Narendranath Epperla, The Ohio State University Comprehensive Cancer Center
Adam S. Zayac, Alpert Medical School of Brown University
Daniel J. Landsburg, University of Pennsylvania
Allison M. Bock, Huntsman Cancer Institute at the University of Utah
Grzegorz S. Nowakowski, Mayo Clinic
Emily C. Ayers, University of Virginia
Mark Girton, University of Virginia School of Medicine
Marie Hu, University of Minnesota
Amy Beckman, University of Minnesota
Shaoying Li, The University of Texas MD Anderson Cancer Center
L Jeffrey Medeiros, The University of Texas MD Anderson Cancer Center
Julie E. Chang, University of Wisconsin School of Medicine and Public Health
Habibe Kurt, Rhode Island Hospital
Jose Sandoval-Sus, Moffitt Cancer Center
Mohammad Ali Ansari-Lari, Moffitt Cancer Center
Shalin K. Kothari, Yale University
Anna Kress, Yale University
Mina L. Xu, Yale University
Pallawi Torka, Roswell Park Comprehensive Cancer Center
Suchitra Sundaram, Roswell Park Comprehensive Cancer Center
Stephen D. Smith, Fred Hutchinson Cancer Research Center
Kikkeri N. Naresh, University of Washington
Yasmin Karimi, University of Michigan Health
David A. Bond, The Ohio State University Comprehensive Cancer Center
Andrew M. Evens, Rutgers Cancer Institute of New Jersey
Seema G. Naik, Penn State Hershey Medical Center
Manali Kamdar, University of Colorado Cancer Center
Bradley M. Haverkos, University of Colorado Cancer Center
Reem Karmali, Robert H. Lurie Comprehensive Cancer Center
Umar Farooq, University of Iowa
Julie M. Vose, University of Nebraska Medical CenterFollow
Paul Rubinstein, University of Illinois at Chicago
Amina Chaudhry, University of Illinois at Chicago
Adam J. Olszewski, Alpert Medical School of Brown University

Document Type

Article

Journal Title

Blood Advances

Publication Date

2024

Volume

8

Abstract

Little is known about the central nervous system (CNS) risk in high-grade B-cell lymphoma, not otherwise specified (HGBL NOS). Hence, we sought to describe the rates of baseline CNS involvement, risk of CNS recurrence after primary therapy, and management strategies in HGBL NOS. In this multicenter retrospective study, we included 160 adults with newly diagnosed HGBL NOS treated between 2016 and 2021 at 20 US institutions. Eleven patients (7%) had baseline CNS involvement at diagnosis (leptomeningeal = 6, parenchymal = 4, and both = 1). Baseline CNS involvement was significantly associated only with MYC rearrangement (OR = 3.5) and testicular (in men) or female pelvic (in women) involvement (OR = 8.1). There was no significant difference in survival outcomes between patients with HGBL NOS with (median PFS = 4 years) or without (median PFS = 2.4 years) baseline CNS involvement (P = 0.45). The cumulative incidence of CNS recurrence at 3 years was 11%. Patients with baseline CNS involvement were at the highest risk (48.5% vs 8% for those without baseline CNS involvement) and were excluded from the risk factors analysis for CNS recurrence. The risk for CNS recurrence was significantly associated with blood or bone marrow involvement, CD5 expression, non-germinal center B-cell subtype, and "dual-expresser lymphoma" phenotype, however, high CNS IPI was not. The prognosis of relapsed HGBL NOS was poor, regardless of whether recurrence was systemic or limited to the CNS, and with currently available salvage strategies, including autologous transplantation and chimeric antigen receptor T-cell modalities, almost all patients with CNS recurrence ultimately succumbed to their disease.

MeSH Headings

Humans, Female, Male, Middle Aged, Adult, Central Nervous System Neoplasms, Aged, Retrospective Studies, Lymphoma, B-Cell, Neoplasm Grading, Aged, 80 and over, Young Adult, Prognosis, Treatment Outcome

ISSN

2473-9537

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