Incidence and risk factors for central nervous system relapse in patients with primary mediastinal large B-cell lymphoma in the rituximab era

Theodoros P. Vassilakopoulos*, Fotios Panitsas, Zois Mellios, John Apostolidis, Michalis Michael, Ronit Gurion, Burhan Ferhanoglu, Eleftheria Hatzimichael, Stamatios Karakatsanis, Maria Dimou, Christina Kalpadakis, Eirini Katodritou, Theoni Leonidopoulou, Ioannis Kotsianidis, Hara Giatra, Nick Kanellias, Ayman Sayyed, Tamar Tadmor, Olga Meltem Akay, Maria K. AngelopoulouNetanel Horowitz, Maria Bakiri, Gerassimos A. Pangalis, Panayiotis Panayiotidis, Sotirios G. Papageorgiou

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Central nervous system (CNS) involvement is rare in primary mediastinal large B-cell lymphoma (PMLBCL). We aimed to evaluate the incidence of CNS relapse as first treatment failure event and the effect of the induction chemotherapy regimen, central nervous system - international prognostic index (CNS-IPI) and other clinical and laboratory variables on the risk of CNS relapse in 564 PMLBCL patients treated with immunochemotherapy. Only 17 patients (3.0%) received CNS prophylaxis. During a 55-month median follow-up only 8 patients experienced CNS relapse as first event, always isolated. The 2-year cumulative incidence of CNS relapse (CI-CNSR) was 1.47% and remained unchanged thereafter. The CI-CNSR was not affected by the chemotherapy regimen (R-CHOP or R-da-EPOCH). None of the established International Prognostic Index factors for aggressive lymphomas predicted CNS relapse in PMLBCL. The 2-year CI-CNSR in patients with versus without kidney involvement was 13.3% versus 0.96% (p < 0.001); 14.3% versus 1.13% with versus without adrenal involvement (p < 0.001); and 10.2% versus 0.97% with versus without either kidney or adrenal involvement. CNS-IPI was also predictive (2-year CI-CNSR in high-risk vs. intermediate/low-risk: 10.37% vs. 0.84%, p < 0.001). However, this association may be driven mainly by kidney and/or adrenal involvement. In conclusion, in PMLBCL, CNS relapse is rare and appears to be strongly associated with kidney and/or adrenal involvement.

Original languageEnglish
Pages (from-to)97-107
Number of pages11
JournalHematological Oncology
Issue number1
StatePublished - Feb 2023


  • aggressive lymphoma
  • central nervous system
  • large cell
  • primary mediastinal
  • relapse


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