title: Relapse pattern and prognostic factors for patients with primary central nervous system lymphoma.
abstract: BACKGROUND
  Primary central nervous system lymphoma (PCNSL) rarely relapses in extracranial sites, and no specialized guidelines for follow-up evaluation have been proposed.
  
  
  METHODS
  We analyzed 65 patients with newly diagnosed PNCSL to evaluate the pattern of relapse and prognostic factors.
  
  
  RESULTS
  Of the 65 patients analyzed, 55 had only parenchymal brain disease, and 10 had both intracranial and extracranial lesions. As a first-line treatment, 29 patients received chemotherapy only (CTx), 13 received chemotherapy followed by whole brain radiotherapy (CTx-WBRT), 18 received chemotherapy followed by autologous stem cell transplantation (CTx-ASCT), 2 received palliative WBRT, and 3 received best supportive care. The overall response rate to the initial treatment was 75.8%, with specific response rates of 62.1% to CTx, 84.6% to CTx-WBRT, and 100% to CTx-ASCT. The complete response (CR) rate was higher with CTx-ASCT than in the absence of ASCT (77.8% vs. 43.2%; P=0.025). After a median follow-up of 18.8 months, the median failure-free survival (FFS) and overall survival (OS) were 13.0 and 36.1 months, respectively. No systemic relapse without a CNS lesion was noted. Multivariate analysis showed that ASCT was predictive of better FFS but not of OS. Age and the Memorial-Sloan Kettering Cancer Center prognostic score were predictive of survival.
  
  
  CONCLUSIONS
  We observed no systemic relapse without a CNS lesion, suggesting that regular systematic evaluation of extracranial sites may not always be necessary. Age was prognostic of survival irrespective of treatment scheme. ASCT may improve CR rate and FFS.
authors.affiliation: Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Dok Hyun
authors.initials: DH
authors.lastname: Yoon
authors.forename: Shin
authors.initials: S
authors.lastname: Kim
authors.forename: Dae Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Hee
authors.initials: YH
authors.lastname: Yoon
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Chi
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Chan-Sik
authors.initials: CS
authors.lastname: Park
authors.forename: Jooryung
authors.initials: J
authors.lastname: Huh
authors.forename: Cheolwon
authors.initials: C
authors.lastname: Suh