Improved prognosis of diffuse histiocytic and undifferentiated lymphoma by use of high dose methotrexate alternating with standard agents (M-BACOD).

1983 ◽  
Vol 1 (2) ◽  
pp. 91-98 ◽  
Author(s):  
A T Skarin ◽  
G P Canellos ◽  
D S Rosenthal ◽  
D C Case ◽  
J M MacIntyre ◽  
...  
Keyword(s):  
Remission Rate ◽  
New Combination ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Prior Therapy ◽  
Dose Methotrexate ◽  
The Central Nervous System ◽  
Disease Free ◽  
Free Rate

A new combination chemotherapy program (M-BACOD) was administered to 101 patients with advanced diffuse histiocytic and diffuse undifferentiated lymphoma (DHL and DUL). High dose methotrexate (M) 3 g/m2 with leucovorin factor rescue was given on day 14 between cycles of bleomycin (B), adriamycin (A), cyclophosphamide (C), oncovin (O), and dexamethasone (D) administered every 3 weeks for 10 cycles. The complete remission rate (CR) was 72% in all 101 patients or 77% in 95 evaluable patients. The median follow-up is 3 yr 2 mo with one-third of CR patients followed beyond 4 yr. Twenty-six percent of CR patients have relapsed with a projected 5-yr survival rate of 80% (5-yr disease-free rate 65%). The overall survival of all 101 study patients reaches a plateau at 59% projected out to 5 yr. Patients with prior therapy had a significantly lower CR rate than those without prior treatment (p = 0.001); however, no other unfavorable prognostic characteristics could be identified. Relapse in the central nervous system CNS occurred in only 5.4% of CR patients. M-BACOD results in prolonged survival and possible cure in a high proportion of all patients with DHL and DUL.

A controlled pilot study of high-dose methotrexate as postsurgical adjuvant treatment for primary osteosarcoma.

1984 ◽  
Vol 2 (3) ◽  
pp. 152-156 ◽  
Author(s):  
J H Edmonson ◽  
S J Green ◽  
J C Ivins ◽  
G S Gilchrist ◽  
E T Creagan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adjuvant Chemotherapy ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Term Survival ◽  
Dose Methotrexate ◽  
Primary Osteosarcoma ◽  
Chemotherapy Patients ◽  
One Year

Thirty-eight patients whose primary extremity or limb girdle osteosarcomas had been completely excised (37 amputations, one limb sparing procedure) were allocated at random to two treatment groups receiving respectively regular follow-up examinations plus a high-dose methotrexate (HDMTX) regimen or regular follow-up without primary adjuvant chemotherapy. Although the vincristine, HDMTX, leucovorin regimen was generally quite tolerable when given at three-week intervals for one year and most of the chemotherapy patients followed the planned HDMTX dose escalations from 3 to 6 to 7.5 g/m2, delayed methotrexate excretion limited dosage escalations in 25%. An estimated 52% of the 38 patients were surviving five years after randomization and an estimated 42% remained continuously relapse-free after five years. No significant differences between the outcomes of the 20 treated and the 18 untreated patients were apparent; however, power to detect differences was low. Furthermore, no significant differences in postmetastasis survival were apparent between the 12 treated and 10 untreated patients who relapsed. Approximately 20% of these failing patients appear to have been salvaged for long-term survival. This pilot study of HDMTX confirms the continuing need for controlled clinical trials in determining the therapeutic value of adjuvant chemotherapy programs for patients with primary osteosarcoma.

High-Dose Methotrexate, Ifosfamide, Etoposide and Dexamethasone (MIED) Is an Active Salvage Regimen for Children with Recurrent or Refractory Malignant Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3434-3434
Author(s):  
John T. Sandlund ◽  
Ching-Hon Pui ◽  
Yinmei Zhou ◽  
Eric J. Lowe ◽  
Sue C. Kaste ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Hodgkin Lymphoma ◽  
Large Cell ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Salvage Regimen ◽  
Hematopoietic Stem ◽  
Not Otherwise Specified ◽  
Dose Methotrexate ◽  
Disease Free

