scholarly journals ML-23 The outcome of malignant lymphoma of the central nervous system in a single institution

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii18-ii18
Author(s):  
Kiyonori Kuwahara ◽  
Shigeo Ohba ◽  
Kazuyasu Matsumura ◽  
Saeko Higashiguchi ◽  
Daijiro Kojima ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Adverse Events ◽  
Malignant Lymphoma ◽  
Survival Time ◽  
Progression Free Survival ◽  
Treatment Method ◽  
The Other ◽  
High Dose ◽  
Other Hand

Abstract Background: Although high dose-methotrexate therapy has been performed for primary central nervous system malignant lymphoma (PCNSL), R-MPV (rituximab, methotrexate (MTX), procarbazine and vincristine) therapy is currently the first line therapy for (PCNSL) in our hospital. This study examines the results of R-MPV therapy comparing with past treatment. Method/Subjects: Thirty-seven patients treated at our hospital from 2009 to 2020 were included. Overall survival time, progression free survival time, and toxicities were evaluated. Results: The average age of patients was 65.7 years. Patients included 21 males and 16 females. Thirty-six patients were diagnosed DLBCL by resected brain tumor tissues, and one was diagnosed DLBCL by vitreous biopsy. As initial treatment, rituximab±HD-MTX therapy (R±MTX group) was performed in 20 cases, HD-MTX therapy plus radiation (R±MTX+RT group) was performed in 12 cases, and RMPV therapy was performed in 5 cases (R-MPV group). Median OS of all cases was 69 months and median PFS was 38 months. Median OS was 69 months in R±MTX group and could not be calculated in R±MTX+RT, and R-MPV groups. Median PFS was 16 months and 56 months in R±MTX group and R±MTX+RT, respectively, and could not be calculated in the R-MPV group. Although the R-MPV group had a short follow-up period, the results were considered to be comparable to those of the R±MTX+RT group. On the other hand, grade 3/4 adverse events occurred in 50%, 25%, and 100%, respectively. Conclusion: R-MPV therapy may delay the timing of radiation and reduce the amount of radiation. On the other hand, the frequency of adverse events is high, and more strict management of treatment is required.

scholarly journals Treatment of secondary central nervous system involvement in systemic aggressive B cell lymphoma using R-MIADD chemotherapy: a single-center study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuchen Wu ◽  
Xuefei Sun ◽  
Xueyan Bai ◽  
Jun Qian ◽  
Hong Zhu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Involvement ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Cns Involvement ◽  
The Central Nervous System ◽  
Secondary Central Nervous System

Abstract Background Secondary central nervous system lymphoma (SCNSL) is defined as lymphoma involvement within the central nervous system (CNS) that originated elsewhere, or a CNS relapse of systemic lymphoma. Prognosis of SCNSL is poor and the most appropriate treatment is still undetermined. Methods We conducted a retrospective study to assess the feasibility of an R-MIADD (rituximab, high-dose methotrexate, ifosfamide, cytarabine, liposomal formulation of doxorubicin, and dexamethasone) regimen for SCNSL patients. Results Nineteen patients with newly diagnosed CNS lesions were selected, with a median age of 58 (range 20 to 72) years. Out of 19 patients, 11 (57.9%) achieved complete remission (CR) and 2 (10.5%) achieved partial remission (PR); the overall response rate was 68.4%. The median progression-free survival after CNS involvement was 28.0 months (95% confidence interval 11.0–44.9), and the median overall survival after CNS involvement was 34.5 months. Treatment-related death occurred in one patient (5.3%). Conclusions These single-centered data underscore the feasibility of an R-MIADD regimen as the induction therapy of SCNSL, further investigation is warranted.

scholarly journals INNV-21. EFFECTIVE REGIMEN OF HIGH-DOSE METHOTREXATE PLUS TEMOZOLOMIDE FOR PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA: A SINGLE-CENTER RETROSPECTIVE STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii120-ii121
Author(s):  
Jun-ping Zhang ◽  
Jing-jing Ge ◽  
Cheng Li ◽  
Shao-pei Qi ◽  
Feng-jun Xue ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
Complete Response ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Better Than

