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Primary central nervous system lymphomas in immunocompromised patients require specific response criteria

Nina Schulz1, Lucia Nichelli2, Laurence Schenone3,4

  • 1Department of Neurooncology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France. nina.u.schulz@gmail.com.

Journal of Neuro-Oncology
|June 12, 2024
PubMed

Insights

Immunosuppression increases risk for primary central nervous system lymphomas (PCNSL). Alarming MRI findings post-treatment in these patients are common but not predictive of poor outcomes, suggesting adapted response criteria are needed.

Area of Science:

  • Neuro-oncology
  • Radiology
  • Immunology

Background:

  • Primary central nervous system lymphomas (PCNSL) are associated with immunosuppression.
  • Immunocompromised patients with PCNSL exhibit distinct radiological features.
  • Current MRI response criteria may not accurately assess PCNSL in this population.

Purpose of the Study:

  • To describe the radiological evolution of treated PCNSL in immunocompromised patients.
  • To propose adapted MRI response criteria for immunocompromised individuals with PCNSL.

Main Methods:

  • Multicenter retrospective study.
  • Inclusion of adult immunocompromised patients with newly diagnosed PCNSL.
  • Evaluation of MRI data at baseline, intermediate, end-of-treatment, and follow-up.

Main Results:

  • At baseline, most PCNSL lesions were necrotic and some hemorrhagic.
  • Post-treatment, many patients showed persistent contrast enhancement and large necrotic lesions.
  • These concerning radiological features were not associated with poorer outcomes and diminished over time.

Conclusions:

  • End-of-treatment MRI in immunocompromised patients with PCNSL may show alarming features like persistent enhancement.
  • These findings are often linked to lesion necrosis and hemorrhage, not necessarily a worse prognosis.
  • Adapted MRI response criteria are proposed for this specific patient group.
Abstract

Keywords:
HIVImmunodepressionMRIPrimary central nervous system lymphomaResponse criteriaSolid organ transplantation

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