Treatment-related Outcomes and Patterns of Relapse in Secondary CNS Involvement by Large B-cell Lymphoma

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

Institutions

Publication Details

Journal
Blood
Published
2026-01-05
DOI
https://doi.org/10.1182/blood.2025031455
Primary Topic
CNS Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Treatment-related Outcomes and Patterns of Relapse in Secondary CNS Involvement by Large B-cell Lymphoma

Thomas A. Ollila, Jeff Smith, Mayur Subhash Narkhede, Hua-Jay Jeffery Cherng et al.
Blood
CNS Lymphoma Diagnosis and Treatment
article

Treatment-related Outcomes and Patterns of Relapse in Secondary CNS Involvement by Large B-cell Lymphoma

Thomas A. Ollila, Jeff Smith, Mayur Subhash Narkhede, Hua-Jay Jeffery Cherng, Danielle Wallace, H. Tun, Javier Naranjo, Amrita Desai, Kim Linton, Rita Tavarozzi, Anna Santarsieri, John Graham Sharp, Sunwoo Han, Anca Prica, Paola Ghione, Chathuri Abeyakoon, Jose Sandoval‐Sus, Victoria Calvert, Nagah Elmusharaf, Sarah Monick, 吉川 京燦, Andrea Kühnl, Jessica Okosun, NARENDRANATH EPPERLA, A. Danilov, Imran Nizamuddin, Adam J. Olszewski, Joanna Meehan Rhodes, Tamara Kay Moyo, K. Cwynarski, Jahanzaib Khwaja, Amy A. Ayers, Seda S. Tolu, Wendy Osborne, Brad S. Kahl, Natalie Sophia Grover, Rachel Treitman, Juan Pablo Alderuccio, Dima El‐Sharkawi, Jean Louise Koff, Diva Baggio, Ning Dong, Iris Margalit Trutzer, Farheen Karim, William D. Hann, Jacopo Calabrese De Feo, Nilanjan Ghosh, Yucai Wang, Praveen Ramakrishnan Geethakumari, Avyakta Kallam, Julio C. Chavez, Adrian Matthew Maraj, Graham P. Collins, Nina D. Wagner-Johnston, Ammar Hilali, Vismay Deshani, Firas Baidoun Firas, Aditi Saha, Aisling Barrett, Izel Okcu, Manali Kamdar
article en

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.

Blood
Rutgers, The State University of New Jersey (US), University of North Carolina at Chapel Hill (US), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University College Hospital (GB), City Of Hope National Medical Center (US), Royal Marsden NHS Foundation Trust (GB), Mayo Clinic (US), Memorial Sloan Kettering Cancer Center (US), University College London Hospitals NHS Foundation Trust (GB), Johns Hopkins University (US), University of Miami (US), Emory University (US), Queen Mary University of London (GB), Washington University in St. Louis (US), University of Utah (US), Barts Health NHS Trust (GB), Brown University (US), Columbia University Irving Medical Center (US), Johns Hopkins Medicine (US), University Hospital of Wales (GB), Huntsman Cancer Institute (US), Jacksonville College (US), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), Freeman Hospital (GB), WinnMed (US), Cambridge University Hospitals NHS Foundation Trust (GB), Princess Margaret Cancer Centre (CA), The Ohio State University Wexner Medical Center (US), Clatterbridge Cancer Centre NHS Foundation Trust (GB), University of Manchester (GB), University of Rochester Medical Center (US), Moffitt Cancer Center (US), University of Alabama at Birmingham (US), University of Chicago (US), Southwestern Medical Center (US), Memorial Healthcare System (US), Levine Cancer Institute (US), City of Hope (US), King's College Hospital NHS Foundation Trust (GB), Royal Marsden Hospital (GB), Mayo Clinic Hospital (US), The Christie NHS Foundation Trust (GB), University of Colorado Cancer Center (US), Oregon Health and Science University Hospital (US), Mayo Clinic in Florida (US), Oxford University Hospitals NHS Trust (GB), The Royal Wolverhampton NHS Trust (GB), Sylvester Comprehensive Cancer Center (US), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT), Southwestern Medical Center (US), Rutgers Cancer Institute (US), UNC Lineberger Comprehensive Cancer Center, University College London (GB), The University of Texas Southwestern Medical Center (US), University of Colorado Denver (US)
Openalex Percentile: Top 98%
CNS Lymphoma Diagnosis and Treatment
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.