Open AccessThe risk of central nervous system relapses in patients with peripheral T-cell lymphoma
Author(s) -
Dai Chihara,
Michelle A. Fanale,
Roberto N. Miranda,
Mansoor Noorani,
Jason R. Westin,
Loretta J. Nastoupil,
Fredrick B. Hagemeister,
Luis Fayad,
Jorge Romaguera,
Felipe Samaniego,
Francesco Turturro,
Hun J. Lee,
Sattva S. Neelapu,
Maria Alma Rodriguez,
Michael Wang,
Nathan Fowler,
R. Eric Davis,
L. Jeffrey Medeiros,
Yasuhiro Oki
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0191461
Subject(s) - medicine , lymphoma , anaplastic large cell lymphoma , cumulative incidence , gastroenterology , anaplastic lymphoma kinase , peripheral t cell lymphoma , incidence (geometry) , t cell lymphoma , primary central nervous system lymphoma , adverse effect , t cell , immunology , transplantation , immune system , physics , optics , malignant pleural effusion , pleural effusion
We performed a retrospective analysis to identify risk factors and survival outcome for central nervous system (CNS) relapse of peripheral T-cell lymphoma (PTCL) by histologic type. Records of 600 PTCL patients diagnosed between 1999 and 2014 were analyzed including PTCL not otherwise specified (PTCL-NOS, 174 patients), angoimmunoblastic T-cell lymphoma (AITL, 144), ALK+anaplastic large cell lymphoma (ALCL, 74), ALK-ALCL (103), extranodal NK-cell lymphoma (ENKL, 54), or others (51). With a median follow up of 57 months, 13 patients (4 PTCL-NOS, 1 AITL, 4 ALK+ALCL, 2 ALK-ALCL, 2 ENKL) experienced CNS relapse. One-year and 5-year cumulative incidence of CNS relapse were 1.5% (95%CI: 0.7–2.8%) and 2.1% (95%CI: 1.1–3.5%), respectively. The 5-year cumulative incidence of CNS relapse was 1.8% in PTCL-NOS, 0.7% in AITL, 5.4% in ALK+ALCL, 2.1% in ALK-ALCL and 3.7% in ENKL. Extranodal involvement >1 site was the only significant factor associated with higher chance of CNS relapse (HR: 4.9, 95%CI: 1.6–15.0, p = 0.005). Patients with ALK+ALCL who had extranodal involvement >1 (N = 19) had very high risk of CNS relapse with one year cumulative incidence of 17% (95%CI: 4%-37%), all occurring within six months after diagnosis. All patients with CNS relapse eventually died (median, 1.5 months; range, 0.1–10.1 months). CNS relapse in patients with PTCL is rare event but the risk varies by subtype. ALK+ALCL patients with extranodal involvement >1 site have a very high risk of early CNS relapse, and thus evaluation of CNS involvement at the time of diagnosis and possible CNS-directed prophylaxis may be considered.