Abstract
Purpose: Primary central nervous system lymphoma (PCNSL) is an aggressive disease with many tools for management that may be subject to resource barriers. This study compares the treatment patterns and survival outcomes among PCNSL patients treated at a safety-net hospital versus a tertiary academic institution.Methods:We retrospectively reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed.Results:Compared to the tertiary academic center, patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher proportion of presenting patients with HIV. The safety-net hospital cohort was significantly less likely to receive induction chemotherapy (67% vs 86%, p = 0.003) than those at the academic center. Safety-net hospital patients were significantly less likely to receive autologous stem cell transplant (ASCT) consolidation (0% vs. 44%, p = 0.001) and had higher rates of consolidative WBRT (35% vs 15%, p = 0.001). Younger age and receiving consolidation were associated with improved progression-free survival (PFS, p = 0.001) and overall survival (OS, p = 0.001). Hospital location had no statistical effect on PFS (p = 0.725) or OS (p = 0.226) on age-adjusted analysis. Conclusions:Our study showed significant treatment differences between a public safety-net hospital and an academic cancer center reflecting access disparities. Despite variable treatment patterns, survival outcomes were not different. Further research is needed to determine optimal treatments for an orphan disease like PCNSL and it will be essential to advocate for equitable access in resource-limited settings.
Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma – feasibility of MTX‐based regimens in clinical routine
