P14.48 Extracerebral relapses of primary CNS lymphoma (PCNSL): a LOC network retrospective study

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii47-ii47
Author(s):  
J Dufour ◽  
S Choquet ◽  
A Schmitt ◽  
G Ahle ◽  
R Houot ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Molecular Mechanisms ◽  
Univariate Analysis ◽  
Primary Cns Lymphoma ◽  
Complete Response ◽  
Cns Lymphoma ◽  
High Dose ◽  
Cns Relapse ◽  
Systemic Relapse ◽  
Work Up

Abstract BACKGROUND Classically PCNSL remain confined within the CNS throughout their evolution for reasons still unknown (> 80% cerebral relapses). The aim of this study was to describe the characteristics and outcomes of the rare extracerebral relapses of PCNSL. MATERIAL AND METHODS This is a multicenter, retrospective study. We included all immunocompetent patients newly diagnosed with diffuse large B-cell PCNSL registered in the national LOC network database since 2010 and followed prospectively, who presented an extracerebral relapse, pure (extracerebral only site) or associated with concomitant CNS relapse (mixed). All had body scan and/or TEP -CT at diagnosis work up. RESULTS Of the 1968 PCNSL included in the database, 29 (1.5%) patients presented a systemic relapse [median age 71 years, median KPS 70% at relapse], either pure (n=19) or mixed (n=10), with a histological confirmation in 19 cases (66%). The median delay between initial diagnosis and systemic relapse was 15 months [2–49 months], with 5 very early relapses (<8 months) and 10 late relapses (>21 months). 27 patients had symptoms, 21 related to the location of relapse and 6 with only general symptoms. The localization was thoracic (n=11), abdominal/pelvic (n=14), head/neck (n=6) and limbs (n=9). We found visceral (n=24, 83%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n=12, 41%) and peripheral nervous system (PNS) (n=8, 28%; 4 plexus and 4 extradural roots) involvement. 27 patients were treated with chemotherapy, either with only systemic target (n=8) (R-CHOP alone) or mixed systemic and CNS target (n=19) (R-CHOP-MTX, R-ICE, GEMOX, RDHAC) and consolidated by high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) in 4 cases [median age 55 years, median KPS 80%], with 34% of complete response. After systemic relapse, median progression-free survival was 8 months and overall survival (OS) was 9 months, 15 months for pure systemic and 4.5 months for mixed relapses. KPS>70%, pure systemic relapses and complete response were significantly associated with higher OS in univariate analysis. CONCLUSION Extracerebral PCNSL relapses are very rare, mainly extranodal and involve a large spectrum of anatomical sites, the most frequent being testis, breast and PNS. Prognosis was worse in case of mixed relapse than in pure systemic relapse that was similar to non PCNSL lymphomas. Very early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic work up that should include systematically a FDG PET-CT. More studies are needed to refine their treatment and to specify the role of HCT-ASCT. Paired tumor tissues at diagnosis (CNS)/relapse (extracerebral) analysis would provide a better understanding of underlying molecular mechanisms.

scholarly journals High-dose methotrexate-based regimens and post-remission consolidation for treatment of newly diagnosed primary CNS lymphoma: meta-analysis of clinical trials

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Junyao Yu ◽  
Huaping Du ◽  
Xueshi Ye ◽  
Lifei Zhang ◽  
Haowen Xiao
Keyword(s):  
Meta Analysis ◽  
Primary Cns Lymphoma ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
Complete Response ◽  
Cns Lymphoma ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Newly Diagnosed ◽  
Dose Methotrexate

