Fig. 2: Implications of CSF-ctDNA analyses for clinical management of patients. | Leukemia

Fig. 2: Implications of CSF-ctDNA analyses for clinical management of patients.

From: Guiding clinical management of patients with CNS lymphomas by minimal-invasive detection of ctDNA in cerebrospinal fluid

Fig. 2

A Overview and graphical depiction of the reasons for CSF submissions for routine MYD88 L265P testing in CSF. Left [1]: Patients with unclear brain lesions and CNSL as differential diagnosis and either high-risk situation due to patient frailty or tumor lesions in eloquent brain regions [1a], delay of surgical intervention due to concomitant corticosteroid or antiplatelet treatment [1b], or unclear diagnosis after surgical intervention [1c]. Middle [2]: Patients with suspected secondary CNS involvement of systemic lymphomas either as occult [2a], synchronous [2b], or metachronous [2c] manifestation or suspected PCNSL relapse [2 d]. Right [3]: CSF submitted from patients with known CNSL for CSF-ctDNA monitoring. Bar plots and pie charts showing the fraction of patients with CSF-ctDNA positivity (red) and negativity (grey) among patients in categories [1a,b] (B) and [1c] (C) and the effects of CSF-ctDNA detection for surgical planning and treatment initiation. D Bar plot and pie chart showing the fraction of patients with CSF-ctDNA positivity (tourquoise) and negativity (grey) among patients in categories [2] and the effects of CSF-ctDNA detection for surgical planning and treatment initiation. E This panel highlights patients who received CNSL-specific treatment based on CSF-ctDNA positivity. The left bar plot shows the fraction of patients obtaining either curative-intent (dark blue) or palliative (light blue) CNS-directed therapies. Right: These two bar plots highlight the response to these therapies. Dark green: radiological CR, light green: radiological PR, lightest green: clinical response (radiologically LFU or no evaluable brain lesion), grey: no evaluable brain lesion by MRI due to occult involvement, red: radiological PD. F Kaplan-Meier analysis of PFS (black) and OS (grey) in patients undergoing curative-intent therapy based on positive CSF-ctDNA results. The dotted line marks the 1-year time point. G Bar charts revealing the proportion of CSF samples being ctDNA positive (blue) or negative (grey) in patients with no corticosteroids (left) or with corticosteroid treatment (right) prior to and during lumbar puncture. CNSL, central nervous system lymphoma; SCNSL, secondary CNSL; PCNSL, primary CNSL; CSF, cerebrospinal fluid; ctDNA, circulating tumor DNA; CR, complete response; PR, partial response; PD, progressive disease; LFU, last follow-up; PFS, progression-free survival; OS, overall survival.

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