Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study

Anjo Riemens; Jacoline Bromberg; Valerie Touitou; Bianka Sobolewska; Tom Missotten; Seerp Baarsma; Carel Hoyng; Miguel Cordero-Coma; Oren Tomkins-Netzer; Anna Rozalski; Ilknur Tugal-Tutkun; Yan Guex-Crosier; Leonoor I. Los; Jan Geert Bollemeijer; Andrew Nolan; Joya Pawade; Francois Willermain; Bahram Bodaghi; Ninette ten Dam-van Loon; Andrew Dick; Manfred Zierhut; Susan Lightman; Friederike Mackensen; Alexandre Moulin; Roel Erckens; Barbara Wensing; Phuc le Hoang; Henk Lokhorst; Aniki Rothova

doi:10.1001/jamaophthalmol.2014.4755

Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study

Anjo Riemens^*, Jacoline Bromberg, Valerie Touitou, Bianka Sobolewska, Tom Missotten, Seerp Baarsma, Carel Hoyng, Miguel Cordero-Coma, Oren Tomkins-Netzer, Anna Rozalski, Ilknur Tugal-Tutkun, Yan Guex-Crosier, Leonoor I. Los, Jan Geert Bollemeijer, Andrew Nolan, Joya Pawade, Francois Willermain, Bahram Bodaghi, Ninette ten Dam-van Loon, Andrew DickManfred Zierhut, Susan Lightman, Friederike Mackensen, Alexandre Moulin, Roel Erckens, Barbara Wensing, Phuc le Hoang, Henk Lokhorst, Aniki Rothova

^*Corresponding author voor dit werk

Onderzoeksoutput: Article › Academic › peer review

106 Citaten (Scopus)

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IMPORTANCE The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown.

OBJECTIVE To evaluate the outcomes of treatment regimens used for PVRL in the of subsequent CNSL.

DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period.

INTERVENTIONS The term extensive treatment was used for various combinations of and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy.

MAIN OUTCOMES AND MEASURES Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens.

RESULTS Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35%[95% CI, 50% to 86%]) than in patients without CNSL (68%[95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure.

CONCLUSIONS AND RELEVANCE In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.

Originele taal-2	English
Pagina's (van-tot)	191-197
Aantal pagina's	7
Tijdschrift	Jama ophthalmology
Volume	133
Nummer van het tijdschrift	2
DOI's	https://doi.org/10.1001/jamaophthalmol.2014.4755
Status	Published - feb.-2015

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Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study
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Riemens, A., Bromberg, J., Touitou, V., Sobolewska, B., Missotten, T., Baarsma, S., Hoyng, C., Cordero-Coma, M., Tomkins-Netzer, O., Rozalski, A., Tugal-Tutkun, I., Guex-Crosier, Y., Los, L. I., Bollemeijer, J. G., Nolan, A., Pawade, J., Willermain, F., Bodaghi, B., ten Dam-van Loon, N., ... Rothova, A. (2015). Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study. Jama ophthalmology, 133(2), 191-197. https://doi.org/10.1001/jamaophthalmol.2014.4755

@article{8d8af65864d14f82a16517b240a34d46,

title = "Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study",

abstract = "IMPORTANCE The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown.OBJECTIVE To evaluate the outcomes of treatment regimens used for PVRL in the of subsequent CNSL.DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period.INTERVENTIONS The term extensive treatment was used for various combinations of and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy.MAIN OUTCOMES AND MEASURES Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens.RESULTS Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35%[95% CI, 50% to 86%]) than in patients without CNSL (68%[95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure.CONCLUSIONS AND RELEVANCE In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.",

keywords = "NERVOUS-SYSTEM LYMPHOMA, PRIMARY INTRAOCULAR LYMPHOMA, PRIMARY CNS LYMPHOMA, STEM-CELL RESCUE, IMMUNE-PRIVILEGED SITES, HIGH-DOSE CHEMOTHERAPY, INTRAVITREAL METHOTREXATE, INTENSIVE CHEMOTHERAPY, TESTICULAR LYMPHOMA, TREATMENT OUTCOMES",

