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Article Dans Une Revue Neuro-Oncology Année : 2016

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

Caroline Houillier
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Hervé Ghesquières
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Franck Morschhauser
Alexandra Benouaich-Amiel
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Guido Ahle
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Marie-Pierre Moles-Moreau
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Pascal Bourquard
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Ghandi Damaj
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Delphine Larrieu
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Emmanuel Gyan
Oumedaly Reman
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Jean-Pierre Marolleau
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Michel Fabbro
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Florian Naudet

Résumé

Background - 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 < 70), sensitivity to first-line therapy (relapsed vs refractory disease), duration of first remission (progression-free survival [PFS] ≥1 y vs <1 y), and management at relapse/progression (palliative care vs salvage therapy). Patients who relapsed early after first-line therapy (ie, PFS < 1 y) had a poor outcome, comparable to that of refractory patients. Conversely, patients experiencing late relapses (PFS ≥ 1 y) and/or undergoing consolidation with ICT + AHSCT experienced prolonged survival.

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.

Dates et versions

hal-01290413 , version 1 (18-03-2016)

Identifiants

Citer

Sophie Langner-Lemercier, Caroline Houillier, Carole Soussain, Hervé Ghesquières, Olivier Chinot, et al.. Primary CNS lymphoma at first relapse/progression: characteristics, management, and outcome of 256 patients from the French LOC network. Neuro-Oncology, 2016, 18 (9), pp.1297-1303. ⟨10.1093/neuonc/now033⟩. ⟨hal-01290413⟩
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