Retrospective Study in Primary Central Nervous System Lymphoma: The Impact of Treatment Strategies of the Last 20 Years

Abstract Background Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. Methods A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. Results A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7–6.4). Conclusions Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.

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Primary Central Nervous System Lymphoma in Elderly Patients: Management and Perspectives

Cancers ◽

10.3390/cancers13143479 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3479

Author(s):

Andrea Morales-Martinez ◽

Fernando Lozano-Sanchez ◽

Alberto Duran-Peña ◽

Khe Hoang-Xuan ◽

Caroline Houillier

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Elderly Patients ◽

Treatment Strategies ◽

Central Nervous System Lymphoma ◽

High Dose Chemotherapy ◽

Current Treatment ◽

Cns Lymphoma ◽

High Dose ◽

Consolidation Phase

The management of elderly patients suffering from primary central nervous system (CNS) lymphoma, who represent a rapidly growing population, is challenging. Despite the advances made in PCNSL treatment, the prognosis in older patients remains unsatisfactory. The high risk of systemic and CNS toxicity induced by a high-dose chemotherapy regimen and radiation therapy, respectively, limits the use of consolidation phase treatments in elderly patients and contributes to the poor outcome of these patients. Here, we review the current treatment strategies and ongoing trials proposed for elderly PCNSL patients.

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

Neuro-Oncology ◽

10.1093/neuonc/noaa215.504 ◽

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.

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Risk Factors for Early Mortality in Patients with Primary Central Nervous System Lymphoma: A Large-Cohort Retrospective Study

World Neurosurgery ◽

10.1016/j.wneu.2020.03.150 ◽

2020 ◽

Vol 138 ◽

pp. e905-e912

Author(s):

Xingwang Zhou ◽

Xiaodong Niu ◽

Junhong Li ◽

Shuxin Zhang ◽

Wanchun Yang ◽

...

Keyword(s):

Risk Factors ◽

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Central Nervous System Lymphoma ◽

Early Mortality ◽

Large Cohort

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PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMAS

Romanian Journal of Neurology ◽

10.37897/rjn.2015.2.3 ◽

2015 ◽

Vol 14 (2) ◽

pp. 77-84

Author(s):

Adriana Octaviana Dulamea ◽

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Treatment Strategies ◽

Central Nervous System Lymphoma ◽

B Cell Lymphoma ◽

Diagnostic Methods ◽

Hematopoietic Stem ◽

Whole Brain Radiation ◽

Author Review ◽

Immunocompetent Patients

Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin B-cell lymphoma with characteristic clinical behavior, biological features and poor prognosis despite complex treatment. PCNSL has a median survival of 17 to 45 months in immunocompetent patients, and only 20-30% of cases can be cured successfully. Clinical outcome has improved since the advances in combination chemotherapy protocols, addition of whole brain radiation therapy, encouraging responses of rituximab administration in refractory PCNSL and autologous hematopoietic stem-cell transplantation as consolidative therapy. The author review the recent data on pathogenesis, diagnostic methods and treatment strategies of PCNSL in immunocompetent patients.

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Characteristics and Outcomes of Primary Central Nervous System Lymphoma: A Retrospective Study of 91 Cases in a Chinese Population

World Neurosurgery ◽

10.1016/j.wneu.2018.10.034 ◽

2019 ◽

Vol 123 ◽

pp. e15-e24

Author(s):

Chengliang Mao ◽

Feili Chen ◽

Yanwen Li ◽

Xinmiao Jiang ◽

Sichu Liu ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Chinese Population ◽

Central Nervous System Lymphoma

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P14.64 Primary Central Nervous System Lymphoma (PCNSL) with HD- MTX based chemotherapy: tolerability and results

Neuro-Oncology ◽

10.1093/neuonc/noz126.299 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii82-iii82

Author(s):

A Silvani ◽

E Anghileri ◽

G Simonetti ◽

M Eoli ◽

G Finocchiaro ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Adverse Events ◽

Treatment Strategies ◽

Central Nervous System Lymphoma ◽

Response Assessment ◽

Collaborative Group ◽

Combination Regimen ◽

Group Response ◽

Radiological Data

Abstract BACKGROUND Primary Central nervous system (CNS) lymphomas (PCNSL) are extranodal, malignant non- Hodgkin lymphomas of the diff use large B-cell type, confined to CNS. It accounts for up to 1% of all lymphomas and about 3% of all CNS tumours. The incidence continues to rise in immuno- competent elderly patients.Although the prognosis of PCNSL remains poor, it has improved in the past two decades as a result of better treatment strategies. However, treatment recommendations still result mainly from retrospective series or single-arm phase 2 studies and a few three completed randomised trials. We described a series of patients with newly diagnosis of PCNSL treated with modified-schedula published by Omuro MATERIAL AND METHODS Patients was treated with HD-MTX, procarbazine, vincristine, received four 28-day cycles of chemotherapy, on schedule: HD-MTX (3·5 g/m²) days 1 and 15; Procarbazine (100 mg/m²) on days 1–7. Vincristine (1·4 mg/m²) on days 1 and 15. Toxicity was assessed with Common Terminology Criteria for Adverse Events version 4. The International PCNSL Collaborative Group Response Criteria were used for response assessment. Endpoints include overall survival (OS) and adverse events (AE). RESULTS 21 immunocompetent patients (12 females and 9 males) were retrospectively studied, among 2014 to 2019. Median age at diagnosis 61 years (range 41–76). Median KPS at diagnosis was 70 (range 40–100). Clinical and radiological data and treatment related toxicity were described CONCLUSION Present combination regimen is effective; however, AE incidence is high, and often induces schedule modification

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