Abstract OBJECTIVE To evaluate the efficacy and safety of high-dose methotrexate combined with temozolomide in the treatment of newly diagnosed primary central nervous system lymphoma. METHODS A retrospective study was performed to analyze the clinical data of patients with primary central nervous system lymphoma treated with high-dose methotrexate plus temozolomide in the Department of Neuro-oncology, Capital Medical University, Sanbo Brain Hospital from May 2010 to December 2018. RESULTS A total of 41 patients were identified. Median age was 57 years (range, 27–76 years). The maximal extent of surgery was total resection in 6, partial resection in 8, and biopsy in 27 patients. Of the 35 patients with evaluable lesions, 32 achieved complete response (CR) and 3 achieved partial response. CR rate was 91.4%. The median follow-up time was 36.5 months (range, 4.9–115.4 months). After treatment, the median progression-free survival (PFS) was 45.1 months. PFS rate at 1, 2, 5 years were 85.4%, 70.1% and 43.8%, respectively. The OS rate at 1, 2, 5 years were 92.7%, 82.4% and 66.5%, respectively. The median PFS of patients younger than 65 years was better than that of patients ≥65 years (98.8 months vs 27.9 months, p=0.039). There was no association between efficacy and extent of resection (p=0.836). After disease progression, 6 of the 21 patients received radiotherapy. There was no statistical difference in OS between the patients with or without radiotherapy (36.9 months vs 28.4 months). The main severe adverse events were myelosuppression (36.6%) and elevated transaminase (34.1%). Three patients were discontinued due to drug-related toxicities. CONCLUSIONS High-dose methotrexate combined with temozolomide is effective in the treatment of primary central nervous system lymphoma, with a low incidence of severe adverse reactions. This efficacy may be better than the historical control of methotrexate alone or methotrexate plus rituximab.

On the incubation period in neurolues

1927 ◽  
Vol 23 (10) ◽  
pp. 1046-1050
Author(s):  
E. V. Sukhova
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Incubation Period ◽  
The Other ◽  
Other Hand ◽  
General Number ◽  
The Central Nervous System

Speaking about syphilis lesions of the central nervous system, it is impossible not to note that these lesions are among the most severe diseases of the latter. But, on the other hand, their severity is redeemed to some extent by the specific means of combating them which we have in our hands. In this case, the fight against neurolues is reduced not so much to its treatment as to its prevention. Hence the interest with which the question of the influence of various conditions on the occurrence of syphilitic lesions of the central nervous system has recently begun to be comprehensively discussed and the exact causes which, from the general number of syphilitics, distinguish the group subsequently condemned to neurolues have been sought to be elucidated.

scholarly journals Single-Agent Ibrutinib in Recurrent/Refractory Central Nervous System Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 783-783 ◽  
Author(s):  
Christian Grommes ◽  
Alessandro Pastore ◽  
Igor Gavrilovic ◽  
Thomas Kaley ◽  
Craig Nolan ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Adverse Events ◽  
Clinical Response ◽  
Central Nervous System Lymphoma ◽  
Cns Lymphoma ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Methotrexate Chemotherapy

Abstract BACKGROUND: Primary Central Nervous System Lymphoma (PCNSL) is an aggressive primary brain tumor with median progression free survival (PFS) after upfront methotrexate-based chemotherapy of 2-3 years. Outcome and treatment options are poor for recurrent/refractory (r/r) disease. Response rates (ORR) range between 30-60% with a PFS of 2-5 months. Ibrutinib has shown promising clinical response in Mantel cell lymphoma, CLL, and Waldenström. This trial investigates Ibrutinib in patients with r/r PCNSL and SCNSL. METHODS: Eligible patients had r/r PCNSL or Secondary CNS Lymphoma (SCNSL), age≥18, ECOG≤2, normal end-organ function, and unrestricted number of CNS directed prior therapies. In patients with SCNSL disease, systemic disease needed to be absent. RESULTS: Twenty patients were enrolled (3 at 560 mg; 17 at 840 mg). Median age was 69 (range 21-85); 12 were women. Median ECOG was 1 (0: 2, 1: 12, 2: 6). 65% had PCNSL and 35% SCNSL; 70% had recurrent disease. Eleven had parenchymal disease, 3 isolated cerebrospinal fluid (CSF) involvement and 6 both. Five grade 4 adverse events were observed in 4 patients (lymphopenia (2), sepsis (1), neutropenia (2)). Ten patients developed grade 3 toxicities, including lymphopenia in 3 patients, thrombocytopenia in 2, hyperglycemia in 2, lung infection in 2, neutropenia in 1, urinary tract infection in 1, colitis in 1, and fungal encephalitis in 1. The most common toxicities were hyperglycemia, anemia, and thrombocytopenia. After a median follow-up of 193 days, 19/20 patients were evaluated for response: 8 CR, 7 PR, 1 SD and 3 PD; 75% (15/20) ORR. The median PFS is 7.29 months (95% CI: 3.80-15.43 months (longest: 15.3 months)). The mean Ibrutinib concentration in the CSF 2h post administration at day 1 and 29 is 1.75 ng/mL (3.97 nM) and 2.51 ng/mL (5.6 nM) which is above the IC50 (1nM) required in vitro to reduce growth of lymphoma cells.An additional treatment arm has been added to the trial which will evaluate adverse events of the combination of ibrutinib and high-dose methotrexate chemotherapy. Enrollment into the combination arm is ongoing and updates will be presented at the meeting. CONCLUSION: Patients with CNS lymphoma tolerate Ibrutinib with manageable adverse events. Drug concentrations in CSF are higher at steady state (day 29) and meaningful CSF concentrations are reached. Clinical response was seen in 75% of CNS lymphoma patients. A combination arm will assess the adverse events of ibrutinib in combination with high-dose methotrexate chemotherapy. Disclosures No relevant conflicts of interest to declare.

