A prospective observational study of real-world treatment and outcome in secondary CNS lymphoma


  • S. Habringer
  • U.M. Demel
  • A.K. Fietz
  • F. Lammer
  • R. Schroers
  • S. Hofer
  • O. Bairey
  • J. Braess
  • A.S. Meier-Stiegen
  • R. Stuhlmann
  • M. Schmidt-Hieber
  • J. Hoffmann
  • B. Zinngrebe
  • U. Kaiser
  • P. Reimer
  • R. Möhle
  • P. Fix
  • H.G. Höffkes
  • U. Langenkamp
  • C.M.Z. Büschenfelde
  • O. Hopfer
  • A. Stoltefuß
  • P. La Rosée
  • H. Blasberg
  • K. Jordan
  • S. Kaun
  • A. Meurer
  • M. Unteroberdörster
  • A.C. von Brünneck
  • D. Capper
  • F.L. Heppner
  • B. Chapuy
  • M. Janz
  • S. Schwartz
  • F. Konietschke
  • P. Vajkoczy
  • A. Korfel
  • U. Keller


  • European Journal of Cancer


  • Eur J Cancer 196: 113436


  • BACKGROUND: Secondary central nervous system lymphoma (SCNSL) confers a dismal prognosis and treatment advances are constrained by the lack of prospective studies and real-world treatment evidence. METHODS: Patients with SCNSL of all entities were included at first diagnosis and patient characteristics, treatment data, and outcomes were prospectively collected in the Secondary CNS Lymphoma Registry (SCNSL-R) (NCT05114330). FINDINGS: 279 patients from 47 institutions were enrolled from 2011 to 2022 and 243 patients (median age: 66 years; range: 23-86) were available for analysis. Of those, 49 (20 %) patients presented with synchronous (cohort I) and 194 (80 %) with metachronous SCNSL (cohort II). The predominant histology was diffuse large B-cell lymphoma (DLBCL, 68 %). Median overall survival (OS) from diagnosis of CNS involvement was 17·2 months (95 % CI 12-27·5), with longer OS in cohort I (60·6 months, 95 % CI 45·5-not estimable (NE)) than cohort II (11·4 months, 95 % CI 7·8-17·7, log-rank test p < 0.0001). Predominant induction regimens included R-CHOP/high-dose MTX (cohort I) and high-dose MTX/cytarabine (cohort II). Rituximab was used in 166 (68 %) of B-cell lymphoma. Undergoing consolidating high-dose therapy and autologous hematopoietic stem cell transplantation (HDT-ASCT) in partial response (PR) or better was associated with longer OS (HR adjusted 0·47 (95 % CI 0·25-0·89), p = 0·0197). INTERPRETATION: This study is the largest prospective cohort of SCNSL patients providing a comprehensive overview of an international real-world treatment landscape and outcomes. Prognosis was better in patients with SCNSL involvement at initial diagnosis (cohort I) and consolidating HDT-ASCT was associated with favorable outcome in patients with PR or better.