A prospective observational study of real-world treatment and outcome in secondary CNS lymphoma
Menée en Allemagne dans un contexte de vie réelle à partir de données portant sur 243 patients atteints d'un lymphome secondaire du système nerveux central (âge médian : 66 ans), cette étude de cohorte prospective analyse les stratégies thérapeutiques et leur efficacité
Background: Secondary central nervous system lymphoma (SCNSL) confers a dismal prognosis and treatment advances are constrained by the lack of prospective studies and real-world treatment evidence. Methods: Patients with SCNSL of all entities were included at first diagnosis and patient characteristics, treatment data, and outcomes were prospectively collected in the Secondary CNS Lymphoma Registry (SCNSL-R) (NCT05114330). Findings: 279 patients from 47 institutions were enrolled from 2011 to 2022 and 243 patients (median age: 66 years; range: 23-86) were available for analysis. Of those, 49 (20%) patients presented with synchronous (cohort I) and 194 (80%) with metachronous SCNSL (cohort II). The predominant histology was diffuse large B-cell lymphoma (DLBCL, 68%). Median overall survival (OS) from diagnosis of CNS involvement was 17·2 months (95% CI 12-27·5), with longer OS in cohort I (60·6 months, 95% CI 45·5-not estimable (NE)) than cohort II (11·4 months, 95% CI 7·8-17·7, log-rank test p<0.0001). Predominant induction regimens included R-CHOP/high-dose MTX (cohort I) and high-dose MTX/cytarabine (cohort II). Rituximab was used in 166 (68%) of B-cell lymphoma. Undergoing consolidating high-dose therapy and autologous hematopoietic stem cell transplantation (HDT-ASCT) in partial response (PR) or better was associated with longer OS (HR adjusted 0·47 (95% CI 0·25-0·89), p=0·0197). Interpretation: This study is the largest prospective cohort of SCNSL patients providing a comprehensive overview of an international real-world treatment landscape and outcomes. Prognosis was better in patients with SCNSL involvement at initial diagnosis (cohort I) and consolidating HDT-ASCT was associated with favorable outcome in patients with PR or better.