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Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study

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Abstract

Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.

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Authors and Affiliations

  1. Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France

    J. Dufour, K. Hoang-Xuan & C. Houillier

  2. Hôpital Pitié-Salpêtrière, Service d’Hématologie clinique, Paris, France

    S. Choquet

  3. Institut de Bergonie, Service d’Hématologie, Bordeaux, France

    A. Schmitt

  4. Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France

    G. Ahle

  5. Hôpital Universitaire de Rennes, Service d’Hématologie, Rennes, France

    R. Houot

  6. Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France

    L. Taillandier

  7. Hôpital Universitaire de Grenoble, Service d’Hématologie, Grenoble, France

    R. Gressin

  8. Hôpital Universitaire de Dijon, Service d’hematologie clinique, Dijon, France

    O. Casasnovas

  9. Hôpital Universitaire d’Amiens, Service d’Hematologie clinique, Amiens, France

    J.P. Marolleau

  10. Hôpital Cochin, Service d’Hématologie, Paris, France

    J. Tamburini

  11. Centre Hospitalier de Perpignan, Service d’Hématologie, Perpignan, France

    C. Serrier

  12. Hôpital Universitaire de la Réunion, Service d’oncologie-hématologie, Paris, La Réunion, France

    E. Perez

  13. Hôpital Universitaire d’Angers, Service d’Hématologie, Angers, France

    J. Paillassa

  14. Hôpital Universitaire de Tours, Service d’Hématologie, Tours, France

    E. Gyan

  15. Hôpital Universitaire de Besançon, Service d’Hématologie, Besançon, France

    A. Chauchet

  16. Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France

    R. Ursu

  17. Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France

    A. Kas

  18. Institut Curie, Service d’Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France

    C. Soussain

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  1. J. Dufour
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  2. S. Choquet
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  3. K. Hoang-Xuan
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  19. C. Soussain
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  20. C. Houillier
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Correspondence to C. Houillier.

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Dufour, J., Choquet, S., Hoang-Xuan, K. et al. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 102, 1159–1169 (2023). https://doi.org/10.1007/s00277-023-05108-6

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