AbstractWith the exception of high-dose methotrexate (HD-MTX), there is currently no defined standard treatment for newly diagnosed primary central nervous system lymphoma (PCNSL). This review focused on first-line induction and consolidation treatment of PCNSL and aimed to determine the optimal combination of HD-MTX and the long-term beneficial consolidation methods. A comprehensive literature search of MEDLINE identified 1407 studies, among which 31 studies met the inclusion criteria. The meta-analysis was performed by using Stata SE version 15. Forest plots were generated to report combined outcomes like the complete response rate (CRR), overall survival, and progression-free survival. We also conducted univariate regression analyses of the baseline characteristics to identify the source of heterogeneity. Pooled analysis showed a CRR of 41% across all HD-MTX-based regimens, and three- and four-drug regimens had better CRRs than HD-MTX monotherapy. In all combinations based on HD-MTX, the HD-MTX + procarbazine + vincristine (MPV) regimen showed pooled CRRs of 63% and 58% with and without rituximab, respectively, followed by the rituximab + HD-MTX + temozolomide regimen, which showed a pooled CRR of 60%. Pooled PFS and OS showed that post-remission consolidation with autologous stem cell transplantation (ASCT) was associated with the best survival outcome, with a pooled 2-year OS of 80%, a 2-year PFS of 74%, a 5-year OS of 77%, and a 5-year PFS of 63%. Next, whole-brain radiation therapy (WBRT) + chemotherapy showed a pooled 2-year OS of 72%, 2-year PFS of 56%, 5-year OS of 55%, and 5-year PFS of 41%, with no detectable CR heterogeneity throughout the entire treatment process. In HD-MTX-based therapy of newly diagnosed PCNSL, MPV with or without rituximab can be chosen as the inductive regimen, and the rituximab + HD-MTX + temozolomide regimen is also a practical choice. Based on our study, high-dose chemotherapy supported by ASCT is an efficacious approach for consolidation. Consolidation with WBRT + chemotherapy can be another feasible approach.

scholarly journals PC3 - 130 A Meta-Analysis on the use of High-Dose Methotrexate Only Versus Combination Chemotherapy for the Treatment of Newly-Diagnosed Patients with Primary CNS Lymphoma

2016 ◽  
Vol 43 (S4) ◽  
pp. S20-S21
Author(s):  
M.C. Concepcion Sales
Keyword(s):  
Side Effects ◽  
Disease Progression ◽  
Combination Chemotherapy ◽  
Primary Cns Lymphoma ◽  
Complete Response ◽  
Cns Lymphoma ◽  
High Dose ◽  
Cochrane Central Register ◽  
High Dose Methotrexate ◽  
Dose Methotrexate

Primary CNS Lymphoma (PCNSL) is an unusual extranodal form of Non-Hodgkin’s Lymphoma with a locally aggressive course but a rare tendency to disseminate systemically. There are various modalities available for the treatment of PCNSL which include chemotherapy, radiotherapy, surgery and immunotherapy. The effectiveness of adding another anti-neoplastic agent to HD-MTX have been optimized in small scale studies yet the “ perfect combination” has yet to be elucidated Objectives: This study aims to 1) compare the response to treatment of monotherapy with high-dose Methotrexate (HD-MTX) versus HD-MTX and an additional anti-neoplastic agent by evaluating complete response, partial response, stable disease and disease progression and 2) to compare the hematologic and non-hematologic side effects among patients subjected to monotherapy vs combination chemotherapy. Methodology: Journals from Medline, EMBASE, Cochrane Central Register of Control Trials (CENTRAL) and other relevant websites (www.clinicaltrials.org) without any restrictions in the year, language and status of publication were searched. Literatures cited by eligible studies and systemic reviews were also checked to identify useful articles. The following Medical Subject Headings (MeSH) were used: ‘primary CNS lymphoma’, ‘treatment’, ‘chemotherapy’ and ‘randomized control trial’. Statistical analysis was performed using the RevMan software version 5.1. Odds ratio (OR) and 95 % confidence interval (95% CI) were used as summary statistics. Results and Conclusion: The use of high-dose methotrexate and another anti-neoplastic agent showed benefit in terms of achieving complete response and delaying disease progression among patients diagnosed with PCNSL. However, the risks of hematologic toxicities such as anemia, neutropenia, thrombocytopenia and infection was higher in patients treated with the combination chemotherapy. Significant non-hematologic side effects such as mucositis was also observed in patients receiving an add-on to high dose methotrexate.

scholarly journals ML-7 Liquid biopsy for MYD88 mutation in cerebrospinal fluid in patients with suspected primary CNS lymphoma

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi23-vi23
Author(s):  
Yamagishi Yuki ◽  
Nobuyoshi Sasaki ◽  
Yuko Matsushita ◽  
Saki Shimizu ◽  
Yoshie Matsumoto ◽  
...  
Keyword(s):  
Liquid Biopsy ◽  
Primary Cns Lymphoma ◽  
Central Nervous System Lymphoma ◽  
Complete Response ◽  
Digital Pcr ◽  
Cns Lymphoma ◽  
High Dose ◽  
Mr Images ◽  
Ataxic Gait ◽  
Surgical Biopsy