Abstract Significant advances have been made in the treatment of malignant lymphomas in children; however, approximately 20–30% will have refractory or recurrent disease. These patients are felt to have a relatively poor prognosis primarily because of the comprehensive and intensive nature of their frontline therapies; therefore, they are generally considered for a novel or more aggressive salvage regimen. The purpose of this study is to determine the activity and toxicity profile of the MIED regimen (high-dose methotrexate, ifosfamide, etoposide and dexamethasone) in children with refractory or recurrent non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). From 1991 to 2006, 62 children with refractory/recurrent NHL (n=24) and HL (n=38) were treated with 1 to 6 sequential cycles of MIED (methotrexate, 8 grams/m2 on day 1; ifosfamide, 2 grams/m2 on days 2–4; etoposide, 200 mg/m2 on days 2–4; and dexamethasone, 40 mg/m2 on days 1–4). Children with NHL also received intrathecal MHA (methotrexate, hydrocortisone, and cytarabine at age adjusted dosages) on day 1. Response evaluation was performed after 1 – 2 cycles of MIED. Children with either a PR or CR were considered for an intensification phase with hematopoietic stem cell transplantation (HSCT); patients with HL also received involved-field irradiation. Forty-six (75%) of the 61 evaluable children with refractory or recurrent lymphoma responded to MIED (CR, 23; PR, 23). Among the 24 children with NHL (large cell, 18 [anaplastic large cell, 8; diffuse large B-cell, 3; T-cell large cell, 2; large cell not otherwise specified, 5]; Burkitt, 3; lymphoblastic, 2; other, 1), responses included: CR (n=10), and PR (n=5) for a combined CR+PR rate of 63%. Among the 37 children with HL (nodular sclerosis, n = 29; mixed cellularity, n =4; lymphocyte predominant, n =1; and HL not otherwise specified, n=3) responses included: CR (n=13), and PR (n=18) for a combined CR+PR rate of 84% among 37 evaluable patients. MIED was generally well tolerated (associated with grade IV hematologic toxicity in most cases and frequently associated with mucositis and/or fever with neutropenia). Nineteen of 24 children with NHL and 31 of 37 children with HL received an intensification phase with HSCT support (autologous, 46; allogeneic, 4) at some point following MIED therapy. Nine of 24 children (38%) with NHL are alive and disease-free. Twenty-eight of 37 children (76%) with HL are currently alive (24 disease-free post HSCT). MIED is an active and generally well tolerated regimen for children with refractory or recurrent malignant lymphoma.

Rituximab Plus Hypercvad Alternating with High Dose Methotrexate and Cytarabine for Patients with Newly Diagnosed Mantle Cell Lymphoma. A Multicenter Trial from GISL

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3050-3050 ◽  
Author(s):  
Francesco Merli ◽  
Stefano Luminari ◽  
Fiorella Ilariucci ◽  
Caterina Stelitano ◽  
Mario Petrini ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Hematological Toxicity ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Dose Methotrexate ◽  
Mantle Cell

