Isolated intra-ocular relapses of primary central nervous system lymphoma

Abstract published in European Journal of Neurology 24(Suppl 1):52, 2017International audienceBackground and aims: Relapses in primary central nervous system lymphoma (PCNSL) are usually cerebral and severe. Isolated intraocular relapses (IIOR) are much rarer and have not been specifically studied so far.Methods: We retrospectively selected patients treated within the French national expert network on PCNSL (LOC network). The inclusion criteria were: histologically proven PCNSL with at least a cerebral localization, immunocompetent status, 1st line treatment based on high-dose methotrexate and isolated IIOR subsequently.Results: 47 patients met the inclusion criteria (median age: 64.5 years (32.8-79.7), median Karnofsky Performance Status (KPS): 70 (40-100)). Initially, 13 patients had an ocular involvement, 16 had no ocular involvement and 18 had unknown status. The IIOR was the first relapse in 80% of cases. Median time from PCNSL diagnosis to IIOR was 14 months (3-51). Median KPS at IIOR was 80 (70-90), the affection was symptomatic in 95%. Decreased visual acuity was the prominent symptom. 76% of the patients received systemic chemotherapy (CT): ifosfamide-based CT (25%), methotrexate-based CT (25%), temozolomide (19%), in association with rituximab in 47%. 32% received a local treatment (intraocular CT or ocular radiotherapy) alone or in association with systemic CT. 31% subsequently received high-dose CT with autologous stem cells rescue). 60% of patients relapsed subsequently (35% in the brain, 62% in the eye) with a median PFS of 10,8 months. 5-year survival rate from relapse was 53.6% (0.28-1).Conclusion: IIOR of PCNSL seem to have a better prognosis than brain relapses. That might be explained by a better KPS allowing intensification chemotherapy for up to the third of patients

Isolated intra-ocular relapses of primary central nervous system lymphoma

Abstract published in European Journal of Neurology 24(Suppl 1):52, 2017International audienceBackground and aims: Relapses in primary central nervous system lymphoma (PCNSL) are usually cerebral and severe. Isolated intraocular relapses (IIOR) are much rarer and have not been specifically studied so far.Methods: We retrospectively selected patients treated within the French national expert network on PCNSL (LOC network). The inclusion criteria were: histologically proven PCNSL with at least a cerebral localization, immunocompetent status, 1st line treatment based on high-dose methotrexate and isolated IIOR subsequently.Results: 47 patients met the inclusion criteria (median age: 64.5 years (32.8-79.7), median Karnofsky Performance Status (KPS): 70 (40-100)). Initially, 13 patients had an ocular involvement, 16 had no ocular involvement and 18 had unknown status. The IIOR was the first relapse in 80% of cases. Median time from PCNSL diagnosis to IIOR was 14 months (3-51). Median KPS at IIOR was 80 (70-90), the affection was symptomatic in 95%. Decreased visual acuity was the prominent symptom. 76% of the patients received systemic chemotherapy (CT): ifosfamide-based CT (25%), methotrexate-based CT (25%), temozolomide (19%), in association with rituximab in 47%. 32% received a local treatment (intraocular CT or ocular radiotherapy) alone or in association with systemic CT. 31% subsequently received high-dose CT with autologous stem cells rescue). 60% of patients relapsed subsequently (35% in the brain, 62% in the eye) with a median PFS of 10,8 months. 5-year survival rate from relapse was 53.6% (0.28-1).Conclusion: IIOR of PCNSL seem to have a better prognosis than brain relapses. That might be explained by a better KPS allowing intensification chemotherapy for up to the third of patients