Abstract Background: Treatment intervention for central nervous system lymphoma (CNSL) requires pathological diagnosis by surgical biopsy. However, there are some cases in which the risk of surgery is high due to age, comorbidities, localization of lesions, etc. We are developing a CNSL diagnostic method based on the detection of MYD88 L265P mutation by digital PCR (dPCR) using CSF-DNA, and a high accuracy with a sensitivity of 92.9% and a specificity of 100% has been reported. Here, we report two cases with suspected brain stem CNSL, whose treatment strategy was determined by integrated clinico-laboratory information including neurological presentations, imaging, and the result of liquid biopsy. Result: Case 1. A 63-year-old woman visited our hospital with a complaint of right hemiplegia, which deteriorated in two months. MR images revealed a contrast-enhancing lesion in the left midbrain-ventral pons, suggesting CNSL. Biopsy was not considered because of its location, while dPCR using CSF-DNA showed a cluster of MYD88 mutation signals. Based on these work-ups, she was treated with high-dose methotrexate-based chemotherapy, resulting in a complete response with marked improvement of symptoms. Case 2. An 83-year-old man was referred for a history of diplopia and ataxic gait lasting for a month. MR images revealed an invasive lesion on his right midbrain-dorsal pons. Biopsy was declined due to the location, and liquid biopsy using CSF-DNA was performed to assist the diagnosis. In the first test, the CSF-DNA yield was too insufficient to determine the mutation signal by dPCR. The second dPCR using sufficient amount of CSF-DNA resulted in the Target/Total value of 0.049% which was lower than the threshold, suggesting the absence of MYD88 mutation. The patient underwent radiation therapy accordingly.Conclusions: CSF MYD88 mutation analysis by dPCR may have clinical utility and requires sufficient amount of CSF-DNA for exclusion of noise signals.

Early Relapses in Primary CNS Lymphoma (PCNSL) without Intraventricular Treatment.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4440-4440
Author(s):  
Ingo G.H. Schmidt-Wolf ◽  
Hendrick Pels ◽  
Annika Jurgens ◽  
Axel Glasmacher ◽  
Holger Schulz ◽  
...  
Keyword(s):  
Primary Cns Lymphoma ◽  
Response Duration ◽  
Complete Response ◽  
High Response Rate ◽  
High Rate ◽  
Cns Lymphoma ◽  
High Dose ◽  
Median Response ◽  
Kaplan Meier ◽  
Intraventricular Treatment

Abstract Background: A systemic and intraventricular polychemotherapy regimen (“Bonn protocol”) with deferred radiotherapy had resulted in durable responses in 75% of patients < 60 years with primary CNS lymphoma (PCNSL), but had been complicated by a high rate of Ommaya reservoir infections. Purpose: Here, efficacy and toxicity of this regimen but without intraventricular treatment was evaluated in PCNSL. Patients and Methods : From 08/03 to 11/05, 18 patients with PCNSL < 60 years (median age 53 years) were treated within a phase II trial with a high-dose methotrexate (MTX; cycles 1,2,4 and 5) and cytarabine (Ara-C; cycles 3 and 6) based systemic therapy including dexamethasone, vinca-alkaloids, ifosfamide and cyclophosphamide. Results: Study accrual was prematurely stopped in 11/05 due to a high rate of early relapses. Seventeen/18 patients were assessable for response: Nine (53%) achieved complete response (CR), two (12%) complete response/unconfirmed (CRu), two (12%) partial response (PR), four (24%) showed progressive disease (PD); in one treatment was stopped due to toxicity. Median follow-up is 23 months; Kaplan-Meier estimates for median response duration were ten months only in responding patients and for median time to treatment failure (TTF) eight months in the whole group; median overall survival (OS) has not yet been reached. Systemic toxicity was mainly hematologic. Conclusions: In patients < 60 years with PCNSL polychemotherapy without intraventricular treatment results in a high response rate, but is associated with early relapses in the majority of cases. This is in contrast to the results achieved with the same protocol but with inclusion of intraventricular treatment.

Phase II trial of chemotherapy alone for primary CNS and intraocular lymphoma.