Abstract BACKGROUND. Rituximab plus HyperCVAD alternating with High Dose Methotrexate and Cytarabine (R-HCVAD) has been tested in patients with newly diagnosed Mantle Cell Lymphoma (MCL) with promising results (Romaguera et al. JCO 2005). In 2005 the Gruppo Italiano Studio Linfomi (GISL) started a phase II multicenter study investigating clinical activity and toxicity of R-HCVAD in a similar group of patients. PATIENTS AND METHODS. To be included in the trial patients must have histologically confirmed diagnosis of MCL, be younger than 70 years, have adequate organ function. Chemotherapy consisted of rituximab plus fractionated cyclophosphamide, vincristine, doxorubicine, and dexamethasone(considered one cycle) alternating every 21 days with rituximab plus high dose methotrexate-cytarabine (considered one cycle) for a total of eight cycles per the MD Anderson protocol. Patients with baseline PCR positivity for t(11;14) on bone marrow (BM) had to perform PCR assessment of BM at evaluation of response and during follow-up. Only patients achieving partial response (PR) were to be addressed to HDC followed by ASCT. RESULTS. Thirty-two patients were enrolled. There were 23 males and 9 females; median age was 54 yrs (29 to 66), 80% were in stage IV, 50% and 71% had Gastrointestinal (GI) and BM involvement, respectively; PCR for t(11;14) was positive on BM in 51% of cases. Seven patients did not complete treatment due to toxicity; of these, two patients died (one with septic shock at cycle 1, one with pulmonary aspergillosis at cycle 4), one patient had thrombosis of central line extended to right atrium at cycle 1, one had grade IV skin reaction at cycle 3, one had a severe pneumonia at cycle 1, two had persistent grade IV hematological toxicity after cycle 1 and 5, respectively. All patients had grade III–IV hematological toxicity. Response was assessed in 17 patients with 16 CR and 1 PR. PCR for t(11;14) negativity on BM was achieved in 4/9 patients after cycle 4 and in 8/9 after cycle 8. After a median follow-up of 24 months 1 patient progressed at 6 months and 1 patient relapsed after 26 months of follow-up. Two-year Failure Free Survival (FFS) was 75% (IC95% 53 to 87) and 2 year Disease Free Survival was 93%(IC95% 59–99). CONCLUSIONS. Though longer follow-up is needed R-HCVAD regimen used in our multicenter setting confirmed high efficacy in terms of response (both clinical and molecular) and FFS. However the regimen was associated to a severe toxicity profile that caused treatment discontinuation in several patients and that may limit its use in the clinical setting.

Rituximab with High Dose Methotrexate in the Management of Primary Central Nervous System Diffuse Large B-Cell Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3090-3090 ◽  
Author(s):  
Roopesh R. Kansara ◽  
Tamara Shenkier ◽  
Joseph M Connors ◽  
Alina S. Gerrie ◽  
Richard Klasa ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Initial Treatment ◽  
Response Rates ◽  
High Dose ◽  
Time Interval ◽  
High Dose Methotrexate ◽  
Dose Methotrexate

Abstract Introduction: Outcomes of patient with primary central nervous system lymphoma (PCNSL) remain poor despite high-dose methotrexate (HDMTX)-based chemotherapy regimens. The addition of rituximab (R) to chemotherapy improves response rates and outcomes in patients with systemic B-cell non-Hodgkin lymphomas. However, R does not penetrate the blood-brain barrier, and therefore its impact in patients with PCNSL is unknown. With disappointing outcomes, in 2006, we routinely started adding R to HDMTX for the treatment of PCNSL. Herein, we evaluated the outcome of patients receiving HDMTX with or without R. Methods: Patients diagnosed with PCNSL (DLBCL histology only) between January 2000 and December 2013, and who were treated with at least one cycle of HDMTX, were identified in the Lymphoid Cancer Database. Since January 2000, patients with PCNSL in British Columbia have been treated with HDMTX 8 g/m2 every 2 weeks, pro-rated for creatinine clearance. Responding patients received a maximum of 10 cycles. Beginning in December 2006, rituximab 375 mg/m2 is given every 2 weeks with HDMTX for a total of 4 doses. Progression free survival (PFS) was defined as the time interval from date of diagnosis to first evidence of progression/relapse, death or last follow-up. Overall survival (OS) was defined as the time interval from date of diagnosis to death or last follow-up. Results: A total of 82 patients were identified. Median age at diagnosis was 61years (range 18-80), 42 (51%) were >60 years old, 48 (59%) were male, 18 (23%) had elevated LDH and 50 (61%) had performance status > 1. Median largest mass size was 4cm (range 1-9). Concurrent ocular (7 patients), leptomeningeal (3 patients), and spinal cord (1 patient) involvements were seen. For treatment, 55 (67%) received HDMTX and 27 (33%) received HDMTX+R. Patients received a median of 4 (range 1-9) HDMTX cycles, with no difference between R versus no R groups. Ten (12%) patients (6 HDMTX, 4 HDMTX+R) received whole brain radiotherapy (RT), as part of initial treatment due to chemo-intolerance. In 79 patients evaluable for response, the overall response rate to initial treatment was 55%: CR 40%, PR 15%, SD 5%, and PD 41%. There were no significant differences in the baseline characteristics or response rates between the two groups. A total of 14/32 patients (44%) relapsed after CR (all in the brain, including 1 to the contralateral eye) and 8/12 (67%) relapsed after PR (7 in brain, 1 to bilateral eyes). At 1st relapse/progression (N = 56), 39 (69%) patients received RT, 4 received repeat courses of HDMTX, 2 received high dose chemotherapy/autologous stem cell transplantation (ASCT) and 1 received temozolamide + R. 10 patients were managed supportively. Four patients had a systemic relapse without involvement of the CNS (1 Breast, 1 testis, 1 axilla and 1 scalp). They received R-CHOP (3), CHOP then R-GDP and ASCT (1). After a median follow-up of 5 years (range 0.1 to 12.7) in living patients, the 5-year OS was 38% (SE 6%), with no difference between patients treated with or without R (HR 0.81, 95% CI 0.40, 1.63; p= 0.55). The 5-year PFS was 20% (SE 5%), again with no difference between the two groups (HR 0.84, 95% CI 0.47, 1.48; p= 0.54). In the subset of 50 patients receiving > 4 cycles of chemotherapy (34 HDMTX, 16 HDMTX+R), the addition of rituximab did not impact PFS (p= 0.36) or OS (p= 0.08). In the subset of 72 patients who did not receive WBRT as part of initial therapy (49 HDMTX, 23 HDMTX + R), the addition of rituximab did not impact PFS (p= 0.48) or OS (p= 0.47). Conclusions: Our preliminary data shows no advantage to the addition of systemic R on the outcomes of PCNSL, consistent with its known poor CNS penetrance. Improved treatment modalities for PCNSL are still warranted. Disclosures Shenkier: F Hoffmann-La Roche: Other. Connors:F Hoffmann-La Roche: Other. Gerrie:F Hoffmann-La Roche: Other. Klasa:F Hoffmann-La Roche: Other. Savage:F Hoffmann-La Roche: Other. Sehn:F Hoffmann-La Roche: Other. Villa:F Hoffmann-La Roche: Other.

