A multi-institution retrospective analysis of central nervous system recurrence of ASHT cell lymphoma in 2021

The annual American Society of Hematology (ASH) annual meeting is one of the largest and most comprehensive international academic conferences in the field of hematology in the world
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This year, the 63rd ASH Annual Conference will be held offline and online from December 11th to 14th
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A study by the team of Professor Rahul S.
Bhansali from the United States was selected for the Poster section of this year's ASH annual meeting.
The editor will organize the main content as follows for the reference of readers
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Research background Studies have identified risk factors for recurrence of the central nervous system (CNS) in patients with lymphoma, such as high tumor burden and extranodal (EN) disease
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However, most studies have focused on B-cell non-Hodgkin’s lymphoma (NHL), while data on T-cell lymphoma (TCL) is rare.
T-cell lymphoma is uncommon and more heterogeneous
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A few reports on CNS recurrence of TCL show that the median overall survival (OS) is less than 3 months, and the incidence is 2.
6-9%
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In order to better define the CNS recurrence of TCL, the researchers conducted a retrospective analysis of TCL patients with CNS recurrence in multiple institutions, and described here the clinicopathological characteristics and treatment of CNS recurrence
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Research methods The researchers used data from 9 American academic centers to conduct a retrospective observational study that included the diagnosis of mature T-cell tumors between January 1, 2009 and January 1, 2019 (WHO classification in 2016) Standard) adult patients, these patients were found to have CNS recurrence after the initial diagnosis, and the patient, disease and treatment characteristics at the time of initial diagnosis and at the time of CNS recurrence were collected
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Patients who were diagnosed with precursor T-cell malignancies or were found to have CNS diseases before the initial TCL diagnosis (TCLd) and/or first-line treatment were excluded
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Research Results This analysis reports the results of 75 patients (45 males and 30 females)
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At TCLd, the median age was 59 years (range: 20-81), 61% of patients (n=46) had an IPI score of at least 3, 92% (n=69) had EN involvement, and 37% (n= 28) At least 2 EN sites were involved, 59% (n=44) had BM involvement
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The most common pathological diagnosis is non-specific type of peripheral T-cell lymphoma (PTCL, NOS; 24%, n=18), angioimmunoblastic T-cell lymphoma (AITL; 17%, n=13), adult T-cell Leukemia/lymphoma (ATLL; 17%, n=13) and mycosis fungoides (MF; 12%, n=9) (Figure A)
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The first-line systemic treatment of TCL includes anthracyclines, accounting for 72% (n=54)
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Respectively, 12% (n=9) and 8% (n=6) of patients underwent autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation before CNS recurrence
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Before CNS recurrence, 48% (n=36) of patients had non-CNS recurrence
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24% of patients (n=18) used central nervous system preventive measures in the initial treatment of systemic lymphoma, mainly intrathecal methotrexate (IT MTX; n=16)
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The median time from TCLd to CNS recurrence was 8.
5 months, but MF (46.
8 months [range 17.
5-187.
7]) was better than PTCL, NOS (7.
6 months [range 1.
1-58.
4], P=0.
0002), AITL (21.
2 Months [range 2.
0-61.
6, P=0.
008) and ATLL (7.
3 months [range 0.
7-46.
4], P=0.
0005) were significantly longer (Figure B)
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31% of patients (n=23) had CNS recurrence within 6 months after TCLd, and 57% (n=43) occurred within 12 months
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71% of patients (n=53) had symptoms related to CNS recurrence
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CNS recurrence involves 61% of meninges (n=46), 21% of brain parenchyma (n=16), and 17% of both (n=13).
There is no obvious difference between meningeal or brain parenchymal diseases Survival difference (HR 1.
45, 95% CI 0.
78-2.
70, P=0.
28)
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59% of patients (n=44) had systemic relapses
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The most common central nervous system treatment for CNS recurrence is IT MTX (56%; n=42), but many different IT and/or systemic treatment regimens are also used
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The median number of central nervous system treatments received by patients was 1 (range: 0-5)
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The overall response rate of initial central nervous system treatment was 32% (16% CR, 16% PR)
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After CNS recurrence, the median follow-up was 40.
7 months
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At the last follow-up, 83% of the patients had died (n=62)
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The median OS after CNS recurrence was 4.
6 months (range: 0.
1-68.
7) (Figure C)
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The median OS of ATLL patients after CNS recurrence was the shortest (2.
7 months), while MF was 6.
3 months (HR 3.
69, 95% CI 1.
44-9.
42, P=0.
005), and AITL was 6.
5 months (HR 2.
16, 95%) CI 0.
92-5.
06, P=0.
054), PTCL, NOS was 4.
8 months (HR 1.
49, 95% CI 0.
70-3.
19, P=0.
27) (Figure D)
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The most common cause of death is lymphoma progression (77%; n=48)
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The study concluded that most CNS recurrences occurred within 12 months, but CNS recurrences in MF patients occurred later
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Although the prognosis after CNS recurrence is generally poor, the researchers found that the median OS for CNS recurrence is longer than previously reported, which may reflect the effectiveness of the treatment of CNS and systemic recurrence
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Due to the small sample size and heterogeneity in the study cohort, further analysis of the impact of different treatment strategies and outcomes in CNS recurrence is limited.
Future analysis in larger cohorts should focus on factors related to the outcome
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Reference source: Rahul S.
Bhansali, et al.
2021 ASH.
Abstract #1382.
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