Outcome and prognostic factors of very old patients with primary CNS lymphoma: a retrospective analysis of patients ≥80 years treated with high-dose methotrexate-based chemotherapy

Seidel, Sabine; Kowalski, Thomas E.; Nilius‐Eliliwi, Verena; Schroers, Roland; Schlegel, Uwe

doi:10.1080/10428194.2022.2100371

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…This standard has been accomplished in most patients of this study as 90% of the cohort were treated with HD‐MTX‐combination therapy. It reflects the current concept that most patients, even those above the age of 80, can receive HD‐MTX 16,17 . An analysis of 9165 PCNSL cases treated in the USA between 2004 and 2013 showed that the estimated OS was 37.7% at 3 years and reached 51.8% in the subgroup treated with multiagent chemotherapy 13 .…”

Section: Discussionsupporting

confidence: 58%

“…It reflects the current concept that most patients, even those above the age of 80, can receive HD-MTX. 16,17 An analysis of 9165 PCNSL cases treated in the USA between 2004 and 2013 showed that the estimated OS was 37.7% at 3 years and reached 51.8% in the subgroup treated with multiagent chemotherapy. 13 At the same time, the proportion of patients treated with radiotherapy dropped from 37.6% to 18.8%.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective study of 222 patients with newly diagnosed primary central nervous system lymphoma—Outcomes indicative for improved survival overtime

Bairey

Lebel

Buxbaum

et al. 2023

Hematological Oncology

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Primary central nervous system lymphoma (PCNSL) is a rare disease with an incidence of 0.4/per 100,000 person‐years. As there is a limited number of prospective randomized trials in PCNSL, large retrospective studies on this rare disease may yield information that might prove useful for the future design of randomized clinical trials. We retrospectively analyzed the data of 222 newly diagnosed PCNSL patients treated in five referral centers in Israel between 2001 and 2020. During this period, combination therapy became the treatment of choice, rituximab has been added to the induction therapy, and consolidation with irradiation was largely laid off and was mostly replaced by high‐dose chemotherapy with or without autologous stem cell transplantation (HDC‐ASCT). Patients older than 60 comprised 67.5% of the study population. First‐line treatment included high‐dose methotrexate (HD‐MTX) in 94% of patients with a median MTX dose of 3.5 g/m2 (range 1.14–6 g/m2) and a median cycle number of 5 (range 1–16). Rituximab was given to 136 patients (61%) and consolidation treatment to 124 patients (58%). Patients treated after 2012 received significantly more treatment with HD‐MTX and rituximab, more consolidation treatments, and autologous stem cell transplantation. The overall response rate was 85% and the complete response (CR)/unconfirmed CR rate was 62.1%. After a median follow‐up of 24 months, the median progression‐free survival (PFS) and overall survival (OS) were 21.9 and 43.5 months respectively with a significant improvement since 2012 (PFS: 12.5 vs. 34.2 p = 0.006 and OS: 19.9 vs. 77.3 p = 0.0003). A multivariate analysis found that the most important factors related to OS were obtaining a CR followed by rituximab treatment and Eastern Cooperative Oncology Group performance status. The observed improvement in outcomes may be due to multiple components such as an intention to treat all patients regardless of age with HD‐MTX‐based combination chemotherapy, treatment in dedicated centers, and more aggressive consolidation with the introduction of HDC‐ASCT.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

A retrospective study of 222 patients with newly diagnosed primary central nervous system lymphoma—Outcomes indicative for improved survival overtime

Bairey

Lebel

Buxbaum

et al. 2023

Hematological Oncology

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“…Toxicity was manageable [55 ▪ ]. Another retrospective study including 19 patients > 80 years, showed the feasibility of HD-MTX polychemotherapy in this population, with a median OS of 16.3 months [56]. However, the available data do not clearly support the use of IT chemotherapy in elderly patients with PCNSL due to lack of robust prospective data.…”

Section: How To Treat Newly-diagnosed Elderly Patients With Primary C...mentioning

confidence: 96%

“…However, particularly in the elderly population, the risk-benefit balance is not clearly established between a potential improvement of PCNSL response versus the risk of an increase of immunosuppression. The phase 3, HOVON trial explored the M ethotrexate, BCNU, etoposide, Prednisone (MBVP) protocol with (n ¼ 99) or without rituximab (n ¼ 100), median age was 61 (55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67). We only observed a trend in favor of rituximab, PFS at 1 years was 58% and 65% (P ¼ 0.18) and median OS was 56.7 months and not reached (P ¼ 0Á74) for R-MBVP and MBVP respectively [53].…”

Section: Rituximabmentioning

confidence: 99%

Primary central nervous system lymphoma (PCNSL) in older patients

Bertucci

Harlay

Chinot

et al. 2023

Current Opinion in Oncology

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Introduction Primary central nervous system lymphoma (PCNSL) is a rare, chemo and radio-sensitive tumor limited to the central nervous system. The incidence of PCSNL increases notably in the elderly population which represented approximately half of the patients. The limit of ‘elderly’ population remained debated and nonuniform, including 60 years as a cutoff for brain radiotherapy, 65 years for autologous stem-cell transplantation, and 70 years for the last clinical trials. Current therapeutic options include first line treatment based on high-dose methotrexate based polychemotherapy, consolidation chemotherapy, and adapted autologous stem cell transplantation for highly selected patients. At relapse, single agent targeted therapies or salvage chemotherapy followed by intensive consolidation are promising therapeutic options. Nevertheless, improving management of elderly patients is an urgent medical need that currently remains unresolved. Objective We will focus on elderly patients with PCNSL and their specificities including clinical presentations, available therapeutic options and adaptations to be made. Conclusion To improve survival, it will be necessary to personalized and adapt the treatments, to each patient and his comorbidities, to increase their effectiveness and limit their toxicity in this frail population. Finally, inclusion of these patients in clinical trials is one of the major challenges to significantly change PCNSL elderly patient prognosis.

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Performance status, comorbidities, and cycles of methotrexate exert the greatest influence on outcomes of primary and secondary CNS lymphomas: the Lexington experience

Curry

Munker

et al. 2022

Ann Hematol

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Outcome and prognostic factors of very old patients with primary CNS lymphoma: a retrospective analysis of patients ≥80 years treated with high-dose methotrexate-based chemotherapy

Cited by 4 publications

References 27 publications

A retrospective study of 222 patients with newly diagnosed primary central nervous system lymphoma—Outcomes indicative for improved survival overtime

A retrospective study of 222 patients with newly diagnosed primary central nervous system lymphoma—Outcomes indicative for improved survival overtime

Primary central nervous system lymphoma (PCNSL) in older patients

Performance status, comorbidities, and cycles of methotrexate exert the greatest influence on outcomes of primary and secondary CNS lymphomas: the Lexington experience

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