID: 34637053 DOI: 10.1007/s10147-021-02042-3

Abstract

BACKGROUND: Elderly patients with primary central nervous system malignant lymphoma (EL-PCNSL) may not be given sufficient treatment due to their poor pre-treatment Karnofsky Performance Status (KPS) and comorbidities. Therefore, a retrospective, cohort study was performed to evaluate risk factors associated with a poor prognosis of EL-PCNSL in the Tohoku Brain Tumor Study Group.

METHODS: Patients aged ≥ 71 years with PCNSL were enrolled from eight centers. Univariate analysis was performed with the log-rank test. A Cox proportional hazards model was used for multivariate analysis.

RESULTS: Three of the total 142 cases received best supportive care (BSC). Treatment was given to 30 cases without a pathological diagnosis, 3 cases with cerebrospinal fluid (CSF) cytology, and 100 cases with a pathological diagnosis. After confirmation of no differences in progression-free survival (PFS) and overall survival (OS) between the group treated without pathology and the groups diagnosed by pathology or CSF cytology and between median age ≥ 76 years and < 76 years, a total of 133 patients were studied. The median pre-treatment KPS was 50%. Median PFS and median OS were 16 and 24 months, respectively. Risk factors associated with poor prognosis on Cox proportional hazards model analysis were pre-treatment cardiovascular disease and central nervous system disease comorbidities, post-treatment pneumonia and other infections, and the absence of radiotherapy or chemotherapy.

CONCLUSIONS: Pre-treatment comorbidities and post-treatment complications would affect the prognosis. Radiation and chemotherapy were found to be effective, but no conclusions could be drawn regarding the appropriate content of chemotherapy and whether additional radiotherapy should be used.

© 2021. Japan Society of Clinical Oncology.

