1. Impact of contemporary regimens on the outcomes and toxicity of primary CNS lymphoma: a single-center retrospective analysis of 73 patients.
- Author
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Sarid N, Bokstein F, Blumenthal DT, Weiss-Meilik A, Gibstein L, Avivi I, Perry C, and Ram R
- Subjects
- Adult, Aged, Aged, 80 and over, Central Nervous System Neoplasms pathology, Cytarabine administration & dosage, Female, Follow-Up Studies, Humans, Lymphoma pathology, Male, Methotrexate administration & dosage, Middle Aged, Neoplasm Recurrence, Local pathology, Prognosis, Retrospective Studies, Rituximab administration & dosage, Survival Rate, Venous Thromboembolism chemically induced, Antineoplastic Combined Chemotherapy Protocols adverse effects, Central Nervous System Neoplasms drug therapy, Lymphoma drug therapy, Neoplasm Recurrence, Local drug therapy, Venous Thromboembolism pathology
- Abstract
Introduction: Primary central nervous system lymphoma (PCNSL) is a rare disease with a dismal prognosis compared to its systemic large B-cell lymphoma counterpart. Real world data are limited, when considering a uniform backbone treatment., Methods: A retrospective study of all adult patients treated sequentially with a high-dose methotrexate (HD MTX)-based regimen in a single tertiary medical center between 2003 and 2019., Results: The 2015-2019 period differed from its predecessor in that most patients were treated with an HD MTX-based polychemotherapy regimen as opposed to HD MTX monotherapy (81% vs. 13%, P < .001), rituximab was given as standard of care (100% vs. 56%, P < .01), and most induction-responsive patients received consolidation treatment (70% vs. 18%, P = .01). The median progression-free and overall survival (OS) for the entire cohort (n = 73, mean age 64 years) was 9.9 and 29.8 months, respectively. Patients diagnosed between 2015 and 2019 had superior OS (P = .03) compared to those treated earlier. An interim partial response (PR) state, documented after two cycles of chemotherapy, was associated with increased incidence of progression, with only 33% of those patients achieving end-of-induction complete response. Twenty-three percent of patients developed thrombotic events and 44% developed grade 3-4 infections. HD MTX-based polychemotherapy induction was associated with both increase in thrombotic and infection incidence., Conclusions: Contemporary HD MTX-based combination therapies suggestively improved the outcomes for PCNSL, but at a cost of increased incidence of toxicity. Patients who achieve an interim PR status are at a high risk for treatment failure.
- Published
- 2021
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