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The CNS relapse in T-cell lymphoma index predicts CNS relapse in patients with T- and NK-cell lymphomas

Bhansali, R.S. ; Relander, T. LU ; Jerkeman, M. LU and Barta, S.K. (2024) In Blood Advances 8(13). p.3507-3518
Abstract
Little is known about risk factors for central nervous system (CNS) relapse in mature T-cell and natural killer cell neoplasms (MTNKNs). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at the highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKNs, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse–enriched training set. Using a complete case analysis (n = 182), including 91 with CNS relapse, we applied a least absolute shrinkage and... (More)
Little is known about risk factors for central nervous system (CNS) relapse in mature T-cell and natural killer cell neoplasms (MTNKNs). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at the highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKNs, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse–enriched training set. Using a complete case analysis (n = 182), including 91 with CNS relapse, we applied a least absolute shrinkage and selection operator Cox regression model to select weighted clinicopathologic variables for the CITI score, which we validated in an external cohort from the Swedish Lymphoma Registry (n = 566). CNS relapse was most frequently observed in patients with peripheral T-cell lymphoma, not otherwise specified (25%). Median time to CNS relapse and median overall survival after CNS relapse were 8.0 and 4.7 months, respectively. We calculated unique CITI risk scores for individual training set patients and stratified them into risk terciles. Validation set patients with low-risk (n = 158) and high-risk (n = 188) CITI scores had a 10-year cumulative risk of CNS relapse of 2.2% and 13.4%, respectively (hazard ratio, 5.24; 95% confidence interval, 1.50-18.26; P = .018). We developed an open-access web-based CITI calculator (https://redcap.link/citicalc) to provide an easy tool for clinical practice. The CITI score is a validated model to predict patients with MTNKN at the highest risk of developing CNS relapse. © 2024 by The American Society of Hematology. (Less)
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Contribution to journal
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keywords
anaplastic lymphoma kinase, azacitidine, cytarabine, etoposide, Janus kinase 2, lactate dehydrogenase, methotrexate, acute lymphoblastic leukemia, acute myeloid leukemia, adolescent, adult, aged, anemia, Article, cohort analysis, controlled study, cutaneous gamma delta T cell lymphoma, female, flow cytometry, fluorescence in situ hybridization, graft versus host reaction, hematologic malignancy, human, human tissue, kidney transplantation, large granular lymphocyte leukemia, lymphoblastoma, major clinical study, male, multicenter study, mycosis fungoides, non small cell lung cancer, panniculitis, platelet count, progression free survival, recurrence free survival, relapse, risk factor, subcutaneous T cell lymphoma, survival rate, T cell lymphoma, thrombocytopenia, treatment response
in
Blood Advances
volume
8
issue
13
pages
12 pages
publisher
American Society of Hematology
external identifiers
  • scopus:85198556389
  • pmid:38739715
ISSN
2473-9529
DOI
10.1182/bloodadvances.2024012800
language
English
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yes
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e439e094-b634-4428-bf3d-d66b4b6062f3
date added to LUP
2024-09-11 15:22:25
date last changed
2025-04-04 14:28:49
@article{e439e094-b634-4428-bf3d-d66b4b6062f3,
  abstract     = {{Little is known about risk factors for central nervous system (CNS) relapse in mature T-cell and natural killer cell neoplasms (MTNKNs). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at the highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKNs, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse–enriched training set. Using a complete case analysis (n = 182), including 91 with CNS relapse, we applied a least absolute shrinkage and selection operator Cox regression model to select weighted clinicopathologic variables for the CITI score, which we validated in an external cohort from the Swedish Lymphoma Registry (n = 566). CNS relapse was most frequently observed in patients with peripheral T-cell lymphoma, not otherwise specified (25%). Median time to CNS relapse and median overall survival after CNS relapse were 8.0 and 4.7 months, respectively. We calculated unique CITI risk scores for individual training set patients and stratified them into risk terciles. Validation set patients with low-risk (n = 158) and high-risk (n = 188) CITI scores had a 10-year cumulative risk of CNS relapse of 2.2% and 13.4%, respectively (hazard ratio, 5.24; 95% confidence interval, 1.50-18.26; P = .018). We developed an open-access web-based CITI calculator (https://redcap.link/citicalc) to provide an easy tool for clinical practice. The CITI score is a validated model to predict patients with MTNKN at the highest risk of developing CNS relapse. © 2024 by The American Society of Hematology.}},
  author       = {{Bhansali, R.S. and Relander, T. and Jerkeman, M. and Barta, S.K.}},
  issn         = {{2473-9529}},
  keywords     = {{anaplastic lymphoma kinase; azacitidine; cytarabine; etoposide; Janus kinase 2; lactate dehydrogenase; methotrexate; acute lymphoblastic leukemia; acute myeloid leukemia; adolescent; adult; aged; anemia; Article; cohort analysis; controlled study; cutaneous gamma delta T cell lymphoma; female; flow cytometry; fluorescence in situ hybridization; graft versus host reaction; hematologic malignancy; human; human tissue; kidney transplantation; large granular lymphocyte leukemia; lymphoblastoma; major clinical study; male; multicenter study; mycosis fungoides; non small cell lung cancer; panniculitis; platelet count; progression free survival; recurrence free survival; relapse; risk factor; subcutaneous T cell lymphoma; survival rate; T cell lymphoma; thrombocytopenia; treatment response}},
  language     = {{eng}},
  number       = {{13}},
  pages        = {{3507--3518}},
  publisher    = {{American Society of Hematology}},
  series       = {{Blood Advances}},
  title        = {{The CNS relapse in T-cell lymphoma index predicts CNS relapse in patients with T- and NK-cell lymphomas}},
  url          = {{http://dx.doi.org/10.1182/bloodadvances.2024012800}},
  doi          = {{10.1182/bloodadvances.2024012800}},
  volume       = {{8}},
  year         = {{2024}},
}