1998 ◽  
Vol 16 (9) ◽  
pp. 3000-3006 ◽  
Author(s):  
V Sandor ◽  
V Stark-Vancs ◽  
D Pearson ◽  
R Nussenblat ◽  
S M Whitcup ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Response Rate ◽  
Survival Rates ◽  
Primary Cns Lymphoma ◽  
Progression Free Survival ◽  
Complete Response ◽  
Intraocular Lymphoma ◽  
Cns Lymphoma ◽  
High Dose ◽  
Free Survival

PURPOSE Primary CNS lymphoma (PCNSL) and primary intraocular lymphoma (IOL) are usually treated with radiation therapy alone or in combination with chemotherapy. The neurotoxicity of these treatments can be substantial. This study attempts to define the toxicity and efficacy of the treatment of this disease with chemotherapy alone. PATIENTS AND METHODS Fourteen nonimmunocompromised patients were accrued to a chemotherapy regimen that incorporated a 24-hour infusion of high-dose methotrexate total dose of 8.4 g/m2 with leucovorin rescue; thiotepa 35 mg/m2; vincristine 1.4 mg/m2; dexamethasone; and intrathecal cytarabine (Ara-C) and methotrexate (MTV) administered in 21-day cycles. Seven patients were prospectively followed up with formal neuropsychologic assessments for evidence of CNS toxicity. RESULTS The response rate was 100% with 11 (79%) complete responses and three (21%) partial responses. Cumulative survival and progression-free survival rates at more than 4.5 years were 68.8% and 34.3%, respectively. Median survival has not been reached, and median progression-free survival was 16.5 months. Toxicity included severe leukoencephalopathy that was clearly attributable to chemotherapy (two patients), grade 3 or 4 neutropenia in 50% of the cycles administered, ileus (one patient), and seizures (two patients). Mucositis and renal and hepatic toxicity were mild and not therapy limiting. CONCLUSION The MTV regimen is generally well tolerated and produces a high complete response rate. Chemotherapy alone should be investigated further in this disease to assess the necessity of initial radiation therapy, either alone or in combined modality regimens, for the achievement of optimal response and survival.

scholarly journals Safety Profile of Maintenance Obinutuzumab in Patients with Primary CNS Lymphoma in Complete Response

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-12
Author(s):  
Nancy D. Doolittle ◽  
Prakash Ambady ◽  
David M. Peereboom ◽  
Douglas E. Ney ◽  
Larry Junck ◽  
...  
Keyword(s):  
Disease Control ◽  
Safety Profile ◽  
Skin Infection ◽  
Primary Cns Lymphoma ◽  
Response Duration ◽  
Complete Response ◽  
Cns Lymphoma ◽  
High Dose ◽  
First Line ◽  
Maintenance Group

Background: Although high initial response rates have been reported, fewer than 50% of newly diagnosed primary CNS lymphoma (PCNSL) patients remain disease free 2 yrs after high-dose (HD) methotrexate (MTX)-based regimens. Treatment options at relapse including HD chemotherapy with or without autologous stem cell transplantation and/or whole brain radiotherapy can lead to considerable toxicity and are not ideal especially for elderly and high-risk patients. New approaches to prolong disease control and response duration in PCNSL are needed. Maintenance rituximab has increased response duration in follicular and mantle cell lymphomas. Several reports (Ney and Abrey [2009]; Ambady et al [2020]) suggest that maintenance rituximab after achieving complete response (CR) to MTX-based chemotherapy, will prolong disease control in PCNSL. We designed a randomized study to evaluate the effect of maintenance obinutuzumab on CR duration in CD20+ B-cell PCNSL patients who attain CR to first-line HD MTX-based chemotherapy. We report adverse events (AEs) to-date in the maintenance group. Methods:This was a multicenter, non-blinded, randomized phase II study, with an estimated sample size of 120 patients randomly assigned to maintenance obinutuzumab or observation. Patients in the maintenance group received obinutuzumab (1000 mg) every 60 days for 2 yrs. Eligible patients were within 75 days of completing first-line MTX-based regimen, and in CR. The primary endpoint was CR duration. Lab tests and safety assessments were performed throughout the study until 60 days after the patient's last obinutuzumab infusion. We graded AEs according to NCI CTCAE v4, and summarized AEs descriptively. Clinical Trial Information: NCT02498951. Results: As of July 1, 2020, 24 patients were enrolled at 11 U.S. centers. Twelve patients (5F, 7M) with median age of 68 yrs (range: 39 - 82), median KPS 90 (range: 80 - 100) were in the maintenance group. Seven of the 12 patients were older than 65 yrs. The 12 patients received 87 obinutuzumab infusions (median 7 [range 2 - 12]). The only grade (Gr) 3 AEs attributable to study drug were nausea, vomiting and skin infection (1 patient [8%] each). The most frequent Gr 2 AEs were respiratory infection and diarrhea (2 patients [17%] each). Gr 2 nausea, vomiting and skin infection occurred in 1 patient (8%, each). Gr 1 dizziness and flushing during cycle 1 infusion occurred in 3 patients (25%). Conclusions: Maintenance obinutuzumab was well tolerated with an encouraging safety profile in PCNSL patients in remission. However, enrollment closed prematurely due to slow accrual made worse by the coronavirus pandemic. Thus the role of maintenance obinutuzumab in prolonging CR duration in this patient population remains unknown. Disclosures Barth: Sanofi:Membership on an entity's Board of Directors or advisory committees.

