{"doi":"10.1093/neuonc/noae115","title":"Outcomes and relapse patterns in primary central nervous system lymphoma: Longitudinal analysis of 559 patients diagnosed from 1983 to 2020","abstract":"BACKGROUND: Contemporary outcomes and relapse patterns in primary CNS lymphoma (PCNSL) are lacking. We analyzed factors associated with relapse in a large cohort with extensive follow-up. METHODS: T1-post-contrast-enhancing disease was characterized in immunocompetent PCNSL (diffuse large B-cell) patients from 1983 to 2020. Patients were stratified by response to induction and consolidation (complete/unconfirmed [CR/CRu], partial, stable, progression [POD]). Refractory was POD during (or relapse ≤3 months of) induction. Initial relapse site was categorized as local (involving/adjacent to baseline), distant intraparenchymal, leptomeningeal, or other. Progression-free (PFS) and overall survival (OS) were assessed with proportional hazards. Cumulative incidence with competing risks was used to assess local relapse. RESULTS: Median follow-up was 7.4 years (N = 559). Most (321, 57%) were recursive partitioning analysis class 2 (age ≥50, Karnosfky Performance Status [KPS] ≥70). Most had supratentorial (420, 81%), multifocal (274, 53%), bilateral (224, 43%), and deep structure involvement (314, 56%). Nearly all received methotrexate-based induction (532, 95%). There was no difference in PFS or OS from consolidation based on initial response to induction (CR/CRu vs PR) in patients who ultimately achieved a CR/CRu to consolidation. PFS at 1-, 5 years for 351 patients with CR/CRu to consolidation was 80% (95% confidence interval [95% CI]: 76%-84%) and 46% (95% CI: 41%-53%), respectively; 1-year cumulative incidence of local versus nonlocal relapse was 1.8% versus 15%, respectively. For 97 refractory patients, 1-year cumulative incidence of local versus nonlocal relapse was 57% versus 42%, respectively. Deep structure involvement (HR 1.89, 95% CI: 1.10%-3.27%) was associated with local relapse in refractory patients. CONCLUSIONS: We report the first comprehensive relapse patterns in a large PCNSL cohort. While relapses post-CR to consolidation are typically distant and unpredictable, refractory patients had a relatively high incidence of local relapse. These findings can help optimize multimodality therapy for this highest-risk population.","journal":"Neuro-Oncology","year":2024,"id":428211,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6645,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":108867,"name":"Michael Scordo","orcid":"0000-0002-9484-0240","position":1,"is_corresponding":false},{"id":336917,"name":"Joachim Yahalom","orcid":"0000-0003-1658-8585","position":2,"is_corresponding":false},{"id":972820,"name":"Charlie White","orcid":"0000-0003-1671-3155","position":3,"is_corresponding":false},{"id":281409,"name":"Zhigang Zhang","orcid":"0000-0002-1556-7945","position":4,"is_corresponding":false},{"id":275769,"name":"Behroze Vachha","orcid":"0000-0001-7462-1422","position":5,"is_corresponding":false},{"id":291177,"name":"G. Cederquist","orcid":"0000-0003-4749-6093","position":6,"is_corresponding":false},{"id":281416,"name":"Lauren Schaff","orcid":"0000-0002-4664-670X","position":7,"is_corresponding":false},{"id":281418,"name":"Lisa M. DeAngelis","orcid":"0000-0002-6290-7818","position":8,"is_corresponding":false},{"id":281414,"name":"Christian Grommes","orcid":"0000-0002-7485-0441","position":9,"is_corresponding":false},{"id":363895,"name":"Brandon S. Imber","orcid":"0000-0002-1281-5915","position":10,"is_corresponding":false},{"id":329264,"name":"Kathryn R. Tringale","orcid":"0000-0002-1506-4870","position":0,"is_corresponding":true}],"reference_count":49,"raw_metadata":null,"created_at":"2026-07-19T01:58:57.592578Z","pmid":"38915246","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}