PORTLAND, OR—High response rates can be achieved with first-line high-dose methotrexate (HD-MTX) based regimens for primary central nervous system lymphoma (PCNSL), but many patients relapse within two years of diagnosis, according to a study in the journal Fluids and Barriers of the CNS.1
A study team led by researchers from the Portland VAMC and the Oregon Health & Science University sought to describe the pattern of relapse and review the potential mechanisms involved in relapse.
To do that, they identified 78 consecutive patients who attained complete radiographic response (CR) during or after first-line treatment for newly-diagnosed PCNSL (CD20+, diffuse large B cell type).
After patients were treated with HD-MTX-based regimen in conjunction with blood-brain barrier disruption (HD-MTX/BBBD), 44 of them subsequently relapsed. Researchers retrospectively reviewed images and medical records of these 44 consecutive patients, identifying and comparing the anatomical location of enhancing lesions at initial diagnosis and at the time of relapse.
Results indicate that 37 of 44 fulfilled inclusion criteria and had new measurable enhancing lesions at relapse, which were identified by pattern and location. The report noted that, at relapse, the new enhancement was at a spatially distinct site in 30 of 37 patients. Local relapse was found only in seven patients.
“Unlike gliomas, the majority of PCNSL had radiographic relapse at spatially distinct anatomical locations within the brain behind a previously intact neurovascular unit (NVU), and in few cases outside, the central nervous system (CNS),” study authors wrote. “This may suggest either (1) reactivation of occult reservoirs behind an intact NVU in the CNS (or ocular) or (2) seeding from bone marrow or other extra CNS sites.”
The researchers suggested that “recognizing patterns of relapse is key for early detection and may provide insight into potential mechanisms of relapse as well as help develop strategies to extend duration of complete response.”
1. Ambady P, Fu R, Netto JP, Kersch C, Firkins J, Doolittle ND, Neuwelt EA.Patterns of relapse in primary central nervous system lymphoma: inferencesregarding the role of the neuro-vascular unit and monoclonal antibodies intreating occult CNS disease. Fluids Barriers CNS. 2017 Jun 2;14(1):16. doi:10.1186/s12987-017-0064-3. PubMed PMID: 28577579; PubMed Central PMCID:PMC5457655.
Hemodial Int. 2017 Jun;21 Suppl 1:S78-S82. doi: 10.1111/hdi.12561. Epub 2017 Apr 12.
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