The Clinical Analysis Of Patients With Secondary Central Nervous System Lymphoma

BackgroundPatients with secondary central nervous system lymphoma(SCNSL)have an aggressive clinical course and poor prognosis.Its occurrence is mainly related to the pathological subtype,primary site,and tumor burden of lymphoma.The low incidence causes the difficulty of relevant research,resulting in limited treatment options.Moreover,previous studies mainly focus on the highly aggressive non-Hodgkin lymphoma and diffuse large B cell lymphoma(DLBCL),lacking the relevant research on aggressive T cell lymphoma.Objective1 The aim was to describe clinical characteristics of SCNSL patients,and analyze the differences between various races;2 The aim was to explore the potential therapy for SCNSL patients,providing novel ideas for the future studies;3 The aim was to establish a model for predicting the risk of CNS involvement in patients with extranodal NK/T cell lymphoma(ENKL),reducing the incidence of CNS involvement and improving the prognosis of patients.Methods1 The general information,laboratory indicators,imaging results,treatment options,and prognosis of patients in a single-center and SEER database from 2010 to 2018 were analyzed.All patients were followed up by outpatient reviews or by telephone conversations.The last follow-up time was March 2021.Statistical analysis was performed on SPSS 22.0.2 Differences in clinical characteristics were analyzed with Pearson’s chisquared test(χ2).Cox regression analyses were performed to identify the potential regimens for SCNSL patients.3 Univariate Cox regression analysis and Kaplan-Meier analysis were performed to identify the prognostic factors,and variables with a P-value<0.05 were included in Multivariate Cox regression analysis to determine the independent factors.A risk model was established using relevant parameters,and a patient cohort was used to test the clustering performance of this model.ResultsA total of 1728 patients with moderately/highly aggressive lymphoma were included,of which 65 were with CNS involvement.The CNS involvement rates in precursor lymphoid tumor,DLBCL,ENKL,and peripheral T-cell lymphoma was 12.9%,2.5%,5.2%,and 2.0%,respectively.Compared with patients in the SEER database,SCNSL patients from the single-center were mainly young males with T-cell subtypes.The further analysis found that SCNSL patients from single-center mostly were males under 60 years old with Ann Arbor stage Ⅲ/Ⅳ,and most patients developed CNS involvement after six months but within two years following their initial diagnosis.Brain parenchyma and bone is the most common involvement site.Patients who accepted radiotherapy and lenalidomide/thalidomide following CNS involvement had a better prognosis.Of 306 ENKL patients,sixteen were with CNS involvement,and these patients were usually non-upper aerodigestive tract type(31.3%vs.10.7%)with Ann Arbor stage Ⅲ/Ⅳ(50.0%vs.24.1%).No treatment options were found to affect the prevalence of CNS involvement.Cox regression model and KM survival analysis identified the PINK risk score and the involvement of bone,adrenal gland,and testes as the relevant factors of CNS involvement.Based on these factors,a predictive model was established,classifying ENKL patients into low-risk,intermediate-risk,and high-risk groups,of whom the 5-year CNS involvement rates were 0.5%,10.3%,and 30.0%,respectively.Conclusion1 The clinical features and survival prognosis between patients with T cell subtype and B cell subtype are significantly different,suggesting that CNS involvement mechanisms may differ.2 The application of small molecule targeted drugs improves the prognosis of SCNSL patients,and some patients achieve complete remission and long-term survival.3 The predictive model can identify different risk groups of ENKL patients.However,its specificity and sensitivity require further validation.