The elderly left behind—changes in survival trends of primary central nervous system lymphoma over the past 4 decades

Mendez, Joe; Ostrom, Quinn T.; Gittleman, Haley; Kruchko, Carol; DeAngelis, Lisa M.; Barnholtz‐Sloan, Jill S.; Grommes, Christian

doi:10.1093/neuonc/nox187

Cited by 187 publications

(168 citation statements)

References 24 publications

(26 reference statements)

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“…Rather, the median OS reached 8.4 years, increasing remarkably when compared with previous reports . This substantiated the results reported by some specialized centers, as well as those from large national databases, indicating significant improvement in survival of PCNSL over past decades. The generalized improvement in patient outcomes may be attributed to several key reasons, such as the use of autologous stem cell transplant as consolidation therapy, availability of neutrophil growth factors and improved supportive care to bolster the administration of high‐dose MTX as well as multi‐agent chemotherapy, and prevalent use of recent‐generation imaging modalities, namely improved MRI and PET/CT scanners, allowing for accurate staging (eg, elimination of patients with non‐CNS involvement who may have previously been misdiagnosed with PCNSL).…”

Section: Discussionsupporting

confidence: 88%

A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma

et al. 2020

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Background Although various prognostic models for primary central nervous system lymphoma (PCNSL) have been developed, there is no consensus regarding the optimal prognostic index. We aimed to evaluate potential prognostic factors and construct a novel predictive model for PCNSL patients. Methods We enrolled newly diagnosed PCNSL patients between 2003 and 2015. The primary endpoint was progression‐free survival (PFS), and the secondary endpoint was overall survival (OS). The prognostic factors identified using multivariate Cox proportional hazards models were used to develop a predictive model. We subsequently validated the prognostic model in an independent cohort. We also evaluated the validity of the existing scores: the International Extranodal Lymphoma Study Group (IELSG), the Nottingham/Barcelona (NB), and the Memorial Sloan‐Kettering Cancer Center models (MSKCC). Results We identified 101 patients with newly diagnosed PCNSL at our center. Multivariate analysis showed that age ≥80, deep brain lesions, and ECOG ≥2 were independent risk factors of PFS. Assigning one point for each factor, we constructed a novel prognostic model, the Taipei Score, with four distinct risk groups (0‐3 points). The performances of the Taipei Score in discriminating both PFS and OS in the training cohort were significant, and the score was validated in the external validation cohort. The IELSG, NB and MSKCC models had insufficient discriminative ability for either PFS or OS in both cohorts. Conclusion The Taipei Score is a simple model that discriminates PFS and OS for PCNSL patients. The score may offer disease risk stratification and facilitate clinical decision‐making.

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Section: Discussionsupporting

confidence: 88%

A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma

et al. 2020

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“…This probably reflects the effect of salvage therapy (such as WBRT) that prolongs survival beyond progression regardless of its negative impact on quality of life. Notably, outcomes of published treatment series do not reflect the “real-life” experience where median OS of the elderly remained in the range of 6–7 months [1, 19]. However, HD-MTX is relatively safe treatment for PCNSL patients regardless of age [23], and even patients aged 80 years or more can tolerate the HD-MTX regimen (such as MPV) [12].…”

Section: Diagnosis and Treatment Of Elderly Patients With Pcnslmentioning

confidence: 99%

“…A recent study revealed that the incidence of PCNSL increased from 0.1 per 100,000 in the 1970s to 0.4 per 100,000 in the 1980s, correlating with an increase in the diagnosis of patients ≥70 years [1]. The incidence in elderly patients aged 70–79 years is 4.32 compared to 0.08 in the 3rd decade of life.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence in elderly patients aged 70–79 years is 4.32 compared to 0.08 in the 3rd decade of life. Although PCNSL often responds to initial treatment, survival is inferior when compared to lymphomas located outside the CNS, and despite the fact that the median overall survival (OS) of all patients has doubled over the last 40 years (from 12.5 to 25 months), this survival benefit has remained limited to patients younger than 70 years [1]. The devastating fact is that median survival in the elderly population (aged 70 years or more) has not changed during this period and remained in the range of 6–7 months.…”

Section: Introductionmentioning

confidence: 99%

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Primary CNS Lymphoma in the Elderly: The Challenge

Siegal

Bairey

2019

Acta Haematol

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Primary central nervous system (CNS) lymphoma is an aggressive brain tumor sensitive to chemotherapy and radiotherapy. Its incidence has increased in the elderly, and they account for the majority of patients. The median survival of patients older than 70 years did not change over the last 40 years and remained in the range of 6–7 months. The definition of elderly is nonuniform, and chronological age is not the best marker of treatment tolerability or a predictor of treatment-related toxicity. Some patients who are fit can tolerate induction, consolidation, and even high-dose chemotherapy with autologous stem cell transplantation, whereas others who have multiple comorbidities with reduced renal and bone marrow function can tolerate only intermediate doses of methotrexate. The latter may benefit from maintenance treatment. The “elderly” are also susceptible to the accelerated and detrimental cognitive side effects of whole-brain irradiation which is an alternative consolidation to high-dose chemotherapy. The optimal treatment remains an unresolved matter. A comprehensive comorbidity and geriatric assessment is imperative for appraisal of treatment-induced risks for CNS and systemic toxicity. An individualized approach is required aiming to prolong survival while minimizing toxicity. Future studies should assess the potential of new agents for improving outcome and maintaining quality of life.

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“…Management of primary central nervous system (CNS) lymphoma (PCNSL) in patients aged ≥70 years represents a significant problem (Welch et al , ; Roth & Hoang‐Xuan, ; Mendez et al , ). While older PCNSL patients generally can tolerate and benefit from high‐dose methotrexate‐based induction, whole brain irradiation consolidation is not favoured because of excessive neurotoxicity.…”

Section: Characteristics Of Elderly Pcnsl Patients Who Received Low‐dmentioning

confidence: 99%

Low‐dose lenalidomide maintenance after induction therapy in older patients with primary central nervous system lymphoma

Vu¹,

Mannis

Hwang

et al. 2019

Br J Haematol

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The elderly left behind—changes in survival trends of primary central nervous system lymphoma over the past 4 decades

Abstract: The poor outcome seen in the particularly vulnerable elderly patient population highlights the need for clinical trials targeting the elderly in hopes of improving treatment strategies and survival.

Cited by 187 publications

References 24 publications

A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma

A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma

Primary CNS Lymphoma in the Elderly: The Challenge

Low‐dose lenalidomide maintenance after induction therapy in older patients with primary central nervous system lymphoma

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