scholarly journals High-dose methotrexate-based regimens with or without vincristine for the treatment of primary central nervous system lymphoma

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Tracelyn Freeman ◽  
Carlo S Legasto ◽  
M Alexandra Schickli ◽  
Eric M McLaughlin ◽  
Pierre Giglio ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Treatment Options ◽  
Group Versus ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
Adverse Event Rate ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate

Abstract Background Primary central nervous system lymphoma (PCNSL) is a rare malignancy with few treatment options. One regimen used for induction is rituximab, high-dose methotrexate (HD-MTX), procarbazine, and vincristine (R-MPV). A common institutional practice is removing vincristine (VCR) from this regimen due to its poor CNS penetration and associated toxicities. The aim of this study was to evaluate how the omission of VCR from HD-MTX-based induction impacted clinical outcomes. Methods In a retrospective review, patients with PCNSL who received HD-MTX-based induction therapy between January 1, 2010 and May 31, 2018 were evaluated. Patients were stratified according to treatment into 2 groups, VCR-containing therapy versus no VCR. The primary endpoint was complete response (CR) rate following the completion of induction chemotherapy. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and adverse event rate. Results Twenty-nine patients were included: 16 patients in the VCR group and 13 in the non-VCR group. A CR was achieved in 7 (44%) and 5 (38%) (odds ratio [OR] = 1.24; 95% confidence interval [CI]: 0.28–5.53) patients, respectively. Median OS was 85.3 (95% CI: 20.2–85.3) versus 67.1 months (95% CI: 10.5–NR) and median PFS was 60.7 (95% CI: 9.4–NR) versus 23.7 months (95% CI: 4.7–NR) in the VCR group versus non-VCR group, respectively. The incidence of any grade peripheral neuropathy was higher in the VCR group. Conclusions CR rate, OS, and PFS were similar between groups regardless of VCR inclusion. Adverse events were higher in the VCR group. Larger studies are required to further evaluate the efficacy of VCR in PCNSL induction regimens.

scholarly journals Consolidation Treatment for Primary Central Nervous System Lymphoma: Which Modality for Whom?

2020 ◽  
pp. 1-14
Author(s):  
Osnat Bairey ◽  
Liat Shargian-Alon ◽  
Tali Siegal
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Real Life ◽  
Central Nervous System Lymphoma ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
The Elderly ◽  
High Dose ◽  
Brain Radiotherapy ◽  
Randomized Studies

Primary central nervous system lymphoma is a rare aggressive disease that largely affects elderly patients and is associated with poor prognosis. The optimal treatment approach is not yet defined and it consists of induction and consolidation phases. The combination of high-dose (HD) methotrexate-based chemotherapy followed by whole-brain radiotherapy (WBRT) prolongs the median progression-free survival (PFS) and overall survival 2- to 3-fold as compared to WBRT alone but is associated with significant delayed neurotoxicity. Alternative strategies are being investigated in order to improve disease outcomes and spare patients the neurocognitive side effects. These include reduced-dose WBRT, non-myeloablative HD chemotherapy, or HD chemotherapy with autologous stem cell transplantation (HDC/ASCT). There are no randomized studies that compare all these consolidation regimens head to head but recently HDC/ASCT has been evaluated versus WBRT in prospective randomized studies. These studies proved that WBRT and HDC/ASCT yield similar 2-year PFS with preserved or improved cognitive function after HDC/ASCT. Yet, the proportion of patients treated with such intensive consolidation is low, both in real life and in specialized centers, leaving many unsettled issues. This review is appraising current dilemmas related to the choice of consolidating therapeutic modalities, their associated acute and delayed toxicity, and future prospects for alternative approaches in the elderly.

