Long-term survival in primary CNS lymphoma treated by high-dose methotrexate monochemotherapy: role of STAT6 activation as prognostic determinant

Abstract

We report a single-center experience of 16 immunocompetent patients diagnosed with primary central nervous system lymphoma and treated with monochemotherapy with high-dose methotrexate (MTX) and deferred radiotherapy. MTX was given at a dose of 8.0 g/m2 for induction and at a dose of 3.5-8.0 g/m2 for maintenance. There were eight complete responses (CR), one partial response, one stable disease, and six patients whose tumors progressed in spite of the chemotherapy. At final follow-up, five of five CRs were alive and well without radiotherapy, with median follow-up of 26 months. Overall survival in eight non-CRs treated with the subsequent radiotherapy was 36 months. In the immunohistochemical study, STAT6 was positively expressed in 8 out of 13 cases. They included all non-CRs and two CRs. This observation suggests that STAT6 expression can be used as a prognostic determinant for MTX chemotherapy.

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

“…14 These studies have shown improvement in response rates as compared to HD-MTX alone regimens. 6,[14][15][16] The present study provides additional evidence of this benefit.…”

Feasibility of BU, CY and etoposide (BUCYE), and auto-SCT in patients with newly diagnosed primary CNS lymphoma: a single-center experience

“…Moreover, another factor that should be considered is that the patients included in this investigation were largely young patients with good performance status. A 50% CR rate with HD-MTX chemotherapy has been reported in a Korean study of PCNSL; 25 thus, ethnicity is possibly another variable that requires evaluation, although there are no available data to support variations in the biology of PCNSL among different ethnicities, yet. As shown in a previous study, HD-MTX/Ara-C was effective in mobilizing hematopoietic stem cells.…”

Risk factors for intraocular involvement in patients with primary central nervous system lymphoma

“…Further study with a longer follow-up period would be preferred. However, it could not be easy because of the short survival time of PCNSL patients [3], considering the mean survival time of patients with PCNSL was 33.7 months for a non-ocular group and 32.2 months for an ocular group in a recent study [9].…”

“…It usually occurs in elderly or immunodeficient populations, and has increased in incidence during the last several decades [2]. Although the survival rate of patients with PCNSL has recently improved owing to a shift in treatment modality toward methotrexate-based chemotherapy, the median overall survival is still only about 4 years [3][4][5].…”