Impact of Systemic and Radiation Therapy on Survival of Primary Central Nervous System Lymphoma
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Patient Characteristics
3.2. Treatment Characteristics
3.3. Associations with Patient Outcomes
3.4. Comparisons of Cohorts Treated with and Without Rituximab
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Level | Overall Cohort (n = 95) | Systemic Therapy Cohort (n = 62) | WBRT Cohort (n = 13) |
---|---|---|---|---|
Age | ≥65 | 36 (37.9%) | 25 (40.3%) | 3 (23.1%) |
<65 | 59 (62.1%) | 37 (59.7%) | 10 (76.9%) | |
KPS | ≥70 | 61 (64.2%) | 44 (71.0%) | 4 (30.8%) |
<70 | 34 (35.8%) | 18 (29.0%) | 9 (69.2%) | |
HIV | Positive | 10 (10.5%) | 1 (1.6%) | 5 (38.5%) |
Negative | 85 (89.5%) | 61 (98.4%) | 8 (61.5%) | |
Solid Organ Transplant | Yes | 4 (4.2%) | 1 (1.6%) | 3 (23.1%) |
No | 91 (95.8%) | 61 (98.4%) | 10 (76.9%) | |
Initial Number of Lesions | 2+ | 36 (51.4%) | 26 (51.0%) | 3 (50.0%) |
1 | 34 (48.6%) | 25 (49.0%) | 3 (50.0%) | |
Missing | 25 | 1 | 7 | |
Initial Size of Lesions | ≥14 cc | 32 (45.7%) | 23 (45.1%) | 2 (33.3%) |
<14 cc | 38 (54.3%) | 28 (54.9%) | 4 (66.7%) | |
Missing | 25 | 11 | 7 | |
Histology | DLBCL | 87 (91.6%) | 56 (90.3%) | 13 (100.0) |
Marginal Zone | 5 (5.3%) | 3 (4.8%) | 0 (0.0%) | |
T-Cell | 3 (3.2%) | 3 (4.8%) | 0 (0.0%) | |
CSF Cytology | Positive | 18 (30.0%) | 18 (39.1%) | 0 (0.0%) |
Negative | 42 (70.0%) | 28 (60.9%) | 5 (100.0%) | |
Missing | 35 | 16 | 8 | |
Cycles of HD-MTX | ≥6 | 33 (34.7%) | 35 (56.5%) | 0 (0.0%) |
0–5 | 62 (65.3%) | 27 (43.5%) | 13 (100.0%) | |
Upfront Rituximab | Yes | 38 (61.3%) | 38 (61.3%) | 0 (0.0%) |
No | 24 (38.7%) | 24 (38.7%) | 13 (100.0%) | |
Missing | 33 | 0 | 0 | |
Upfront Temozolomide | Yes | 21 (33.9%) | 41 (66.1%) | 0 (0.0%) |
No | 41 (66.1%) | 21 (33.9%) | 13 (100.0%) | |
Missing | 33 | 0 | 0 | |
Intrathecal Chemotherapy | Yes | 12 (19.4%) | 49 (79.0%) | 0 (0.0%) |
No | 50 (80.6%) | 13 (21.0%) | 13 (100.0%) | |
Missing | 33 | 0 | 0 | |
Type of Surgery | Biopsy | 70 (73.7%) | 49 (79.0%) | 12 (92.3%) |
GTR | 13 (13.7%) | 6 (9.7%) | 0 (0.0%) | |
STR | 12 (12.6%) | 7 (11.3%) | 1 (7.7%) | |
Radiotherapy Use | None | 54 (65.9%) | 47 (75.8%) | 0 (0.0%) |
First-Line | 16 (19.5%) | 3 (4.8%) | 13 (100.0%) | |
Salvage | 12 (14.6%) | 12 (19.4%) | 0 (0.0%) | |
Missing | 13 | 0 | 0 |
Overall Survival | Progression-Free Survival | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
UVA | MVA | UVA | MVA | |||||||
Variable | Level | n | Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value |
Age | ≥65 | 25 | 2.11 (1.12–3.95) | 0.020 | 1.89 (0.98–3.62) | 0.057 | 1.68 (0.96–2.96) | 0.070 | 1.51 (0.85–2.68) | 0.160 |
