Increasing age at diagnosis and worsening renal function in patients with primary central nervous system lymphoma

Abstract

High-dose Methotrexate (MTX) is the most useful cytotoxic drug used in the treatment of primary central nervous system lymphoma (PCNSL). Dose reduction should be made in patients with reduced renal function. We evaluated the age of patients over a period of 22 years and estimated their glomerular filtration rate. One hundred and two patients were treated in Nottingham University Hospitals (a regional centre for neurosurgery) during the period 1986-2008. Patients were treated either with the BVAM regimen (carmustine, vincristine, cytarabine, MTX) or with CHOD (cyclophosphamide, doxorubicin, vincristine and dexamethasone) given for one cycle prior to BVAM. The age at which patients were diagnosed with PCNSL increased during the period of the study. During the first half of the study period (1986-1997) the median age was 60.5 years, compared to a median age of 65 years during the second half of the study period (1998-2008) (P = 0.001). The estimated glomerular filtration rate decreased with age over 40 years in a similar way to the general population. The increasing age of patients with PCNSL and decreasing renal function limit the intensity of chemotherapy with MTX containing regimens.

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

“…The median age of our patients was 50 years, which is about a decade younger than that reported in Western literature (Bataille et al, 2000;Bessell et al, 2011). An earlier multi-centric hospital based study from India had also showed that PCNSL occurs a decade earlier in Indian patients and is only very rarely associated with AIDS (Sarkar et al, 2005).…”

Primary CNS Lymphoma

“…With the median age at diagnosis of PCNSL rising above 63 years [83, 84] and over 20 % patients older than 80 years [85], establishing optimal treatment in older patients is of paramount importance. The true incidence may be underestimated if there is reluctance to biopsy cerebral lesions in this age group, as the possible treatment options are considered to be limited.…”

“…Symptoms can be misinterpreted in older patients resulting in significant treatment delays [86]. Altered metabolism of cytotoxic drugs [38] and impaired organ function [83] present additional therapeutic challenges.…”

Successful change of treatment strategy in elderly patients with primary central nervous system lymphoma by de-escalating induction and introducing temozolomide maintenance: results from a phase II study by The Nordic Lymphoma Group

“…1,2 Median age at diagnosis has increased from 60.5 to 65 years during the last 20 years. 3 In 2002, the Nordic Lymphoma Group published a phase ll trial investigating whether an age-adjusted regimen consisting of chemotherapy alone could induce durable remissions in PCNSL patients. 4 The responses achieved were of short duration.…”