Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: An intent-to-treat analysis Journal Article


Authors: Abrey, L. E.; Moskowitz, C. H.; Mason, W. P.; Crump, M.; Stewart, D.; Forsyth, P.; Paleologos, N.; Correa, D. D.; Anderson, N. D.; Caron, D.; Zelenetz, A.; Nimer, S. D.; Deangelis, L. M.
Article Title: Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: An intent-to-treat analysis
Abstract: Purpose: To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL). Patients and Methods: Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m2) and cytarabine (3 g/m 2 daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue. Results: The objective response rate to the induction-phase chemotherapy was 57%, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43%) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity. Conclusion: This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted. © 2003 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; clinical article; controlled study; treatment outcome; aged; middle aged; survival rate; clinical trial; drug tolerability; mortality; salvage therapy; drug efficacy; drug safety; multimodality cancer therapy; combined modality therapy; primary central nervous system lymphoma; cytarabine; methotrexate; drug megadose; neuroimaging; neurotoxicity; follow up; antineoplastic agent; prospective study; prospective studies; controlled clinical trial; phase 2 clinical trial; neoplasm recurrence, local; etoposide; antineoplastic combined chemotherapy protocols; combination chemotherapy; melphalan; autologous stem cell transplantation; hematopoietic stem cell transplantation; pathology; carmustine; central nervous system tumor; central nervous system neoplasms; nonhodgkin lymphoma; lymphoma, non-hodgkin; multicenter study; tumor recurrence; blood brain barrier; remission; remission induction; safety; transplantation, autologous; autotransplantation; humans; human; male; female; priority journal; article; beam regimen
Journal Title: Journal of Clinical Oncology
Volume: 21
Issue: 22
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2003-11-15
Start Page: 4151
End Page: 4156
Language: English
DOI: 10.1200/jco.2003.05.024
PUBMED: 14615443
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 12 September 2014 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Craig Moskowitz
    372 Moskowitz
  2. Denise D Correa
    65 Correa
  3. Andrew D Zelenetz
    550 Zelenetz
  4. Stephen D Nimer
    342 Nimer
  5. Lauren E Abrey
    272 Abrey