Peripheral T-Cell Lymphomas Involving the Central Nervous System: A Report From the Czech Lymphoma Study Group Registry

Heidi Mocikova; Robert Pytlík; Katerina Benesova; Andrea Janikova; Juraj Duras; Alice Sykorova; Katerina Steinerova; Vit Prochazka; Vit Campr; David Belada; Marek Trneny

doi:10.3389/fonc.2022.874462

Peripheral T-Cell Lymphomas Involving the Central Nervous System: A Report From the Czech Lymphoma Study Group Registry

Front Oncol. 2022 May 12:12:874462. doi: 10.3389/fonc.2022.874462. eCollection 2022.

Authors

Affiliations

¹ Department of Internal Medicine - Hematology, Third Faculty of Medicine, Charles University, Prague, Czechia.
² Institute of Haematology and Blood Transfusion, Prague, Czechia.
³ 1st Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czechia.
⁴ Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czechia.
⁵ Department of Hemato-Oncology, University Hospital and Faculty of Medicine, Ostrava, Czechia.
⁶ 4th Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czechia.
⁷ Department of Clinical Hematology, University Hospital, Pilsen, Czechia.
⁸ Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czechia.
⁹ Institute of Pathology and Molecular Medicine, University Hospital Motol, Prague, Czechia.

Abstract

Introduction: We analyzed the incidence, risk factors of central nervous system (CNS) relapse, and outcome of CNS involvement in patients with peripheral T-cell lymphomas (PTCL) from the Czech Lymphoma Study Group Registry NiHiL (Clinical Trial gov. NCT03199066).

Materials and methods: Out of 1,040 patients with PTCL, we identified 29 patients (2.79%) with CNS involvement: 2 patients with primary CNS T cell lymphoma, 11 patients with CNS and systemic disease at diagnosis, and 16 patients (1.54%) at CNS relapse. The most common histology with CNS disease was PTCL, not otherwise specified. Progression-free survival (PFS) was defined as the time interval from diagnosis to progression or death. PFS-2 was defined as the interval from the date of a new relapse until the next relapse.

Results: Patients with testicular involvement received intrathecal prophylaxis with methotrexate. High-dose methotrexate-based treatment was administered in 44.8% of patients with CNS disease. Median follow-up was 71.3 months. The difference between the median PFS of 1,027 patients without initial CNS disease (32.6 months) and 11 patients with initial CNS and systemic disease (4.8 months) was significant (p = 0.04). The difference between the median PFS2 in CNS relapses (10.1 months) and 493 relapses outside of CNS (9.1 months) was not significant (p = 0.6). Risk factors for CNS relapses included the following: involvement of more than one extranodal site (p = 0.008), soft tissue involvement (p = 0.003), testicular involvement (p = 0.046), and the presence of B symptoms (p = 0.035). The difference between the median OS of 1,027 patients without initial CNS disease (46.0 months) and 11 patients with initial CNS and systemic disease (18.2 months) was significant (p = 0.02). The median OS2 in CNS relapses was 11.8 months and that in relapses outside of CNS was 21.3 months. CNS involvement was not associated with a significantly worse OS compared to relapsed/refractory patients without CNS involvement (p = 0.1).

Conclusions: The incidence of CNS disease at the time of diagnosis and at relapse in PTCL is low and usually associated with other systemic involvement. The prognosis of PTCL with initial CNS involvement is significantly worse when compared to patients without CNS disease at diagnosis. The outcome of CNS relapse is comparable with relapsed PTCL outside of CNS. The optimal treatment is not defined yet.

Keywords: CNS prophylaxis; central nervous system; leptomeningeal infiltration; methotrexate; peripheral T-cell lymphoma.

Associated data

ClinicalTrials.gov/NCT03199066