Isolated intra-ocular relapses of primary central nervous system lymphoma

Abstract published in European Journal of Neurology 24(Suppl 1):52, 2017International audienceBackground and aims: Relapses in primary central nervous system lymphoma (PCNSL) are usually cerebral and severe. Isolated intraocular relapses (IIOR) are much rarer and have not been specifically studied so far.Methods: We retrospectively selected patients treated within the French national expert network on PCNSL (LOC network). The inclusion criteria were: histologically proven PCNSL with at least a cerebral localization, immunocompetent status, 1st line treatment based on high-dose methotrexate and isolated IIOR subsequently.Results: 47 patients met the inclusion criteria (median age: 64.5 years (32.8-79.7), median Karnofsky Performance Status (KPS): 70 (40-100)). Initially, 13 patients had an ocular involvement, 16 had no ocular involvement and 18 had unknown status. The IIOR was the first relapse in 80% of cases. Median time from PCNSL diagnosis to IIOR was 14 months (3-51). Median KPS at IIOR was 80 (70-90), the affection was symptomatic in 95%. Decreased visual acuity was the prominent symptom. 76% of the patients received systemic chemotherapy (CT): ifosfamide-based CT (25%), methotrexate-based CT (25%), temozolomide (19%), in association with rituximab in 47%. 32% received a local treatment (intraocular CT or ocular radiotherapy) alone or in association with systemic CT. 31% subsequently received high-dose CT with autologous stem cells rescue). 60% of patients relapsed subsequently (35% in the brain, 62% in the eye) with a median PFS of 10,8 months. 5-year survival rate from relapse was 53.6% (0.28-1).Conclusion: IIOR of PCNSL seem to have a better prognosis than brain relapses. That might be explained by a better KPS allowing intensification chemotherapy for up to the third of patients

Isolated intra-ocular relapses of primary central nervous system lymphoma

Abstract published in European Journal of Neurology 24(Suppl 1):52, 2017International audienceBackground and aims: Relapses in primary central nervous system lymphoma (PCNSL) are usually cerebral and severe. Isolated intraocular relapses (IIOR) are much rarer and have not been specifically studied so far.Methods: We retrospectively selected patients treated within the French national expert network on PCNSL (LOC network). The inclusion criteria were: histologically proven PCNSL with at least a cerebral localization, immunocompetent status, 1st line treatment based on high-dose methotrexate and isolated IIOR subsequently.Results: 47 patients met the inclusion criteria (median age: 64.5 years (32.8-79.7), median Karnofsky Performance Status (KPS): 70 (40-100)). Initially, 13 patients had an ocular involvement, 16 had no ocular involvement and 18 had unknown status. The IIOR was the first relapse in 80% of cases. Median time from PCNSL diagnosis to IIOR was 14 months (3-51). Median KPS at IIOR was 80 (70-90), the affection was symptomatic in 95%. Decreased visual acuity was the prominent symptom. 76% of the patients received systemic chemotherapy (CT): ifosfamide-based CT (25%), methotrexate-based CT (25%), temozolomide (19%), in association with rituximab in 47%. 32% received a local treatment (intraocular CT or ocular radiotherapy) alone or in association with systemic CT. 31% subsequently received high-dose CT with autologous stem cells rescue). 60% of patients relapsed subsequently (35% in the brain, 62% in the eye) with a median PFS of 10,8 months. 5-year survival rate from relapse was 53.6% (0.28-1).Conclusion: IIOR of PCNSL seem to have a better prognosis than brain relapses. That might be explained by a better KPS allowing intensification chemotherapy for up to the third of patients

Consolidation anti-CD22 fractionated radioimmunotherapy with 90 Y-epratuzumab tetraxetan following R-CHOP in elderly patients with diffuse large B-cell lymphoma: a prospective, single group, phase 2 trial

International audienceRadioimmunotherapy represents a potential option as consolidation after chemoimmunotherapy in patients with diffuse large B-cell lymphoma who are not candidates for transplantation. We aimed to assess activity and toxicity of fractionated radioimmunotherapy using anti-CD22 90Y-epratuzumab tetraxetan as consolidation after front-line induction chemoimmunotherapy in untreated elderly patients with diffuse large B-cell lymphoma

Integrative analysis of a phase 2 trial combining lenalidomide with CHOP in angioimmunoblastic T-cell lymphoma

