Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma
BackgroundPrimary central nervous system lymphoma (PCNSL) is an uncommon variant of non-Hodgkin lymphoma (NHL) with high aggressiveness and poor prognosis. Although complete remission (CR) could be achieved with therapy, some patients remain refractory or recurrently with a worse response to salvage...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1098785/full |
| _version_ | 1797838608067985408 |
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| author | Yu Yang Qing Li Jingjing Ma Hui Kang Zhiguang Lin Yang Wang Yan Ma Bobin Chen |
| author_facet | Yu Yang Qing Li Jingjing Ma Hui Kang Zhiguang Lin Yang Wang Yan Ma Bobin Chen |
| author_sort | Yu Yang |
| collection | DOAJ |
| description | BackgroundPrimary central nervous system lymphoma (PCNSL) is an uncommon variant of non-Hodgkin lymphoma (NHL) with high aggressiveness and poor prognosis. Although complete remission (CR) could be achieved with therapy, some patients remain refractory or recurrently with a worse response to salvage treatment and poor prognosis. No consensus on rescue therapy has been established currently. This study is aimed to evaluate the efficacy of radiotherapy or chemotherapy in first-time relapsed or refractory progressed PCNSL (R/R PCNSL) and analysis the prognostic factors, to explore differences between relapsed and refractory PCNSL.MethodsTotally 105 R/R PCNSL patients from Huashan Hospital between 1 January 2016 and 31 December 2020 were enrolled, underwent salvage radiotherapy or chemotherapy and received response assessments after each course. PFS1 was defined as the time from diagnosis to the first time of recurrence or refractory progression. Statistical analysis was performed with SPSS version 26.0.ResultsResponse and survival were analyzed over a 17.5months (median) follow-up. Compared to relapsed PCNSL (n = 42), refractory PCNSL (n = 63) had a shorter median PFS1 related to deep lesions. 82.4% of cases were discovered as the second relapse or progression. ORR and PFS were both higher in relapsed PCNSL than those in refractory PCNSL. ORR of radiotherapy in both relapsed and refractory PCNSL was higher than that of chemotherapy. Elevated CSF protein and ocular involvement were related to PFS and OS after recurrence respectively in relapsed PCNSL. Age ≥ 60y was unfavorable to OS-R (OS after recurrence or progression) in refractory PCNSL.ConclusionsOur results indicate that relapsed PCNSL responds well to inducing and salvage therapy and has a better prognosis compared to refractory PCNSL. Radiotherapy is effective for PCNSL after the first relapse or progression. Age, CSF protein level, and ocular involvement could be potential factors to predict prognosis. |
| first_indexed | 2024-04-09T15:44:41Z |
| format | Article |
| id | doaj.art-e09d9b78d823452eba2d32f405c64567 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-09T15:44:41Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-e09d9b78d823452eba2d32f405c645672023-04-27T05:29:50ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-04-011310.3389/fonc.2023.10987851098785Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphomaYu Yang0Qing Li1Jingjing Ma2Hui Kang3Zhiguang Lin4Yang Wang5Yan Ma6Bobin Chen7Department of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaDepartment of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, ChinaBackgroundPrimary central nervous system lymphoma (PCNSL) is an uncommon variant of non-Hodgkin lymphoma (NHL) with high aggressiveness and poor prognosis. Although complete remission (CR) could be achieved with therapy, some patients remain refractory or recurrently with a worse response to salvage treatment and poor prognosis. No consensus on rescue therapy has been established currently. This study is aimed to evaluate the efficacy of radiotherapy or chemotherapy in first-time relapsed or refractory progressed PCNSL (R/R PCNSL) and analysis the prognostic factors, to explore differences between relapsed and refractory PCNSL.MethodsTotally 105 R/R PCNSL patients from Huashan Hospital between 1 January 2016 and 31 December 2020 were enrolled, underwent salvage radiotherapy or chemotherapy and received response assessments after each course. PFS1 was defined as the time from diagnosis to the first time of recurrence or refractory progression. Statistical analysis was performed with SPSS version 26.0.ResultsResponse and survival were analyzed over a 17.5months (median) follow-up. Compared to relapsed PCNSL (n = 42), refractory PCNSL (n = 63) had a shorter median PFS1 related to deep lesions. 82.4% of cases were discovered as the second relapse or progression. ORR and PFS were both higher in relapsed PCNSL than those in refractory PCNSL. ORR of radiotherapy in both relapsed and refractory PCNSL was higher than that of chemotherapy. Elevated CSF protein and ocular involvement were related to PFS and OS after recurrence respectively in relapsed PCNSL. Age ≥ 60y was unfavorable to OS-R (OS after recurrence or progression) in refractory PCNSL.ConclusionsOur results indicate that relapsed PCNSL responds well to inducing and salvage therapy and has a better prognosis compared to refractory PCNSL. Radiotherapy is effective for PCNSL after the first relapse or progression. Age, CSF protein level, and ocular involvement could be potential factors to predict prognosis.https://www.frontiersin.org/articles/10.3389/fonc.2023.1098785/fullrelapsed or refractory primary central nervous system lymphomaradiotherapychemotherapyprognosissalvage therapy |
| spellingShingle | Yu Yang Qing Li Jingjing Ma Hui Kang Zhiguang Lin Yang Wang Yan Ma Bobin Chen Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma Frontiers in Oncology relapsed or refractory primary central nervous system lymphoma radiotherapy chemotherapy prognosis salvage therapy |
| title | Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma |
| title_full | Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma |
| title_fullStr | Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma |
| title_full_unstemmed | Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma |
| title_short | Radiotherapy or chemotherapy: a real-world study of the first-time relapsed and refractory primary central nervous system lymphoma |
| title_sort | radiotherapy or chemotherapy a real world study of the first time relapsed and refractory primary central nervous system lymphoma |
| topic | relapsed or refractory primary central nervous system lymphoma radiotherapy chemotherapy prognosis salvage therapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1098785/full |
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