Abstract
Primary central nervous system lymphoma (PCNSL) is a rare but highly aggressive non-Hodgkin lymphoma. Treatment-related cardiovascular lesion has become one of the most common complications in patients with tumor. However, very little is known about the cardiovascular death (CVD) of the patients with PCNSL. This study aims at identifying the cardiovascular outcomes of PCNSL patients and making comparison on CVD with extra central nervous system lymphoma (ECNSL). Clinical information of PCNSL and ECNSL was retrieved from the Surveillance, Epidemiology and End Results database. The risk factors of CVD in PCNSL patients and the comparison on the CVD hazard between PCNSL and ECNSL were assessed with the competing risks regression. A 1:2 propensity score matching was used to reduce the imbalanced baseline characteristics between PCNSL and ECNSL. Four thousand thirty-eight PCNSL subjects and 246,760 ECNSL subjects were enrolled in this retrospective study. CVD was the leading cause (41.2%) of non-cancer death in PCNSL patients and mostly occurred within the first year of diagnosis. Age over 60s and diagnosis in 2000–2008 were significantly associated with the elevated risk of CVD in PCNSL patients, while chemotherapy and radiotherapy play no role on the cardiovascular outcomes. Compared with ECNSL patients, the risk of CVD in PCNSL patients were 40% approximately lower. The risk of CVD in the patients with PCNSL still remains unclear currently. Clinicians ought to pay more attention on the risk of CVD in PCNSL patients, especially the elder patients within the first year of diagnosis.
Highlights
Primary central nervous system lymphoma (PCNSL) is a rare and highly aggressive non-Hodgkin Lymphoma (NHL) that involves the brain, eyes, spinal cord, and cerebrospinal fluid
While patients with NHL are typically treated with rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy regimen [9], high-dose methotrexate (HD-MTX) based chemotherapy is recommended as the first-line treatment among the individuals with PCNSL [10]
This study aims to carry out an analysis on cardiovascular outcomes of Cardiovascular death (CVD) in the PCNSL patients and its comparison with the extra central nervous system lymphoma (ECNSL)
Summary
Primary central nervous system lymphoma (PCNSL) is a rare and highly aggressive non-Hodgkin Lymphoma (NHL) that involves the brain, eyes, spinal cord, and cerebrospinal fluid. The response rate of PCNSL treatment has been ascending over the past decades, the long-term prognosis of PCNSL patients still remains poor due to the delayed treatment-related complications [1]. Despite a number of studies demonstrating chemotherapeutic drugs and radioactive exposure are related to the elevation on risk of CVD in the patients with NHL [4,5,6], research on the cardiovascular outcomes in PCNSL patients has rarely been seen. The risk of CVD in PCNSL patients requires our further inspections because of the disparate characteristics of PCNSL differing from other NHL. PCNSL originates from intracranial site with blood brain barrier, leading to the poor access and efficacy in the brain for the chemotherapeutic drugs used in NHL [7, 8]. What’s more, the median age at diagnosis of PCNSL is 67 years [14], which is older than 54 years in NHL [15], implying that over half of the patients with PCNSL are the elderly and this proportion seems to be enlarging in recent decades [16]
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