scholarly journals Alternative Consolidation Strategy after High Dose Methotrexate, Rituximab and Temozolamide in Primary CNS Lymphoma - the Henry Ford Experience

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 5-5
Author(s):  
Joyce Philip ◽  
Shivani Sharma ◽  
Vijayalakshmi Donthireddy
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Primary Cns Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
Cns Lymphoma ◽  
High Dose ◽  
Cell Transplant ◽  
High Dose Methotrexate ◽  
Dose Methotrexate

Background: Treatment for primary CNS lymphoma involves a methotrexate-based induction therapy followed by consolidation. The optimal consolidation treatment after induction with a high dose Methotrexate (HD-MTX), Rituximab and Temozolomide regimen has not been fully established. The CALGB 50202 regimen using Etoposide and Cytarabine consolidation was associated with significant toxicity. We sought to review the results of alternative consolidation regimens and evaluate the progression free survival and overall survival. Methods: A retrospective cohort study was conducted to evaluate the efficacy of alternative consolidation regimens such as autologous stem cell transplant and HDMTx alone. Patients diagnosed with primary CNS lymphoma between November 2012 and March 2019 were identified. All patients received the same induction chemotherapy based on the CALGB 50202 protocol. Data was collected for baseline characteristics, progression free survival and overall survival. Results: 38 patients had a diagnosis of primary CNS lymphoma. 15 patients received treatment as per the CALBG 50202 induction protocol with high dose Methotrexate, Rituximab and Temozolomide. Of the 15 patients, 11 patients (69%) achieved a complete remission (CR) after induction therapy. 7 patients received an autologous stem cell transplant for consolidation, 5 patients received HD-MTX alone for consolidation and one patient was placed on Lenalidomide maintenance. 2 patients did not receive any consolidation therapy due to progressive disease and/or death. At a median follow up of 2.7 years for the entire cohort, median PFS was 31.7+ months and median OS was 32.5+ months. At a median follow up of 2.7 years for patients who were consolidated with an autologous stem cell transplant, median PFS and median OS was 27.2+ and 32.5+ months respectively. At a median follow up of 5.5 years for patients who were consolidated with treatments other than transplant, median PFS and OS was 65.6+ months. There were no deaths attributed to treatment related toxicity. To date, 4 patients of the entire cohort have died, with a median survival time among surviving patients of 3.6 years (range, 0.68-7.05 years). There were no deaths attributed to treatment related toxicity. Conclusion: Patients with primary CNS lymphoma who received induction therapy as per CALGB 50202 regimen and received alternative consolidation therapies with either autologous stem cell transplant or HD-MTX based consolidation achieved prolonged PFS and OS comparable if not superior to the Etoposide and Cytarabine consolidation. Results of the ongoing CALGB 51101 trial will determine the utility of EA consolidation. Disclosures No relevant conflicts of interest to declare.