International audienceAbstract Angioimmunoblastic T-cell lymphoma (AITL) is a frequent T-cell lymphoma in the elderly population that has a poor prognosis when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy. Lenalidomide, which has been safely combined with CHOP to treat B-cell lymphoma, has shown efficacy as a single agent in AITL treatment. We performed a multicentric phase 2 trial combining 25 mg lenalidomide daily for 14 days per cycle with 8 cycles of CHOP21 in previously untreated AITL patients aged 60 to 80 years. The primary objective was the complete metabolic response (CMR) rate at the end of treatment. Seventy-eight of the 80 patients enrolled were included in the efficacy and safety analysis. CMR was achieved in 32 (41%; 95% confidence interval [CI], 30%-52.7%) patients, which was below the prespecified CMR rate of 55% defined as success in the study. The 2-year progression-free survival (PFS) was 42.1% (95% CI, 30.9%-52.8%), and the 2-year overall survival was 59.2% (95% CI, 47.3%-69.3%). The most common toxicities were hematologic and led to treatment discontinuation in 15% of patients. This large prospective and uniform series of AITL treatment data was used to perform an integrative analysis of clinical, pathologic, biologic, and molecular data. TET2, RHOA, DNMT3A, and IDH2 mutations were present in 78%, 54%, 32%, and 22% of patients, respectively. IDH2 mutations were associated with distinct pathologic and clinical features and DNMT3A was associated with shorter PFS. In conclusion, the combination of lenalidomide and CHOP did not improve the CMR in AITL patients. This trial clarified the clinical impact of recurrent mutations in AITL. This trial was registered at www.clincialtrials.gov as #NCT01553786

Long-term efficacy of anti-PD1 therapy in Hodgkin lymphoma with and without allogenic stem cell transplantation

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Primary CNS lymphoma at first relapse/progression: characteristics, management, and outcome of 256 patients from the French LOC network

International audienceBackground - Treatment of relapsed/refractory (R/R) primary CNS lymphoma (PCNSL) is poorly defined, because randomized trials and large studies are lacking. The aim of this study was to analyze the characteristics, management, and outcome of R/R PCNSL patients after first-line therapy in a nationwide cohort.Methods - We analyzed R/R PCNSL patients following first-line treatment who had been prospectively registered in the database of the French network for oculocerebral lymphoma (LOC) between 2011 and 2014.Results - Among 563 PCNSL patients treated with first-line therapy, we identified 256 with relapsed (n = 93, 16.5%) or refractory (n = 163, 29.0%) disease. Patients who were asymptomatic at relapse/progression (25.5%), mostly diagnosed on routine follow-up neuroimaging, tended to have a better outcome. Patients who received salvage therapy followed by consolidation (mostly intensive chemotherapy plus autologous hematopoietic stem cell transplantation [ICT + AHSCT]) experienced prolonged survival compared with those who did not receive salvage or consolidation therapy. Independent prognostic factors at first relapse/progression were: KPS ≥ 70 vs KPS Conclusions - About a third of PCNSL patients are primary refractory to first line treatment. We identified several independent prognostic factors that can guide the management of R/R PCNSL patients.<br

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study.

Primary mediastinal B-cell lymphoma (PMBL) is a rare type of aggressive lymphoma typically affecting young female patients. The first-line standard of care remains debated. We performed a large multicenter retrospective study in 25 centers in France and Belgium to describe PMBL patient outcomes after first-line treatment in real-life settings. A total of 313 patients were enrolled and received rituximab (R) plus ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) (n = 180) or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) delivered every 14 days (R-CHOP14, n = 76) or 21 days (R-CHOP21, n = 57) and consolidation strategies in modalities that varied according to time and institution, mainly guided by positron emission tomography. Consolidation autologous stem cell transplantation was performed for 46 (25.6%), 24 (31.6%), and 1 (1.8%) patient in the R-ACVBP, R-CHOP14, and R-CHOP21 groups, respectively (P < .001); only 17 (5.4%) patients received mediastinal radiotherapy. The end-of-treatment complete metabolic response rates were 86.3%, 86.8%, and 76.6% (P = .23) in the R-ACVBP, R-CHOP14, and R-CHOP21 groups. The median follow-up was 44 months, and the R-ACVBP, R-CHOP14, and R-CHOP21 three-year progression-free survival probabilities were 89.4% (95% confidence interval [CI], 84.8-94.2), 89.4% (95% CI, 82.7-96.6), and 74.7% (95% CI, 64-87.1) (P = .018). A baseline total metabolic tumor volume (TMTV) ≥360 cm3 was associated with a lower progression-free survival (hazard ratio, 2.18; 95% CI, 1.05-4.53). Excess febrile neutropenia (24.4% vs 5.3% vs 5.3%; P < .001) and mucositis (22.8% vs 3.9% vs 1.8%; P < .001) were observed with R-ACVBP compared with the R-CHOP regimens. Patients with PMBL treated with dose-dense immunochemotherapy without radiotherapy have excellent outcomes. R-ACVBP acute toxicity was higher than that of R-CHOP14. Our data confirmed the prognostic importance of baseline TMTV