scholarly journals Intensive Chemotherapy and Immunotherapy in Patients With Newly Diagnosed Primary CNS Lymphoma: CALGB 50202 (Alliance 50202)

2013 ◽  
Vol 31 (25) ◽  
pp. 3061-3068 ◽  
Author(s):  
James L. Rubenstein ◽  
Eric D. Hsi ◽  
Jeffrey L. Johnson ◽  
Sin-Ho Jung ◽  
Megan O. Nakashima ◽  
...  
Keyword(s):  
Primary Cns Lymphoma ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
Complete Response ◽  
Remission Induction ◽  
Cns Lymphoma ◽  
High Dose ◽  
Newly Diagnosed ◽  
Brain Radiotherapy ◽  
Myeloablative Chemotherapy

Purpose Concerns regarding neurocognitive toxicity of whole-brain radiotherapy (WBRT) have motivated development of alternative, dose-intensive chemotherapeutic strategies as consolidation in primary CNS lymphoma (PCNSL). We performed a multicenter study of high-dose consolidation, without WBRT, in PCNSL. Objectives were to determine: one, rate of complete response (CR) after remission induction therapy with methotrexate, temozolomide, and rituximab (MT-R); two, feasibility of a two-step approach using high-dose consolidation with etoposide plus cytarabine (EA); three, progression-free survival (PFS); and four, correlation between clinical and molecular prognostic factors and outcome. Patients and Methods Forty-four patients with newly diagnosed PCNSL were treated with induction MT-R, and patients who achieved CR received EA consolidation. We performed a prospective analysis of molecular prognostic biomarkers in PCNSL in the setting of a clinical trial. Results The rate of CR to MT-R was 66%. The overall 2-year PFS was 0.57, with median follow-up of 4.9 years. The 2-year time to progression was 0.59, and for patients who completed consolidation, it was 0.77. Patients age > 60 years did as well as younger patients, and the most significant clinical prognostic variable was treatment delay. High BCL6 expression correlated with shorter survival. Conclusion CALGB 50202 demonstrates for the first time to our knowledge that dose-intensive consolidation for PCNSL is feasible in the multicenter setting and yields rates of PFS and OS at least comparable to those of regimens involving WBRT. On the basis of these encouraging results, an intergroup study has been activated comparing EA consolidation with myeloablative chemotherapy in this randomized trial in PCNSL, in which neither arm involves WBRT.

Complete Response After High-Dose Methotrexate-Based Chemotherapy as a Major Prognostic Factor for Primary CNS Lymphoma: An Exploratory Analysis of the LNHCP93 Trial of the Groupe d'Etude Des Lymphomes De l'Adulte.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 101-101
Author(s):  
Hervé Ghesquières ◽  
Celine Ferlay ◽  
Agathe Bajard ◽  
Catherine Sebban ◽  
David Perol ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Performance Status ◽  
Primary Cns Lymphoma ◽  
Complete Response ◽  
Cns Lymphoma ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Status Number

