Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S428 diagnosis of DLBCL and CNS involvement by at least one of the following methods: cytological analysis of cerebrospinal fluid (CSF), flow cytometry of CSF, leptomeningeal or parenchymal involvement by magnetic resonance imaging (MRI), computer tomography (CT) or positron emission tomography (PET-CT) were considered for analysis. Clinical, laboratory, histological features, and treatment modalities were registered. Results: Out of 1236 patients with a histologically proven diagnosis of DLBCL during the 2011-2021 period, 74 (6%) patients were diagnosed with secondary CNS involvement. This was identified at the time of initial diagnosis (n=29, 39%), at relapse (n=20, 27%), or as progressive disease (n=25, 34%). The median age was 52.8±16.7 years; most of the cases were men (n=42, 57%) with advanced clinical stage (n=64, 86%) and germinal center B-cell-like (GCB) by immunohistochemical stain according to Han’s algorithm (n=46, 62%). The number of extra-nodal sites (P<0.0001) and clinical stage (P=0.001) were significantly associated with CNS disease. Mean survival from the time of CNS involvement was considerably worse in patients with progressive disease (mean 9.1 months, 95% CI: 3.26-14.98) and relapse (mean 23.9 months, 95% CI: 6.89-41.09) than in those with diagnosis at initial staging (Mean 55.2 months, 95% CI: 30.76-79.66). Multivariate Cox regression analysis showed a significant association between the timing of CNS involvement with mortality. Conclusions: In patients with DLBCL diagnosis from a reference cancer center in Mexico, progression to CNS involvement during immunochemotherapy was associated with poor outcomes. Patients with CNS involvement identified at initial diagnosis fared considerably better. This underscores the importance of an extensive evaluation for asymptomatic CNS involvement in patients with advanced stage disease and extra-nodal involvement. Keywords: ABCL, lymphoma, CNS involvement, therapy, DLBCL ABCL-276 Neurolymphomatosis: A Rare Presentation Mimicking a Schwannoma Lina El Murr MD, Tracy Karam MD, Farah Katrib MD, Georges El Hachem MD Saint George Hospital University Medical Center, Beirut, Lebanon Nerve sheath tumors arise from the Schwann cells and perineural cells of the peripheral nervous system. Schwannomas represent around 65 percent of intradural nerve sheath tumors and consist almost exclusively of neoplastic proliferation of Schwann cells. Neurolymphomatosis is a relatively rare expression of hematologic malignancies, mainly non-Hodgkin lymphoma, and leukemia. It represents the infiltration of nerves by neurotropic neoplastic cells. We report the case of a 40-year-old female patient with no significant past medical history who presented for hearing loss, tinnitus, and vertigo investigations. Workup revealed sensorineural hearing loss with gadolinium-enhanced brain MRI displaying features of a schwannoma. With the rapid progression of her presentation, our patient underwent surgical resection without any further delays, with a fast postoperative recovery and partial progressive regain of her hearing. Pre-operative workup was unremarkable, with a CBCD within normal limits and normal renal and liver function. Histopathological studies and immunohistochemistry were negative for the S-100B protein, which ruled out the Schwann cell origin. Instead, they favored the diagnosis of lymphoma cells and neurolymphomatosis, with a strong membranous diffuse expression of CD20 and Ki67 of 85%. Given the emerging diagnosis, a whole body FDG PET CT Scan was performed to assess for other sites of involvement, which only revealed a mild heterogenous avidity along the spinal cord with no specific suspicious sites. A lumbar puncture was performed, and cerebrospinal fluid (CSF) analysis and cytology revealed lymphoma cells of the B-cell type. Bone marrow aspirate and biopsy were unremarkable. The patient was therefore started on systemic treatment with high-dose methotrexate and cytarabine, in addition to intrathecal methotrexate, with complete resolution of her symptoms. After three cycles of systemic treatment, a repeat lumbar puncture resulted in a CSF with no malignant lymphoma cells. Neurolymphomatosis occurs in the setting of an unknown or a known hematologic malignancy. Because it is relatively rare, the diagnosis is often delayed. Clinicians must integrate the clinical presentation, which is usually rapidly progressive, imaging findings, and pathologic data from the involved tissue and the CSF. Keywords: ABCL, neurolymphomatosis, non-Hodgkin lymphoma, schwannoma ABCL-279 Reduced‑Intensity Anthracycline‑Free Chemoimmunotherapy in Elderly Patients With Newly Diagnosed or Relapsed Diffuse Large B Cell Lymphoma Adan Rios MD, Binoy Yohannan MD McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA Context: Elderly DLBCL patients have suboptimal outcomes due to poor tolerance of anthracycline-containing regimens. We reported previously 5 elderly patients with new or relapsed DLBCL treated with anthracycline-free chemoimmunotherapy (CI). We are updating this report, including longer follow-up and an increase to 8 patients continuing to demonstrate impressive clinical activity. Objective: To demonstrate the effectiveness and durability of therapeutic responses of an anthracycline-free CI regimen in elderly patients with newly diagnosed or relapsed DLBCL. The regimen consists of rituximab, cyclophosphamide, vincristine, and prednisone in combination with lenalidomide 25 mg daily for 21 days, followed by 1 week off (R2-COP). Clinical Data: There were 5 females and 3 males. All 8 patients (median age:79 years, range:72-87 years) had high grade (Ki-67 >60%) DLBCL ineligible for intensive cytotoxic chemotherapy. Five had stage IV, 1 was stage IE, and another was stage III. Patients 2, 3, 5, and 7 received R2-COP for newly diagnosed DLBCL. Patients 1 and 6 were treated for relapsed disease. Patient 2 had stage 4 breast cancer on hormonal therapy when a new liver lesion biopsy confirmed DLBCL. Response to Treatment: All 8 patients achieved a complete response (100%). At a mean followup of 20 months, 7 patients remain alive and in complete remission (CR). After the 3rd cycle of therapy, 7 patients had a complete metabolic response and one after 4 cycles. One patient died in CR at
RkJQdWJsaXNoZXIy MTk3NTQxMg==