Keywords: Elderly patient; PCNSL; Risk factor

References

  1. Daras M, DeAngelis LM (2013) Management of elderly patients with primary central nervous system lymphoma. Curr Neurol Neurosci Rep 13(5):344. https://doi.org/10.1007/s11910-013-0344-5 - PubMed
  2. Shibui S (2014) Report of brain tumor registry of Japan (2001–2005). Neurol Med Chir 54:10–102, 13th edn - PubMed
  3. Narita Y (2017) Report of brain tumor registry of Japan (2005–2008). Neurol Med Chir 57:9–102, 14th edn - PubMed
  4. Villano JL, Koshy M, Shaikh H et al (2011) Age, gender, and racial differences in incidence and survival in primary CNS lymphoma. Br J Cancer 105(9):1414–1418. https://doi.org/10.1038/bjc.2011.357 - PubMed
  5. Mendez JS, Ostrom QT, Gittleman H et al (2018) The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades. Neuro Oncol 20(5):687–694. https://doi.org/10.1093/neuonc/nox187 - PubMed
  6. Ostrom QT, Gittleman H, Xu J et al (2016) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro Oncol 18(Suppl_5):v1–v75. https://doi.org/10.1093/neuonc/now207 - PubMed
  7. Zeremski V, Koehler M, Fischer T et al (2016) Characteristics and outcome of patients with primary CNS lymphoma in a “real-life” setting compared to a clinical trial. Ann Hematol 95(5):793–799. https://doi.org/10.1007/s00277-016-2602-5 - PubMed
  8. Siegal T, Bairey O (2019) Primary CNS lymphoma in the elderly: the challenge. Acta Haematol 141(3):138–145. https://doi.org/10.1159/000495284 - PubMed
  9. Ferreri AJ, Cwynarski K, Pulczynski E et al (2016) Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol 3(5):e217-227. https://doi.org/10.1016/s2352-3026(16)00036-3 - PubMed
  10. Schorb E, Finke J, Ferreri AJ et al (2016) High-dose chemotherapy and autologous stem cell transplant compared with conventional chemotherapy for consolidation in newly diagnosed primary CNS lymphoma–a randomized phase III trial (MATRix). BMC Cancer 16:282. https://doi.org/10.1186/s12885-016-2311-4 - PubMed
  11. Fallah J, Qunaj L, Olszewski AJ (2016) Therapy and outcomes of primary central nervous system lymphoma in the United States: analysis of the National Cancer Database. Blood Adv 1(2):112–121. https://doi.org/10.1182/bloodadvances.2016000927 - PubMed
  12. Fox CP, Phillips EH, Smith J et al (2019) Guidelines for the diagnosis and management of primary central nervous system diffuse large B-cell lymphoma. Br J Haematol 184(3):348–363. https://doi.org/10.1111/bjh.15661 - PubMed
  13. Goyal P, Kumar Y, Gupta N et al (2017) Usefulness of enhancement-perfusion mismatch in differentiation of CNS lymphomas from other enhancing malignant tumors of the brain. Quant Imaging Med Surg 7(5):511–519. https://doi.org/10.21037/qims.2017.09.03 - PubMed
  14. Macdonald DR, Cascino TL, Schold SC Jr et al (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8(7):1277–1280. https://doi.org/10.1200/jco.1990.8.7.1277 - PubMed
  15. Abrey LE, Batchelor TT, Ferreri AJ et al (2005) Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol 23(22):5034–5043. https://doi.org/10.1200/jco.2005.13.524 - PubMed
  16. Roth P, Martus P, Kiewe P et al (2012) Outcome of elderly patients with primary CNS lymphoma in the G-PCNSL-SG-1 trial. Neurology 79(9):890–896. https://doi.org/10.1212/WNL.0b013e318266fcb2 - PubMed
  17. Roth P, Hoang-Xuan K (2014) Challenges in the treatment of elderly patients with primary central nervous system lymphoma. Curr Opin Neurol 27(6):697–701. https://doi.org/10.1097/wco.0000000000000145 - PubMed
  18. Ney DE, Reiner AS, Panageas KS et al (2010) Characteristics and outcomes of elderly patients with primary central nervous system lymphoma: the Memorial Sloan-Kettering Cancer Center experience. Cancer 116(19):4605–4612. https://doi.org/10.1002/cncr.25363 - PubMed
  19. Schlegel U, Schmidt-Wolf IG, Deckert M (2000) Primary CNS lymphoma: clinical presentation, pathological classification, molecular pathogenesis and treatment. J Neurol Sci 181(1–2):1–12. https://doi.org/10.1016/s0022-510x(00)00385-3 - PubMed
  20. Xie H, Dahiya S, Murphy ES et al (2013) Primary central nervous system lymphoma in the elderly: the Cleveland clinic experience. Anticancer Res 33(8):3251–3258 - PubMed
  21. Lee SY, Okoshi Y, Kurita N et al (2014) Prognosis factors in Japanese elderly patients with primary central nervous system lymphoma treated with a nonradiation, intermediate-dose methotrexate-containing regimen. Oncol Res Treat 37(7–8):378–383. https://doi.org/10.1159/000363435 - PubMed
  22. Kasenda B, Ferreri AJ, Marturano E et al (2015) First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)—a systematic review and individual patient data meta-analysis. Ann Oncol 26(7):1305–1313. https://doi.org/10.1093/annonc/mdv076 - PubMed
  23. Shiozawa E, Yamochi-Onizuka T, Takimoto M et al (2007) The GCB subtype of diffuse large B-cell lymphoma is less frequent in Asian countries. Leuk Res 31(11):1579–1583. https://doi.org/10.1016/j.leukres.2007.03.017 - PubMed
  24. Chiavazza C, Pellerino A, Ferrio F et al (2018) Primary CNS lymphomas: challenges in diagnosis and monitoring. Biomed Res Int 2018:3606970. https://doi.org/10.1155/2018/3606970 - PubMed
  25. Mizobuchi Y, Nakajima K, Fujihara T et al (2019) The risk of hemorrhage in stereotactic biopsy for brain tumors. J Med Invest 66(34):314–318. https://doi.org/10.2152/jmi.66.314 - PubMed
  26. Baraniskin A, Schroers R (2021) Liquid biopsy and other non-invasive diagnostic measures in PCNSL. Cancers 13(11):2665. https://doi.org/10.3390/cancers13112665 - PubMed
  27. Barajas RF, Politi LS, Anzalone N et al (2021) Consensus recommendations for MRI and PET imaging of primary central nervous system lymphoma: guideline statement from the International Primary CNS Lymphoma Collaborative Group (IPCG). Neuro Oncol 23(7):1056–1071. https://doi.org/10.1093/neuonc/noab020 - PubMed
  28. Hiemcke-Jiwa LS, Leguit RJ, Snijders TJ et al (2018) Molecular analysis in liquid biopsies for diagnostics of primary central nervous system lymphoma: review of literature and future opportunities. Crit Rev Oncol Hematol 127:56–65. https://doi.org/10.1016/j.critrevonc.2018.05.010 - PubMed
  29. Watanabe J, Natsumeda M, Kanemaru Y et al (2019) Comparison of circulating tumor DNA between body fluids in patients with primary central nervous system lymphoma. Leuk Lymphoma 60(14):3587–3589. https://doi.org/10.1080/10428194.2019.1639169 - PubMed
  30. Neuro-Oncology TJSf (2019) The Japan Society for Neuro-Oncology, The Japan Neurosurgical Society (2019) Practical Guideline for Neuro-Oncology. Kanahara - PubMed
  31. Kinoshita M, Sasayama T, Narita Y et al (2014) Different spatial distribution between germinal center B and non-germinal center B primary central nervous system lymphoma revealed by magnetic resonance group analysis. Neuro Oncol 16(5):728–734. https://doi.org/10.1093/neuonc/not319 - PubMed
  32. Hans CP, Weisenburger DD, Greiner TC et al (2004) Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 103(1):275–282. https://doi.org/10.1182/blood-2003-05-1545 - PubMed
  33. Phang KC, Hussin NH, Abdul RF et al (2019) Characterisation of immunogenotypes of diffuse large B-cell lymphoma. Malaysian J Pathol 41(2):101–124 - PubMed
  34. Umemura H, Homma M, Shiozwa E et al (2012) Immunohistochemical analysis of the cell cycle-associated proteins in diffuse large B-cell lymphoma. Showa IKaishi 72(1):108–117 - PubMed
  35. Morris PG, Correa DD, Yahalom J et al (2013) Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome. J Clin Oncol 31(31):3971–3979. https://doi.org/10.1200/jco.2013.50.4910 - PubMed
  36. Schuurmans M, Bromberg JE, Doorduijn J et al (2010) Primary central nervous system lymphoma in the elderly: a multicentre retrospective analysis. Br J Haematol 151(2):179–184. https://doi.org/10.1111/j.1365-2141.2010.08328.x - PubMed

Publication Types