Treatment-related outcomes and patterns of relapse in secondary CNS involvement by large B-cell lymphoma
Alderuccio, J. P. Baggio, D. Han, S. Ghione, P. Nizamuddin, I. A. Khwaja, J. Saha, A. Dong, N. Wang, Y. Cherng, H. J.
Alderuccio, J. P.
Baggio, D.
Han, S.
Ghione, P.
Nizamuddin, I. A.
Khwaja, J.
Saha, A.
Dong, N.
Wang, Y.
Cherng, H. J.
Abstract
Secondary central nervous system (CNS) large B-cell lymphoma (SCNSL) occurs in the de novo setting, as a CNS-isolated relapse, or synchronous (concomitant CNS and systemic) relapse. SCNSL is a devastating event without therapeutic consensus. Thus, we aimed to evaluate treatment outcomes in an international cohort. Progression-free survival (PFS), overall survival (OS) and cumulative incidence of relapse (CIR, estimated using competing-risk models) were reported. Prognostic factors were identified in a 6-month landmark multivariate analysis. Outcomes following thiotepa autologous stem cell transplant (ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) delivered at relapse were compared following propensity score matching (PSM). A total of 1139 patients were included in the analysis (de novo: 537; relapsed SCNSL: 602). 2-year PFS estimates were 40.4%, 43.9% and 16.2% for de novo SCNSL, CNS-isolated relapse, and synchronous relapse respectively. Patients with CNS-isolated relapse demonstrated low rates of systemic recurrence (24-month CIR 6%). Thiotepa-ASCT correlated with longer survival in de novo SCNSL (PFS: HR=0.57; P=0.005; and OS: HR=0.62; P=0.023) and CNS-isolated relapses (PFS: HR=0.55; P=0.002; and OS: HR=0.39; P<.0001) in 6-month multivariable landmark analysis. ASCT (thiotepa or non-thiotepa) also associated with improved survival in synchronous relapses (PFS: HR=0.57; P=0.023; and OS: HR=0.48; P=0.019). Higher survival with thiotepa-ASCT compared to CAR-T was observed in survival analyses following PSM (PFS: HR=0.45; P=0.005 and OS: HR=0.41; P=0.014). These data support thiotepa-ASCT in eligible patients, particularly de novo disease and CNS-isolated relapses. CNS-isolated relapse was infrequently associated with systemic recurrence, supporting treatment regimens adopted from primary CNS lymphoma.
Authors
Alderuccio, J. P.
Baggio, D.
Han, S.
Ghione, P.
Nizamuddin, I. A.
Khwaja, J.
Saha, A.
Dong, N.
Wang, Y.
Cherng, H. J.
Tolu, S. S.
Wagner-Johnston, N. D.
Ollila, T. A.
Grover, N. S.
Koff, J. L.
Desai, A.
Ramakrishnan Geethakumari, P.
Moyo, T. K.
Sandoval-Sus, J.
Epperla, N.
Wallace, D. S.
Kamdar, M.
Tavarozzi, R.
Danilov, A. V.
Tun, H. W.
Munoz, J.
Narkhede, M. S.
Rhodes, J. M.
Prica, A.
Kuhnl, A.
Maraj, A. M.
Okosun, J.
Smith, J.
Osborne, W.
Calvert, V.
El-Sharkawi, D.
Hilali, A.
Collins, G. P.
Linton, K.
Elmusharaf, N.
Santarsieri, A.
Karim, F.
Firas, F. B.
Monick, S.
Trutzer, I. M.
Can, J.
Ayers, A. A.
Calabrese De Feo, J.
Sharp, J.
Ghosh, N.
Treitman, R.
Kallam, A.
Okcu, I.
Abeyakoon, C.
Hann, W.
Barrett, A.
Deshani, V.
Kahl, B. S.
Chavez, J. C.
Olszewski, A. J.
Cwynarski, K.
Baggio, D.
Han, S.
Ghione, P.
Nizamuddin, I. A.
Khwaja, J.
Saha, A.
Dong, N.
Wang, Y.
Cherng, H. J.
Tolu, S. S.
Wagner-Johnston, N. D.
Ollila, T. A.
Grover, N. S.
Koff, J. L.
Desai, A.
Ramakrishnan Geethakumari, P.
Moyo, T. K.
Sandoval-Sus, J.
Epperla, N.
Wallace, D. S.
Kamdar, M.
Tavarozzi, R.
Danilov, A. V.
Tun, H. W.
Munoz, J.
Narkhede, M. S.
Rhodes, J. M.
Prica, A.
Kuhnl, A.
Maraj, A. M.
Okosun, J.
Smith, J.
Osborne, W.
Calvert, V.
El-Sharkawi, D.
Hilali, A.
Collins, G. P.
Linton, K.
Elmusharaf, N.
Santarsieri, A.
Karim, F.
Firas, F. B.
Monick, S.
Trutzer, I. M.
Can, J.
Ayers, A. A.
Calabrese De Feo, J.
Sharp, J.
Ghosh, N.
Treitman, R.
Kallam, A.
Okcu, I.
Abeyakoon, C.
Hann, W.
Barrett, A.
Deshani, V.
Kahl, B. S.
Chavez, J. C.
Olszewski, A. J.
Cwynarski, K.
Description
Date
2026
Publisher
Collections
Keywords
Type
Article
Citation
Alderuccio JP, Baggio D, Han S, Ghione P, Nizamuddin IA, Khwaja J, et al. Treatment-related outcomes and patterns of relapse in secondary CNS involvement by large B-cell lymphoma. Blood. 2026 Jan 5. Epub 2026/01/06.