Effectiveness of intravenous high-dose methotrexate for prevention of relapse in patients with DLBCL.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19562-e19562
Author(s):  
Hind Alotaibi ◽  
Ibraheem Motabi ◽  
Ahmad Butt ◽  
Nawal AlShehry ◽  
Mohammed Marei ◽  
...  
Keyword(s):  
High Risk ◽  
B Cell Lymphoma ◽  
Treatment Evaluation ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Data Set ◽  
Dose Methotrexate ◽  
Cns Relapse ◽  
End Of Treatment

e19562 Background: Central nervous system (CNS) relapse develops in 2-10% of patients with diffuse large B cell lymphoma (DLBCL) and has an adverse prognosis. Tools like IPI and CNS-IPI scores identify patients at high risk of systemic or CNS relapse based on the presence of established risk factors ( Schmitz et al. JCO 2016). International guidelines propose prophylactic intravenous high-dose methotrexate (HD-MTX) for patients at high risk of CNS relapse; however, limited data is backing this approach. Methods: We conducted a retrospective review of newly diagnosed DLBCL patients aged 18-75 years treated with curative intent at large academic medical centers in Riyadh, Saudi Arabia, between 2015-2018. Patients who were planned for CNS HD-MTX after cycles 2, 4, and 6 of R-CHOP and received at least one HD-MTX cycle were included. Results: We identified 35 DLBCL patients who received at least one R-CHOP cycle with one cycle of HD-MTX. The median IPI and CNS-IPI score were 3, (range = 0-4) and 3, (range = 0-5), respectively. The median number of R-CHOP cycles received was 6 (range 3-6) and HD-MTX 3 (range 1-6). The overall response rate was 91%, with 3 (9%) primary refractory patients per interim evaluation on cycle 3 of R-CHOP. Achieving complete remission after six cycles of RCHOP was noted in 80%, with four additional patients showed residual disease at the end of treatment evaluation. The entire cohort's overall survival was not reached, and five years estimated survival is 75%. With a median follow-up duration of 37.3 months, none of the patients relapsed after achieving CR at the end of treatment evaluation. The risk of systemic or CNS relapse in our cohort was 0%. In restricting the analysis to CNS-IPI of ≥ 4, a total of 13 patients with a median follow-up of 42 months were included; four patients did not achieve CR by the end of treatment, while nine patients continue to be in CR without any evidence of relapsed disease. Conclusions: High-dose methotrexate with high-intensity chemoimmunotherapy (R-CHOP) seems to be associated with an improvement in the expected rate of CNS relapse. Our data set is small, and a more extensive study evaluating HD-MTX's effectiveness in high-risk DLBCL is warranted.[Table: see text]

Treatment of Primary CNS Lymphoma in the Elderly with High-Dose Methotrexate Containing Chemotherapy Followed Radiotherapy or Chemotherapy Alone Plus Deferred Radiotherapy: Evaluation of Modification of Treatment Modalities in Leon Berard Cancer Center.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2702-2702
Author(s):  
Hervé Ghesquières ◽  
Agathe Bajard ◽  
Gilles Albrand ◽  
Khaoula Alaoui-Slimani ◽  
Philippe Rey ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Visual Inspection ◽  
Primary Cns Lymphoma ◽  
Cns Lymphoma ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Time Periods ◽  
Over Time

