PMID- 28577579
OWN - NLM
STAT- MEDLINE
DCOM- 20180131
LR  - 20181113
IS  - 2045-8118 (Electronic)
IS  - 2045-8118 (Linking)
VI  - 14
IP  - 1
DP  - 2017 Jun 2
TI  - Patterns of relapse in primary central nervous system lymphoma: inferences 
      regarding the role of the neuro-vascular unit and monoclonal antibodies in 
      treating occult CNS disease.
PG  - 16
LID - 10.1186/s12987-017-0064-3 [doi]
LID - 16
AB  - BACKGROUND AND PURPOSE: The radiologic features and patterns of primary central 
      nervous system lymphoma (PCNSL) at initial presentation are well described. High 
      response rates can be achieved with first-line high-dose methotrexate (HD-MTX) 
      based regimens, yet many relapse within 2 years of diagnosis. We describe the 
      pattern of relapse and review the potential mechanisms involved in relapse. 
      METHODS: We identified 78 consecutive patients who attained complete radiographic 
      response (CR) during or after first-line treatment for newly diagnosed PCNSL 
      (CD20+, diffuse large B cell type). Patients were treated with HD-MTX based 
      regimen in conjunction with blood-brain barrier disruption (HD-MTX/BBBD); 44 
      subsequently relapsed. Images and medical records of these 44 consecutive 
      patients were retrospectively reviewed. The anatomical location of enhancing 
      lesions at initial diagnosis and at the time of relapse were identified and 
      compared. RESULTS: 37/44 patients fulfilled inclusion criteria and had new 
      measureable enhancing lesions at relapse; the pattern and location of relapse of 
      these 37 patients were identified. At relapse, the new enhancement was at a 
      spatially distinct site in 30 of 37 patients. Local relapse was found only in 
      seven patients. DISCUSSION: Unlike gliomas, the majority of PCNSL had 
      radiographic relapse at spatially distinct anatomical locations within the brain 
      behind a previously intact neurovascular unit (NVU), and in few cases outside, 
      the central nervous system (CNS). This may suggest either (1) reactivation of 
      occult reservoirs behind an intact NVU in the CNS (or ocular) or (2) seeding from 
      bone marrow or other extra CNS sites. CONCLUSION: Recognizing patterns of relapse 
      is key for early detection and may provide insight into potential mechanisms of 
      relapse as well as help develop strategies to extend duration of complete 
      response.
FAU - Ambady, Prakash
AU  - Ambady P
AD  - Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson 
      Park Road, L603, Portland, OR, 97239, USA.
AD  - Portland Veterans Affairs Medical Center, Portland, OR, USA.
FAU - Fu, Rongwei
AU  - Fu R
AD  - School of Public Health, Oregon Health & Science University, Portland, OR, USA.
AD  - Department of Emergency Medicine, Oregon Health & Science University, Portland, 
      OR, USA.
FAU - Netto, Joao Prola
AU  - Netto JP
AD  - Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson 
      Park Road, L603, Portland, OR, 97239, USA.
AD  - Department of Radiology, Oregon Health & Science University, Portland, OR, USA.
FAU - Kersch, Cymon
AU  - Kersch C
AD  - Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson 
      Park Road, L603, Portland, OR, 97239, USA.
FAU - Firkins, Jenny
AU  - Firkins J
AD  - Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson 
      Park Road, L603, Portland, OR, 97239, USA.
FAU - Doolittle, Nancy D
AU  - Doolittle ND
AD  - Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson 
      Park Road, L603, Portland, OR, 97239, USA.
FAU - Neuwelt, Edward A
AU  - Neuwelt EA
AUID- ORCID: 0000-0002-6679-6203
AD  - Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson 
      Park Road, L603, Portland, OR, 97239, USA. neuwelte@ohsu.edu.
AD  - Portland Veterans Affairs Medical Center, Portland, OR, USA. neuwelte@ohsu.edu.
AD  - Department of Neurosurgery, Oregon Health & Science University, Portland, OR, 
      USA. neuwelte@ohsu.edu.
LA  - eng
GR  - R01 CA137488/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20170602
PL  - England
TA  - Fluids Barriers CNS
JT  - Fluids and barriers of the CNS
JID - 101553157
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Immunologic Factors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antibodies, Monoclonal/*therapeutic use
MH  - Central Nervous System Neoplasms/diagnostic imaging/*drug therapy/*pathology
MH  - Female
MH  - Humans
MH  - Image Processing, Computer-Assisted
MH  - Immunologic Factors/*therapeutic use
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/diagnostic imaging/*physiopathology
MH  - Neurovascular Coupling/drug effects/*physiology
MH  - Retrospective Studies
PMC - PMC5457655
EDAT- 2017/06/05 06:00
MHDA- 2018/02/01 06:00
PMCR- 2017/06/02
CRDT- 2017/06/05 06:00
PHST- 2017/03/23 00:00 [received]
PHST- 2017/05/22 00:00 [accepted]
PHST- 2017/06/05 06:00 [entrez]
PHST- 2017/06/05 06:00 [pubmed]
PHST- 2018/02/01 06:00 [medline]
PHST- 2017/06/02 00:00 [pmc-release]
AID - 10.1186/s12987-017-0064-3 [pii]
AID - 64 [pii]
AID - 10.1186/s12987-017-0064-3 [doi]
PST - epublish
SO  - Fluids Barriers CNS. 2017 Jun 2;14(1):16. doi: 10.1186/s12987-017-0064-3.