<65 | 37 | - | - | - | - | - | - | - | - | |
KPS | ≥70 | 18 | - | - | - | - | ||||
<70 | 44 | 1.39 (0.69–2.78) | 0.356 | 1.26 (0.66–2.39) | 0.488 | |||||
HIV | Positive | 1 | 1.09 (0.15–7.99) | 0.935 | 0.88 (0.12–6.46) | 0.903 | ||||
Negative | 61 | - | - | - | - | |||||
Solid Organ Transplant | Yes | 1 | 10.98 (1.28–94.08) | 0.029 | 11.34 (1.32–97.09) | 0.027 | ||||
No | 61 | - | - | - | - | |||||
Initial Number of Lesions | 2+ | 26 | 1.36 (0.71–2.59) | 0.349 | 1.26 (0.70–2.26) | 0.442 | ||||
1 | 25 | - | - | - | - | |||||
Initial Size of Lesions | ≥14 cc | 23 | 1.30 (0.69–2.44) | 0.418 | 1.09 (0.60–1.99) | 0.766 | ||||
<14 cc | 28 | - | - | - | - | |||||
CSF Cytology | Positive | 18 | - | - | - | - | ||||
Negative | 28 | 1.19 (0.59–2.41) | 0.624 | 1.07 (0.56–2.04) | 0.847 | |||||
Cycles of HD-MTX | ≥6 | 35 | 0.40 (0.21–0.76) | 0.005 | 0.40 (0.21–0.78) | 0.007 | 0.44 (0.24–0.79) | 0.006 | 0.44 (0.24–0.80) | 0.007 |
0–5 | 27 | - | - | - | - | - | - | - | - | |
Upfront Rituximab | Yes | 38 | 2.46 (1.22–4.97) | 0.012 | 2.82 (1.37–5.83) | 0.005 | 2.31 (1.24–4.33) | 0.009 | 2.37 (1.26–4.48) | 0.008 |
No | 24 | - | - | - | - | - | - | - | - | |
Upfront Temozolomide | Yes | 21 | 1.68 (0.87–3.24) | 0.120 | 1.77 (0.96–3.27) | 0.069 | ||||
No | 41 | - | - | - | - | |||||
Intrathecal Chemotherapy | Yes | 13 | 0.59 (0.27–1.27) | 0.174 | 0.68 (0.35–1.33) | 0.262 | ||||
No | 49 | - | - | - | - | |||||
Type of Surgery | Biopsy | 49 | 1.78 (0.72–4.40) | 0.213 | 2.15 (0.89–5.19) | 0.09 | ||||
GTR | 6 | 1.85 (0.55–6.28) | 0.323 | 2.62 (0.81–8.44) | 0.107 | |||||
STR | 7 | - | - | - | - | |||||
Consolidation Radiotherapy | No | 59 | - | - | - | - | ||||
Yes | 3 | 0.24 (0.03–1.74) | 0.156 | 0.37 (0.09–1.59) | 0.182 |
Variable | Level | RMT Regimen (n = 21) | HD-MTX and Rituximab (n = 17) | HD-MTX Alone (n = 19) | p-Value |
---|---|---|---|---|---|
Age | ≥65 | 11 (52.4%) | 10 (58.8%) | 12 (63.2%) | 0.785 |
<65 | 10 (47.6%) | 7 (41.2%) | 7 (36.8%) | ||
KPS | ≥70 | 13 (61.9%) | 12 (70.6%) | 15 (78.9%) | 0.500 |
<70 | 8 (38.1%) | 5 (29.4%) | 4 (21.1%) | ||
HIV | Positive | 0 (0.0%) | 1 (5.9%) | 0 (0.0%) | 0.302 |
Negative | 21 (100.0%) | 16 (94.1%) | 19 (100.0%) | ||
Solid Organ Transplant | Yes | 0 (0.0%) | 1 (5.9%) | 0 (0.0%) | 0.302 |
No | 21 (100.0%) | 16 (94.1%) | 19 (100.0%) | ||
Initial Number of Lesions | 2+ | 12 (60.0%) | 6 (37.5%) | 8 (61.5%) | 0.314 |
1 | 8 (40.0%) | 10 (62.5%) | 5 (38.5%) | ||
Missing | 1 | 1 | 6 | ||
Initial Size of Lesions | ≥14 cc | 9 (45.0%) | 8 (50.0%) | 5 (38.5%) | 0.824 |