Abstract Abstract 101 Background: Treatment of primary CNS lymphoma (PCNSL) is based on high-dose methotrexate (HD-MTX) containing chemotherapy (CT) followed by brain radiotherapy (RT). Initial CT allowed 30% to 63% of complete response (CR) in recent large series. After CT, consolidation RT can increase the CR rate up to 80%. Despite this high rate of response after initial treatment, the outcome of patients remained poor. The impact of the quality of response on outcome is not well known as well as the outcome of PR patients who converted to CR after RT. We assessed these questions in patients with newly diagnosed PCNSL treated with HD-MTX-containing CT followed by RT in the prospective LNHCP93 GELA study. Methods: 99 patients were treated in this prospective phase II study between 1995 and 2002. Patients younger than 61 years received C5R protocol (Blay et al. Blood 1995), Patients aged 61-70 years received reduced doses of C5R protocol and patients older than 70 years received a specific schedule with MTX, vepeside and cyclophosphamide. After CT, brain RT was planned: 20 Gy whole brain and a 36 Gy boost to the tumor bed. Responses after CT and after RT were evaluated by MacDonald criteria. Evaluation of response was made at time of the beginning of RT, 21-35 days after the last course of CT, and one month after the end of RT. Results: Median age of the 99 PCNSL patients was 63 years (range, 20-82), 51% were male, 51% had performance status >1, and 58% had involvement of deep structures of brain. Forty-five patients were younger than 61 years, 36 were aged 61-70 years and 18 older than 70 years. After a median follow-up 83 months, median overall survival (OS) and progression-free survival (PFS) were 33 and 20 months, respectively. Seventeen patients (17%) died of acute toxicity during CT; 3 patients (3%) did not receive RT; 8 patients (8%) progressed or had stable disease after CT and 3 patients (3%) had no available data. Thus, 68 patients were assessable for this exploratory study with thirty-six patients (36%) in PR and 32 patients (32%) in CR after CT. Sixteen of PR patients converted to CR after RT (44% of PR patients after CT). Median OS of patients in CR and PR after CT was 80 and 34 months with a 5-year OS probability of 65% and 29%, respectively (p=0.02). Median PFS of patients in CR and PR after CT was 60 and 21 months with a 5-year PFS probability of 56% and 17%, respectively (p=0.03). In univariate and multivariate analysis, age and response were the two prognostic factors for OS but not performance status, number of tumors at diagnosis, site of tumor (involvement of deep structures). Only response to CT was predictive of PFS in multivariate analysis but not age, performance status, number of tumors, site of tumor at diagnosis. 5-year OS was 65% for CR patients before RT compared to 31% and 28% for PR patients who converted to CR after RT and for patients not in CR after RT, respectively (p=0.06). The 5-year PFS probability was 56% for CR patients before RT compared to 13% and 20% for patients who converted to CR after RT and those not in CR after RT, respectively (p=0.09). Conclusion: Despite the inherent bias of response analysis as a prognostic factor, this analysis of a prospective study of PCNSL patients showed that only patients achieving CR after CT may experience long term survival. This study also showed that PR patients who converted to CR after RT had a poor outcome, similar to patients that did not reach a CR after chemoradiotherapy. Disclosures: No relevant conflicts of interest to declare.

What is the role of whole brain radiation therapy (WBRT) and high-dose cytarabine (Ara-C) as consolidation treatment after initial chemotherapy for primary CNS lymphoma (PCNSL)?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2013-2013
Author(s):  
M. Ekenel ◽  
F. M. Iwamoto ◽  
L. S. Ben Porat ◽  
K. S. Panageas ◽  
J. Yahalom ◽  
...  
Keyword(s):  
Combined Modality Therapy ◽  
Significant Risk ◽  
Primary Cns Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Cns Lymphoma ◽  
High Dose ◽  
Consolidation Therapy ◽  
Whole Brain Radiation ◽  
Significant Difference

2013 Background: Optimal management of PCNSL is not defined. To date the best outcomes have been achieved by combined modality therapy using methotrexate (MTX)-based chemotherapy and WBRT. However, WBRT carries a significant risk of neurotoxicity and may not be required in all patients. Methods: We retrospectively analyzed the data of 122 patients who had complete response (CR) after initial chemotherapy, from a total of 338 PCNSL patients treated in our institution since 1986. Descriptive variables including sex, age, KPS at diagnosis, histology, and extent of CNS involvement were reported. We specifically studied the benefit of consolidation therapy with WBRT and/or high dose Ara-C on OS and PFS. Results: The median age was 60 (19–89) years and a median KPS was 70. Men constituted 57% of the patients. Median follow up was 30 months. Histologically, 83% had diffuse large B cell lymphoma. Ocular and CSF involvements were 13%, and 27%, respectively. Most patients received MTX-based regimens (96%). Five-year OS was 43% and five-year PFS was 50% for all patients. There was no significant difference in OS, between patients who received consolidation therapy with Ara-C (n=35), WBRT (n=12), Ara-C + WBRT (n=28), or no consolidation (n=42) [data from 5 patients are missing]. There was a trend towards improved disease control for patients treated with WBRT; however, these patients were also younger than the other groups. Risk of neurotoxicity was significantly higher in patients who received WBRT (p=0.005). Conclusions: Consolidation therapy does not clearly improve survival in PCNSL patients with a CR to initial treatment. However other important prognostic factors including age and KPS may have been used in the decision making related to consolidation therapy. [Table: see text] No significant financial relationships to disclose.

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