Abstract Abstract 2702 Poster Board II-678 Background: Treatment of Primary CNS lymphoma (PCNSL) is based on high-dose methotrexate (HD-MTX) and cytarabine containing chemotherapy (CT) followed by brain radiotherapy (RT). However, the risk of leukoencephalopathy (LE) is important after chemoradiotherapy, especially for patients older than 60 years old. To reduce neurotoxicity in clinical practice, RT is restricted at relapse or for not responding patients after CT, but no formal randomized trial had evaluated this two modalities of treatment. The objective of this study is to evaluate this modification of clinical practice in our institution over time. Methods: 74 patients older than 60, median age 68 years old (range, 60–81) were treated in our institution between 1986 and 2008. Before 2003, 51 patients were treated with HD-MTX CT followed by RT. Most patients (59%) were treated with HD-MTX + CHOP-like with intermediate dose of MTX (1.5g/m2) and only 25% received 3g/m2 of MTX per course. Evaluation of this schedule in the prospective phase II GELA trial LNHCP93 showed excessive rate of toxic death during CT. Since 2004, 23 patients were treated with expected less toxic protocol and increased dose of MTX (3g/m2, 83% of patients), and RT was omitted for patients in complete response (CR) in order to limit risk of LE. Acute toxicity, initial response, risk of relapse, overall survival (OS) and risk of neurotoxicity were compared between these two periods. As acute treatment toxicity had a powerful impact for these categories of patients especially for patients treated in first period, we access if hazard ratio (HR) was constant over time by determining Schoenfeld residuals. A piecewise Cox proportional model was used in defining time periods after visual inspection of Schoenfeld residuals. Strategy (CT+RT vs.CT only) was tested during each time period in order to detect a difference on survival. Results: Comparison of clinical characteristics showed that patients in second period were slightly older (71 vs. 67, p=0.008) but Performance Status, LDH level, rate of involvement of deep structures of brain, CSF protein level, leptomeningeal involvement were not different between the 2 cohorts. Toxic death rate during treatment was significantly more important in first period (31% vs. 9% p=0.04). CR after CT was significantly better for patients treated after 2003 (33% vs. 48% p=0.01), but was similar at the end of treatment, CT + RT (49%) vs. CT strategy (48%). The follow-up of cohort 1 and 2 was 95 and 27 months, respectively. Median OS was 16.1 and 18.1 months (p=0.8) and progression free survival (PFS) was 9.7 and 5.1 months (p=0.24) between the 2 cohorts, respectively. With CT + RT strategy, 10 patients did not relapse after first line therapy and eleven were alive at last follow-up. With CT strategy four patients were in persistent CR at 13.5, 14.9, 20.3, 21.5 months, respectively. Among patients in partial response (1 pt), progressive disease (9 pts) or in relapse after CR (7 pts) after CT strategy, 4 died after supportive care, 3 patients were treated with CT alone but died rapidly, and 10 had RT alone (4 pts) or after CT (6 pts). Among patients who received deferred RT, 4 were alive at last follow-up. Regarding neurotoxicity, in first cohort, 7 patients (14%) presented treatment-related neurologic toxicity with 4 deaths of LE. Among patients treated with CT strategy, 2 patients died of LE but received deferred RT at relapse and 2 patients presented severe LE after CT alone and deferred RT, respectively (17% of treatment-related neurologic toxicity). The piecewise Cox proportional model could define two time periods after visual inspection of Schoenfeld residuals, before and after 3 months. We observed that CT + RT strategy presented after the first 3 months a better PFS than CT alone strategy (HR 2.71 [1.29–5.73] p=0.009) but OS was not significant with this method. The cumulative risk of LE in the 2 cohorts was not significantly different (p=0.95) Conclusion: This institutional study of modification of treatment practice for elderly patients with PCNSL showed that i) MTX + CHOP like CT had an excessive acute toxicity without any benefit in term of CR rates over others schedules with 3g/m2 of MTX per course ii) OS of patients was in accordance to recent series with the similar median age iii) 59% of patients treated with CT strategy received finally deferred RT iv) a time varying effect was observed for PFS with after treatment period a benefit for CT + RT. An effort to conduct a randomized trial testing CT alone + deferred RT versus CT + RT for patients with PCNSL remained necessary. Disclosures: No relevant conflicts of interest to declare.

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