<14 cc | 11 (55.0%) | 8 (50.0%) | 8 (61.5%) | ||
Missing | 1 | 1 | 6 | ||
Histology | DLBCL | 20 (95.2%) | 16 (94.1%) | 16 (84.2%) | 0.383 |
Marginal Zone | 1 (4.8%) | 1 (5.9%) | 1 (5.3%) | ||
T-Cell | 0 (0.0%) | 0 (0.0%) | 2 (10.5%) | ||
CSF Cytology | Positive | 8 (42.1%) | 2 (18.2%) | 6 (46.2%) | 0.310 |
Negative | 11 (57.9%) | 9 (81.8%) | 7 (53.8%) | ||
Missing | 2 | 6 | 6 | ||
Cycles of HD-MTX | ≥6 | 15 (71.4%) | 7 (41.2%) | 11 (57.9%) | 0.171 |
0–5 | 6 (28.6%) | 10 (58.8%) | 8 (42.1%) | ||
Upfront Rituximab | Yes | 21 (100.0%) | 17 (100.0%) | 0 (0.0%) | <0.001 |
No | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
Upfront Temozolomide | Yes | 21 (100.0%) | 0 (0.0%) | 0 (0.0%) | <0.001 |
No | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
Intrathecal Chemotherapy | Yes | 1 (4.8%) | 4 (23.5%) | 3 (15.8%) | 0.245 |
No | 20 (95.2%) | 13 (76.5%) | 16 (84.2%) | ||
Type of Surgery | Biopsy | 16 (76.2%) | 13 (76.5%) | 15 (78.9%) | 0.888 |
GTR | 3 (14.3%) | 2 (11.8%) | 1 (5.3%) | ||
STR | 2 (9.5%) | 2 (11.8%) | 3 (15.8%) | ||
Radiotherapy Use | None | 15 (71.4%) | 13 (76.5%) | 15 (78.9%) | 0.418 |
First Line | 0 (0.0%) | 1 (5.9%) | 2 (10.5%) | ||
Salvage | 6 (28.6%) | 3 (17.6%) | 2 (10.5%) |
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Janopaul-Naylor, J.R.; Patel, J.S.; Rupji, M.; Hoang, K.B.; McCall, N.S.; Qian, D.C.; Shoaf, M.L.; Kothari, S.; Olson, J.J.; Shu, H.-K.G.; et al. Impact of Systemic and Radiation Therapy on Survival of Primary Central Nervous System Lymphoma. Cancers 2025, 17, 618. https://doi.org/10.3390/cancers17040618
Janopaul-Naylor JR, Patel JS, Rupji M, Hoang KB, McCall NS, Qian DC, Shoaf ML, Kothari S, Olson JJ, Shu H-KG, et al. Impact of Systemic and Radiation Therapy on Survival of Primary Central Nervous System Lymphoma. Cancers. 2025; 17(4):618. https://doi.org/10.3390/cancers17040618
Chicago/Turabian StyleJanopaul-Naylor, James Robert, Jimmy S. Patel, Manali Rupji, Kimberly Bojanowski Hoang, Neal Sean McCall, David C. Qian, Madison Lee Shoaf, Shawn Kothari, Jeffrey J. Olson, Hui-Kuo G. Shu, and et al. 2025. "Impact of Systemic and Radiation Therapy on Survival of Primary Central Nervous System Lymphoma" Cancers 17, no. 4: 618. https://doi.org/10.3390/cancers17040618
APA StyleJanopaul-Naylor, J. R., Patel, J. S., Rupji, M., Hoang, K. B., McCall, N. S., Qian, D. C., Shoaf, M. L., Kothari, S., Olson, J. J., Shu, H.-K. G., Voloschin, A., Zhong, J., Neill, S. G., & Eaton, B. (2025). Impact of Systemic and Radiation Therapy on Survival of Primary Central Nervous System Lymphoma. Cancers, 17(4), 618. https://doi.org/10.3390/cancers17040618