Primary Central Nervous System Lymphoma in Children: A Report of 12 Cases.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3300-3300
Author(s):  
Oussama Abla ◽  
John T. Sandlund ◽  
Susan Blaser ◽  
Penelope Brock ◽  
Rob Corbett ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Large Cell ◽  
The Other ◽  
High Dose ◽  
Radiation Toxicity ◽  
Congenital Immunodeficiency ◽  
Hodgkin's Lymphomas

Abstract We report the treatment and outcome of 12 children with primary central nervous system lymphoma (PCNSL) treated at 6 pediatric oncology centers from 1995 to 2003. The main purpose is to determine whether childhood PCNSL can be cured with chemotherapy alone without cranial radiation therapy (CRT). The clinical charts of 8 immunocompetent and 4 immunodeficient children with PCNSL were retrospectively reviewed. The children were diagnosed from 4 to 17 years of age. All cases were non-Hodgkin’s lymphomas: 7 (58.3%) were phenotypically B-cell (6 mature B, one B-precursor), 3 (25%) were T-cell and 2 (16.6%) were indeterminate-cell type. The histologic subtyping (REAL classification) showed 4 diffuse large cell, 4 anaplastic large cell, 2 immunoblastic large cell, 1 Burkitts and 1 high-grade lymphoma of uncertain lineage. Two patients were t(2;5) positive. Two patients had congenital immunodeficiency and 2 were HIV+. Immunologic work-up was either normal or not done in the remaining 8. EBV was positive in 2 patients, negative in 3 and not assessed in the rest. PCNSL presented as a single lesion in 4 patients and multifocal in 8. The most frequent tumor locations were frontal and parietal lobes. Nine of 12 children received chemotherapy alone, event free survival (EFS) at 4 years was 74±16%. Three had chemo plus CRT (3900–5000 cGy), EFS was 33±27% (P=0.1). The most frequently used drugs at the 6 centers were high dose (HD) MTX (5 to 8 g/m2), HD Ara-C (2 to 3 g/m2), dexamethasone, vincristine and cyclophosphamide. Three children died, 2 of whom were HIV+; 1 died after local relapse while the other died secondary to an opportunistic infection. Two other patients relapsed, one after chemotherapy alone and one after chemotherapy plus CRT. The patient who relapsed after chemotherapy alone is in second CR at 6+ months after chemotherapy, CRT and ABMT; the other patient died from progressive disease. Nine of 12 patients (75%) are alive at a median follow-up time of 72 months (range 18–105 months) in survivors. Six of the 8 children who are in CCR received chemotherapy alone, one received chemotherapy plus ABMT and one received chemotherapy plus CRT. Two of the long-term survivors (in CCR at 88+ and 105+ mo) had congenital immunodeficiency and were treated with chemotherapy alone. It appears that immunocompetent and immunodeficient children with PCNSL may be cured with chemotherapy alone without CRT, avoiding long-term radiation toxicity. Although retrospective, involving a small cohort, it is the largest pediatric series of PCNSL reported to date. Multicentre prospective studies are clearly needed in children with this rare lymphoma, whose frequency seems to be increasing especially in immunocompetent patients.

scholarly journals ML-08 Safety and efficacy of consolidation cytarabine for newly-diagnosed primary central nervous system lymphoma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii16-ii17
Author(s):  
Nobuyoshi Sasaki ◽  
Keiichi Kobayashi ◽  
Kuniaki Saito ◽  
Yuta Sasaki ◽  
Yuma Okamura ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Age Groups ◽  
Central Nervous System Lymphoma ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
High Dose ◽  
Consolidation Therapy ◽  
Safety And Efficacy ◽  
Dose Modification

