Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome Journal Article


Authors: Morris, P. G.; Correa, D. D.; Yahalom, J.; Raizer, J. J.; Schiff, D.; Grant, B.; Grimm, S.; Lai, R. K.; Reiner, A. S.; Panageas, K.; Karimi, S.; Curry, R.; Shah, G.; Abrey, L. E.; Deangelis, L. M.; Omuro, A.
Article Title: Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome
Abstract: A multicenter phase II study was conducted to assess the efficacy of rituximab, methotrexate, procarbazine, and vincristine (R-MPV) followed by consolidation reduced-dose whole-brain radiotherapy (rdWBRT) and cytarabine in primary CNS lymphoma. Patients received induction chemotherapy with R-MPV (five to seven cycles); those achieving a complete response (CR) received rdWBRT (23.4 Gy), and otherwise, standard WBRT was offered (45 Gy). Consolidation cytarabine was given after the radiotherapy. The primary end point was 2-year progression-free survival (PFS) in patients receiving rdWBRT. Exploratory end points included prospective neuropsychological evaluation, analysis of magnetic resonance imaging (MRI) white matter changes using the Fazekas scale, and evaluation of the apparent diffusion coefficient (ADC) as a prognostic factor. Fifty-two patients were enrolled, with median age of 60 years (range, 30 to 79 years) and median Karnofsky performance score of 70 (range, 50 to 100). Thirty-one patients (60%) achieved a CR after R-MPV and received rdWBRT. The 2-year PFS for this group was 77%; median PFS was 7.7 years. Median overall survival (OS) was not reached (median follow-up for survivors, 5.9 years); 3-year OS was 87%. The overall (N = 52) median PFS was 3.3 years, and median OS was 6.6 years. Cognitive assessment showed improvement in executive function (P < .01) and verbal memory (P < .05) after chemotherapy, and follow-up scores remained relatively stable across the various domains (n = 12). All examined MRIs (n = 28) displayed a Fazekas score of ≤ 3, and no patient developed scores of 4 to 5; differences in ADC values did not predict response (P = .15), PFS (P = .27), or OS (P = .33). R-MPV combined with consolidation rdWBRT and cytarabine is associated with high response rates, long-term disease control, and minimal neurotoxicity.
Keywords: adult; treatment outcome; aged; disease-free survival; middle aged; mortality; disease free survival; cytarabine; methotrexate; rituximab; methodology; antineoplastic agent; phase 2 clinical trial; antineoplastic combined chemotherapy protocols; vincristine; procarbazine; central nervous system tumor; skull irradiation; time; cranial irradiation; central nervous system neoplasms; monoclonal antibody; multicenter study; lymphoma; chemoradiotherapy; antibodies, monoclonal, murine-derived; humans; human; male; female; article
Journal Title: Journal of Clinical Oncology
Volume: 31
Issue: 31
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2013-11-01
Start Page: 3971
End Page: 3979
Language: English
PUBMED: 24101038
PROVIDER: scopus
DOI: 10.1200/jco.2013.50.4910
PMCID: PMC5569679
DOI/URL:
Notes: Export Date: 3 February 2014 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Anne S Reiner
    120 Reiner
  2. Patrick Glyn Morris
    107 Morris
  3. Joachim Yahalom
    398 Yahalom
  4. Denise D Correa
    65 Correa
  5. Gaurav D Shah
    12 Shah
  6. Antonio Marcilio Padula Omuro
    176 Omuro
  7. Sasan Karimi
    97 Karimi
  8. Lauren E Abrey
    272 Abrey
  9. Katherine S Panageas
    327 Panageas
  10. Richard Charles Curry
    4 Curry