author = "Anjo Riemens and Jacoline Bromberg and Valerie Touitou and Bianka Sobolewska and Tom Missotten and Seerp Baarsma and Carel Hoyng and Miguel Cordero-Coma and Oren Tomkins-Netzer and Anna Rozalski and Ilknur Tugal-Tutkun and Yan Guex-Crosier and Los, {Leonoor I.} and Bollemeijer, {Jan Geert} and Andrew Nolan and Joya Pawade and Francois Willermain and Bahram Bodaghi and {ten Dam-van Loon}, Ninette and Andrew Dick and Manfred Zierhut and Susan Lightman and Friederike Mackensen and Alexandre Moulin and Roel Erckens and Barbara Wensing and {le Hoang}, Phuc and Henk Lokhorst and Aniki Rothova",

year = "2015",

month = feb,

doi = "10.1001/jamaophthalmol.2014.4755",

language = "English",

volume = "133",

pages = "191--197",

journal = "Jama ophthalmology",

issn = "2168-6165",

publisher = "AMER MEDICAL ASSOC",

number = "2",

}

Riemens, A, Bromberg, J, Touitou, V, Sobolewska, B, Missotten, T, Baarsma, S, Hoyng, C, Cordero-Coma, M, Tomkins-Netzer, O, Rozalski, A, Tugal-Tutkun, I, Guex-Crosier, Y, Los, LI, Bollemeijer, JG, Nolan, A, Pawade, J, Willermain, F, Bodaghi, B, ten Dam-van Loon, N, Dick, A, Zierhut, M, Lightman, S, Mackensen, F, Moulin, A, Erckens, R, Wensing, B, le Hoang, P, Lokhorst, H & Rothova, A 2015, 'Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study', Jama ophthalmology, vol. 133, nr. 2, blz. 191-197. https://doi.org/10.1001/jamaophthalmol.2014.4755

TY - JOUR

T1 - Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study

AU - Riemens, Anjo

AU - Bromberg, Jacoline

AU - Touitou, Valerie

AU - Sobolewska, Bianka

AU - Missotten, Tom

AU - Baarsma, Seerp

AU - Hoyng, Carel

AU - Cordero-Coma, Miguel

AU - Tomkins-Netzer, Oren

AU - Rozalski, Anna

AU - Tugal-Tutkun, Ilknur

AU - Guex-Crosier, Yan

AU - Los, Leonoor I.

AU - Bollemeijer, Jan Geert

AU - Nolan, Andrew

AU - Pawade, Joya

AU - Willermain, Francois

AU - Bodaghi, Bahram

AU - ten Dam-van Loon, Ninette

AU - Dick, Andrew

AU - Zierhut, Manfred

AU - Lightman, Susan

AU - Mackensen, Friederike

AU - Moulin, Alexandre

AU - Erckens, Roel

AU - Wensing, Barbara

AU - le Hoang, Phuc

AU - Lokhorst, Henk

AU - Rothova, Aniki

PY - 2015/2

Y1 - 2015/2

N2 - IMPORTANCE The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown.OBJECTIVE To evaluate the outcomes of treatment regimens used for PVRL in the of subsequent CNSL.DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period.INTERVENTIONS The term extensive treatment was used for various combinations of and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy.MAIN OUTCOMES AND MEASURES Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens.RESULTS Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35%[95% CI, 50% to 86%]) than in patients without CNSL (68%[95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure.CONCLUSIONS AND RELEVANCE In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.

AB - IMPORTANCE The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown.OBJECTIVE To evaluate the outcomes of treatment regimens used for PVRL in the of subsequent CNSL.DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period.INTERVENTIONS The term extensive treatment was used for various combinations of and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy.MAIN OUTCOMES AND MEASURES Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens.RESULTS Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35%[95% CI, 50% to 86%]) than in patients without CNSL (68%[95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure.CONCLUSIONS AND RELEVANCE In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.

KW - NERVOUS-SYSTEM LYMPHOMA

KW - PRIMARY INTRAOCULAR LYMPHOMA

KW - PRIMARY CNS LYMPHOMA

KW - STEM-CELL RESCUE

KW - IMMUNE-PRIVILEGED SITES

KW - HIGH-DOSE CHEMOTHERAPY

KW - INTRAVITREAL METHOTREXATE

KW - INTENSIVE CHEMOTHERAPY

KW - TESTICULAR LYMPHOMA

KW - TREATMENT OUTCOMES

U2 - 10.1001/jamaophthalmol.2014.4755

DO - 10.1001/jamaophthalmol.2014.4755

M3 - Article

SN - 2168-6165

VL - 133

SP - 191

EP - 197

JO - Jama ophthalmology

JF - Jama ophthalmology

IS - 2

ER -

Treatment Strategies in Primary Vitreoretinal Lymphoma A 17-Center European Collaborative Study

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