3.A single-center, retrospective analysis of relapse and progression patterns of primary central nervous system lymphoma: can whole brain radiotherapy be replaced?.
Yue QIN ; Rongping LIU ; Xiaonan ZHANG ; Wan ZHANG ; Chen REN ; Dehua WU
Journal of Southern Medical University 2023;43(4):499-506
OBJECTIVE:
To analyze recurrence and progression patterns of primary central nervous system lymphoma (PCNSL) in patients without whole brain radiotherapy (WBRT) and assess the value of WBRT in PCNSL treatment.
METHODS:
This retrospective single-center study included 27 patients with PCNSL, who experienced recurrence/progression after achieving complete remission (CR), partial remission, or stable disease following initial treatments with chemotherapy but without WBRT. The patients were followed up regularly after the treatment for treatment efficacy assessment. By comparing the anatomical location of the lesions on magnetic resonance images (MRI) at the initial diagnosis and at recurrence/progression, we analyzed the patterns of relapse/progression in patients with different treatment responses and different initial status of the lesions.
RESULTS:
MRI data showed that in 16 (59.26%) of the 27 patients, recurrence/progression occurred in out-field area (outside the simulated clinical target volume [CTV]) but within the simulated WBRT target area in 16 (59.26%) patients, and within the CTV (in-field) in 11 (40.74%) patients. None of the patients had extracranial recurrence of the tumor. Of the 11 patients who achieved CR after the initial treatments, 9 (81.82%) had PCNSL recurrences in the out-field area but within WBRT target area; of the 13 patients with a single lesion at the initial treatment, 11 (84.62%) experienced PCNSL recurrence in the out-field area but within WBRT target area.
CONCLUSIONS
Systemic therapy combined with WBRT still remains the standard treatment for PCNSL patients, especially those who achieve CR after treatment or have a single initial lesion. Future prospective studies with larger sample sizes are needed to further explore the role of low-dose WBRT in PCNSL treatment.
Humans
;
Lymphoma/radiotherapy*
;
Central Nervous System Neoplasms/pathology*
;
Retrospective Studies
;
Prospective Studies
;
Neoplasm Recurrence, Local/drug therapy*
;
Combined Modality Therapy
;
Brain/pathology*
;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*
;
Methotrexate
4.Primary central nervous system T-cell lymphoma in children and adolescents: a clinicopathological analysis of five cases.
Pei Zhu HU ; Heng Yan ZHANG ; Guan Nan WANG ; Wu Gan ZHAO ; Dan Dan ZHANG ; Wen Cai LI
Chinese Journal of Pathology 2023;52(1):37-42
Objective: To study the clinicopathological characteristics, and further understand primary central nervous system T-cell lymphoma (PCNSTCL) in children and adolescents. Methods: Five cases of PCNSTCL in children and adolescents were collected from December 2016 to December 2021 at the First Affiliated Hospital of Zhengzhou University. The clinicopathological characteristics, immunophenotypic, and molecular pathologic features were analyzed, and relevant literatures reviewed. Results: There were two male and three female patients with a median age of 14 years (range 11 to 18 years). There were two peripheral T-cell lymphomas, not otherwise specified, two anaplastic large cell lymphoma, ALK-positive and one NK/T cell lymphoma. Pathologically, the tumor cells showed a variable histomorphologic spectrum, including small, medium and large cells with diffuse growth pattern and perivascular accentuation. Immunohistochemistry and in situ hybridization showed CD3 expression in four cases, and CD3 was lost in one case. CD5 expression was lost in four cases and retained in one case. ALK and CD30 were expressed in two cases. One tumor expressed CD56 and Epstein-Barr virus-encoded RNA. All cases showed a cytotoxic phenotype with expression of TIA1 and granzyme B. Three cases had a high Ki-67 index (>50%). T-cell receptor (TCR) gene rearrangement was clonal in two cases. Conclusions: PCNSTCL is rare, especially in children and adolescents. The morphology of PCNSTCL is diverse. Immunohistochemistry and TCR gene rearrangement play important roles in the diagnosis.
Female
;
Humans
;
Male
;
Central Nervous System/pathology*
;
Central Nervous System Neoplasms/pathology*
;
Epstein-Barr Virus Infections
;
Herpesvirus 4, Human
;
Lymphoma, T-Cell/pathology*
;
Lymphoma, T-Cell, Peripheral/genetics*
;
Receptor Protein-Tyrosine Kinases/genetics*
;
Receptors, Antigen, T-Cell
;
Child
;
Adolescent
7.Analysis of the genomic landscape of primary central nervous system lymphoma using whole-genome sequencing in Chinese patients.
Xianggui YUAN ; Teng YU ; Jianzhi ZHAO ; Huawei JIANG ; Yuanyuan HAO ; Wen LEI ; Yun LIANG ; Baizhou LI ; Wenbin QIAN
Frontiers of Medicine 2023;17(5):889-906
Primary central nervous system lymphoma (PCNSL) is an uncommon non-Hodgkin's lymphoma with poor prognosis. This study aimed to depict the genetic landscape of Chinese PCNSLs. Whole-genome sequencing was performed on 68 newly diagnosed Chinese PCNSL samples, whose genomic characteristics and clinicopathologic features were also analyzed. Structural variations were identified in all patients with a mean of 349, which did not significantly influence prognosis. Copy loss occurred in all samples, while gains were detected in 77.9% of the samples. The high level of copy number variations was significantly associated with poor progression-free survival (PFS) and overall survival (OS). A total of 263 genes mutated in coding regions were identified, including 6 newly discovered genes (ROBO2, KMT2C, CXCR4, MYOM2, BCLAF1, and NRXN3) detected in ⩾ 10% of the cases. CD79B mutation was significantly associated with lower PFS, TMSB4X mutation and high expression of TMSB4X protein was associated with lower OS. A prognostic risk scoring system was also established for PCNSL, which included Karnofsky performance status and six mutated genes (BRD4, EBF1, BTG1, CCND3, STAG2, and TMSB4X). Collectively, this study comprehensively reveals the genomic landscape of newly diagnosed Chinese PCNSLs, thereby enriching the present understanding of the genetic mechanisms of PCNSL.
Humans
;
DNA Copy Number Variations
;
Nuclear Proteins/genetics*
;
Central Nervous System Neoplasms/pathology*
;
Transcription Factors/genetics*
;
Prognosis
;
Lymphoma/genetics*
;
Genomics
;
China
;
Central Nervous System/pathology*
;
Bromodomain Containing Proteins
;
Cell Cycle Proteins/genetics*
Result Analysis
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