Treatment for primary CNS lymphoma: The next step Journal Article

Authors: Abrey, L. E.; Yahalom, J.; Deangelis, L. M.
Article Title: Treatment for primary CNS lymphoma: The next step
Abstract: Purpose: The use of preradiotherapy (RT) methotrexate (MTX) has improved disease control and survival in patients with primary CNS lymphoma (PCNSL). The reported protocol was designed to optimize and enhance the chemotherapeutic component of treatment. Patients and Methods: Fifty-two patients were treated with five cycles of high-dose MTX 3.5 g/m2, procarbazine 100 mg/m2/d, and vincristine 1.4 mg/m2. Thirty patients received whole-brain RT (45 Gy). Twenty-two older patients deferred RT to diminish the risk of delayed neurotoxicity; these patients are compared with 12 older patients who completed the entire treatment regimen. Most patients (n = 35) received high-dose cytarabine after RT. Results: Objective response rate to the induction chemotherapy regimen was 90%; overall median survival is 60 months. Grade 3 or 4 myelosuppression was seen in 30 patients, primarily in association with cytarabine; grade 3 nephrotoxicity due to MTX was seen in two patients. Older patients had similar median survival with or without the addition of RT: 32 versus 33 months, respectively. However, late neurotoxicity was significantly more common in those older patients who received RT (P = .00004). Patients younger than 60 years who received the complete treatment regimen have not reached median disease-free or overall survival. Conclusion: Increasing the dose of MTX and adding procarbazine and vincristine improved disease control and overall survival in patients with newly diagnosed PCNSL. Younger patients in particular fared extremely well with this treatment regimen. In older patients, deferring whole-brain RT did not compromise overall survival but did reduce treatment-related toxicity. (C) 2000 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; aged; aged, 80 and over; middle aged; survival analysis; major clinical study; clinical trial; cancer combination chemotherapy; dose response; drug efficacy; drug safety; cancer radiotherapy; cytarabine; methotrexate; neurotoxicity; drug eruption; nephrotoxicity; bone marrow suppression; mucosa inflammation; antineoplastic combined chemotherapy protocols; vincristine; deep vein thrombosis; procarbazine; cranial irradiation; central nervous system neoplasms; lymphoma, b-cell; lymphoma, non-hodgkin; folinic acid; radiation injuries; sepsis; radiation hazard; brain lymphoma; nervous system diseases; lymphoma, large-cell; shunt infection; humans; human; male; female; priority journal; article; lymphoma, diffuse
Journal Title: Journal of Clinical Oncology
Volume: 18
Issue: 17
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2000-09-17
Start Page: 3144
End Page: 3150
Language: English
PUBMED: 10963643
PROVIDER: scopus
Notes: Export Date: 18 November 2015 -- Source: Scopus