Primary central nervous system lymphoma: The role of consolidation treatment after a complete response to high-dose methotrexate-based chemotherapy Journal Article

Authors: Ekenel, M.; Iwamoto, F. M.; Ben Porat, L. S.; Panageas, K. S.; Yahalom, J.; Deangelis, L. M.; Abrey, L. E.
Article Title: Primary central nervous system lymphoma: The role of consolidation treatment after a complete response to high-dose methotrexate-based chemotherapy
Abstract: BACKGROUND. The most effective treatment for a new diagnosis of primary central nervous system lymphoma is high-dose methotrexate (MTX)-based chemotherapy followed by whole-brain radiation therapy (WBRT). However, this combined modality treatment carries an increased risk of delayed neurotoxicity. For patients who achieve a complete response (CR) after induction that uses high-dose MTX-based chemotherapy, it is not clear if consolidation treatment is necessary. Therefore, a retrospective study was conducted to assess the impact of consolidation treatment after a CR to initial induction chemotherapy on disease control and survival. METHODS. The authors retrospectively analyzed 122 patients who achieved a CR after initial MTX-based chemotherapy. The benefit of consolidation WBRT, high-dose cytarabine (HDAC), or both on failure-free (FFS) and overall survival (OS) was assessed. RESULTS. With a median follow-up of 60 months, FFS was longer in patients who received WBRT plus HDAC as consolidation treatment (P = .03 by univariate analysis); there was no difference in OS observed among patients who received no consolidation treatment, HDAC alone, WBRT plus HDAC, or WBRT alone. Age and Karnofsky performance scale (KPS) were the only independent prognostic factors. Patients who received WBRT alone or in combination with HDAC had higher rates of neurotoxicity. CONCLUSIONS. Consolidation treatment with WBRT, HDAC, or both does not appear to improve survival in patients who achieved a CR with induction MTX-based therapy. Age, KPS, and risk of delayed neurotoxicity must be considered in the choice of consolidation regimens. © 2008 American Cancer Society.
Keywords: survival; adult; cancer chemotherapy; cancer survival; controlled study; human tissue; treatment response; aged; aged, 80 and over; middle aged; survival analysis; retrospective studies; major clinical study; overall survival; multimodality cancer therapy; cancer radiotherapy; combined modality therapy; primary central nervous system lymphoma; cytarabine; methotrexate; rituximab; neurotoxicity; follow up; antineoplastic agent; antineoplastic combined chemotherapy protocols; vincristine; retrospective study; procarbazine; central nervous system tumor; skull irradiation; cranial irradiation; central nervous system neoplasms; risk; nonhodgkin lymphoma; karnofsky performance status; evaluation; lymphoma, non-hodgkin; remission; remission induction; disease control; univariate analysis; non-hodgkin lymphoma; whole brain radiation therapy
Journal Title: Cancer
Volume: 113
Issue: 5
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2008-09-01
Start Page: 1025
End Page: 1031
Language: English
DOI: 10.1002/cncr.23670
PUBMED: 18618509
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 15" - "Export Date: 17 November 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Joachim Yahalom
    395 Yahalom
  2. Meltem Ekenel
    6 Ekenel
  3. Fabio M Iwamoto
    36 Iwamoto
  4. Lauren E Abrey
    272 Abrey
  5. Katherine S Panageas
    327 Panageas