Dr Baggio on Prognostic Patterns of CNS Relapse in LBCL

“The [RS] patients [had] shorter median PFS and OS by more than half compared [with] their [RI] counterparts.”

Diva Baggio, MBBS, a Margaret Spittle CNS Lymphoma Research Fellow at University College London Hospitals NHS Foundation Trust, discussed findings from an international, multicenter study evaluating relapse patterns in patients with central nervous system (CNS) relapse of large B-cell lymphoma (LBCL).

In cases of secondary CNS lymphoma at relapse, the disease can present either as isolated CNS involvement or synchronously with systemic disease, according to Baggio. These 2 clinical scenarios are classified as relapsed isolated secondary CNS lymphoma (RI) and relapsed synchronous secondary CNS lymphoma (RS), respectively, she said. Prior retrospective and prospective analyses have consistently demonstrated that patients with synchronous systemic and CNS relapse have significantly worse outcomes, she explained. For instance, one comprehensive retrospective study reported particularly poor prognoses in this population, with a median overall survival of less than 4 months, she noted. Within that cohort, RS was identified as an independent adverse prognostic factor when compared with RI, she emphasized.

Research presented by Baggio at the 2025 EHA Congress reaffirmed these previously reported trends. This study evaluated 600 patients with LBCL. Notably, leptomeningeal involvement was enriched in patients with RS. Furthermore, leptomeningeal relapses occurred earliest compared with relapses in the brain, spine, and vitreoretinal sites across both the RS and RI cohorts. Patients with RS demonstrated shorter median progression-free survival (PFS) and overall survival relative to those with RI. Specifically, the median PFS in the leptomeningeal RS group was 7.0 months (95% CI, 5.8-11.0), compared with 7.6 months (95% CI, 4.5-12.7) in the leptomeningeal RI group. The median OS in these respective cohorts were 14.9 months (95% CI, 5.7-46.1) vs 10.2 months (95% CI, 5.2-14.2). These findings underscore the importance of relapse pattern in guiding prognosis and therapeutic decision-making in secondary CNS lymphoma, Baggio concluded.

Disclosures: Baggio reported no disclosures.