Abstract Backgrounds: While consolidation therapies which incorporate whole brain radiotherapy (WBRT) and/ or chemotherapies such as high dose (HD)- cytarabine are commonly applied following induction chemotherapies in primary central nervous system lymphoma (PCNSL), the optimal treatment for consolidation therapy has not been established. We aimed to investigate the safety and efficacy of consolidation cytarabine with a dose modification policy in PCNSL. Patients and methods: PCNSL patients initially treated by R-MPV (rituximab, methotrexate, procarbazine and vincristine) and subsequently treated either by WBRT of 24Gy followed by cytarabine (WBRT-AraC group), or cytarabine alone (AraC group) were identified. WBRT was deferred in patients 71 years old or younger who had obtained a complete response (CR) after R-MPV. Cytarabine was dose-modified according to age groups (3 g/m2 in patients 70 years old or younger, 2 g/m2 in patients aged 71–75 years, 1 g/m2 in patients aged 76–80 years). Toxicity profiles, progression-free survival (PFS), overall survival (OS) were analyzed. Results: Twenty-five patients were identified (median age: 69 [range: 34–80], median KPS:70 [range: 40–90]), including 11 patients from the WBRT-AraC group, and 14 patients from the AraC group. Median PFS was unreached in the WBRT-AraC group, and 41.8 months in the AraC group. Median OS was unreached in both groups. The overall rate of grade 3/4 hematologic toxicities was high (92%), but mostly manageable without major complications. Fourteen patients received 3 g/m2, 4 patients received 2 g/m2, 7 patients received 1 g/m2 of cytarabine, and the rate of grade 4 leukopenia/ thrombocytopenia was 64%/57%, 25%/50%, and 29%/29%, respectively. Discussion: HD-cytarabine consolidation therapy with dose modification according to age groups for PCNSL was feasible and well-tolerated in patients 80 years of age or younger. The efficacy of HD-cytarabine was undetermined and further investigation is warranted.

scholarly journals HOUT-16. A RETROSPECTIVE ANALYSIS OF SURVIVAL OUTCOMES BASED ON CONSOLIDATION REGIMENS IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi115-vi115
Author(s):  
Savannah Gelhard ◽  
Amiee Maxwell ◽  
Adam Cohen ◽  
Joe Mendez
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Induction Therapy ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
Autologous Stem Cell Transplant ◽  
High Dose ◽  
Cell Transplant ◽  
Consolidation Therapy ◽  
Eligibility Criteria

Abstract BACKGROUND Currently, Primary Central Nervous System Lymphoma (PCNSL) is treated with induction therapy consisting of polychemotherapy followed by consolidation therapy. Besides the incorporation of high-dose methotrexate as the backbone of induction therapy, there is no accepted standard induction or consolidation regimen for patients with PCNSL in the US. In this study, we compared three consolidation techniques by analyzing overall survival (OS) and progression free survival (PFS) in patients treated for PCNSL. METHODS Patients treated for newly diagnosed PCNSL at Huntsman Cancer Institute after July 1, 2012 with induction followed by consolidation therapy were retrospectively reviewed. Patients who completed one of the following regimens were included: rituximab/methotrexate/vincristine/procarbazine (R-MVP), rituximab/methotrexate/temozolomide (R-MT), or rituximab/methotrexate (R-M) for induction followed by consolidation with etoposide/cytarabine (EA), high-dose cytarabine (HIDAC), or autologous stem cell transplant (ASCT). Patients were excluded if there was evidence of systemic lymphoma on PET/CT or if the patient received radiation as consolidation therapy. Survival was calculated from the date of diagnosis and last date of known survival. RESULTS Twenty-three patients met eligibility criteria and received the following four treatment regimens: R-MT+EA (12), R-MT+ASCT (4), R-M+ASCT (1), and R-MVP+HIDAC (6). The median age of diagnosis was 61. Patients receiving ASCT (5) had a trend towards a more favorable OS (p=0.0675) compared to the other two consolidation therapies with no recurrence or death in those patients treated with ASCT. When comparing non-transplanted patients, R-MVP-HIDAC had a trend towards better OS and PFS compared to R-MT-EA. CONCLUSION This small retrospective review provides evidence that ASCT may be a superior treatment consolidation strategy in patients with PCNSL compared to EA and HIDAC, and that R-MT-EA may be less successful in practice than in published trials. These findings suggest that consolidation with ASCT should be strongly considered in all patients with PCSNL despite which induction therapy was received.

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