Early MRI Predictors of Relapse in Primary Central Nervous System Lymphoma Treated with MATRix Immunochemotherapy

Isabel Cornell; Ayisha Al Busaidi; Stephen Wastling; Mustafa Anjari; Kate Cwynarski; Christopher P Fox; Nicolas Martinez-Calle; Edward Poynton; John Maynard; Steffi C Thust

doi:10.3390/jpm13071182

Early MRI Predictors of Relapse in Primary Central Nervous System Lymphoma Treated with MATRix Immunochemotherapy

J Pers Med. 2023 Jul 24;13(7):1182. doi: 10.3390/jpm13071182.

Authors

Isabel Cornell¹, Ayisha Al Busaidi^{2

3}, Stephen Wastling^{1

2}, Mustafa Anjari^{1

2

4}, Kate Cwynarski⁵, Christopher P Fox⁶, Nicolas Martinez-Calle⁶, Edward Poynton⁵, John Maynard^{1

2}, Steffi C Thust^{1

7

8}

Affiliations

¹ UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK.
² Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK.
³ Neuroradiology Department, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK.
⁴ Radiology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK.
⁵ Haematology Department, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK.
⁶ School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
⁷ Precision Imaging Beacon, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
⁸ Neuroradiology Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.

Abstract

Primary Central Nervous System Lymphoma (PCNSL) is a highly malignant brain tumour. We investigated dynamic changes in tumour volume and apparent diffusion coefficient (ADC) measurements for predicting outcome following treatment with MATRix chemotherapy in PCNSL. Patients treated with MATRix (n = 38) underwent T1 contrast-enhanced (T1CE) and diffusion-weighted imaging (DWI) before treatment, after two cycles and after four cycles of chemotherapy. Response was assessed using the International PCNSL Collaborative Group (IPCG) imaging criteria. ADC histogram parameters and T1CE tumour volumes were compared among response groups, using one-way ANOVA testing. Logistic regression was performed to examine those imaging parameters predictive of response. Response after two cycles of chemotherapy differed from response after four cycles; of the six patients with progressive disease (PD) after four cycles of treatment, two (33%) had demonstrated a partial response (PR) or complete response (CR) after two cycles. ADC_mean at baseline, T1CE at baseline and T1CE percentage volume change differed between response groups (0.005 < p < 0.038) and were predictive of MATRix treatment response (area under the curve: 0.672-0.854). Baseline ADC and T1CE metrics are potential biomarkers for risk stratification of PCNSL patients early during remission induction therapy with MATRix. Standard interim response assessment (after two cycles) according to IPCG imaging criteria does not reliably predict early disease progression in the context of a conventional treatment approach.

Keywords: CNS lymphoma; MATRix; response imaging.

Grants and funding

No grant-specific funding applies to this work. University College London/UCL Hospitals receive a proportion of funding from the NIHR Biomedical Research Centre.