Treatment for Primary CNS Lymphoma: The Next Step

Abrey, Lauren E.; Yahalom, Joachim; DeAngelis, Lisa M.

doi:10.1200/jco.2000.18.17.3144

Cited by 560 publications

(364 citation statements)

References 15 publications

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“…Clinical trials in PCNSL have exploited therapy with high-dose MTX alone [15][16][17], MTXbased polychemotherapy [3,18] and combination of MTX-based chemotherapy with whole brain radiotherapy [19][20][21][22][23]. MTX as a sole treatment in two multicenter trials at a dosage of 8g/m 2 every 14 days for six cycles has resulted in complete response (CR) rates of 29%/52%…”

Section: Discussionmentioning

confidence: 99%

“…Combination chemo-/radiotherapy has resulted in overall survival rates of up to 60 months [21], however, careful follow up has identified a large fraction of such patients suffering from late treatment related neurotoxicity [21,[26][27][28]. Treatment induced neurotoxicity is less frequent in long term survivors after chemotherapy alone for PCNSL [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

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Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study

et al. 2008

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and 5) and cytarabine (Ara-C; cycles 3,6) based systemic therapy including dexamethasone, vinca-alkaloids, ifosfamide and cyclophosphamide.Results: Study accrual was prematurely stopped in 11/05 due to a high rate of early relapses.Seventeen/18 patients were assessable for response: Nine (53%) achieved complete response (CR), two (12%) complete response/unconfirmed (CRu), two (12%) partial response (PR), four (24%) showed progressive disease (PD); one treatment was stopped due to toxicity.Median follow-up is 23 months; median response duration was only ten months in responding patients and median time to treatment failure (TTF) eight months in the whole group; median overall survival (OS) has not been reached. Systemic toxicity was mainly hematologic.Conclusions: In PCNSL patients < 60 years polychemotherapy without intraventricular treatment results in a high response rate, but is associated with early relapses in the majority of cases. This is in contrast to the results achieved with the same protocol but with intraventricular treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study

et al. 2008

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“…According to the results of the present study, the QOL of outpatients with a stable KPS score appeared to deteriorate whenever a recurrence occurred. Furthermore, Abray et al (18) reported that patients aged >60 years who received radiotherapy were at a significantly higher risk of delayed neurotoxicity (83%) and a reduction of the KPS score. In the present study, KPS scores were associated with age at the time of the QOL survey.…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy

Okita

Narita²,

Miyakita³

et al. 2016

Molecular and Clinical Oncology

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Abstract. Chemoradiotherapy for primary central nervous system lymphoma (PCNSL) is associated with a considerable risk of long-term neurotoxicity. The present study aimed to assess the health-related quality of life (HRQOL) of outpatients with PCNSL who have received radiotherapy and high-dose methotrexate (HDMTX) chemotherapy, and to determine the factors that cause a decline in HRQOL and interfere with home living. A total of 37 patients were surveyed 0.9-14.2 years after their initial diagnosis and treatment. Each patient completed a multi-part HRQOL questionnaire that was used to examine the associations of HRQOL scores with leukoencephalopathy, Karnofsky performance status (KPS) scores, age, history of recurrence and HDMTX-based chemoradiotherapy. The results demonstrated that the history of recurrence, number of cycles of MTX chemotherapy and age affected the development of leukoencephalopathy. Reductions in KPS score were associated with a history of recurrence (P=0.03), but not with leukoencephalopathy (P=0.8). KPS score, leukoencephalopathy and age were significantly associated with a decline in HRQOL score. A decline in the HRQOL associated with a reduction in KPS score was also observed by multivariate analyses. Deterioration of the HRQOL among outpatients with PCNSL post-chemoradiotherapy was significantly associated with older age (≥66 years) and decreased KPS score. Older patients with a history of recurrence had a higher risk for deteriorated QOL due to development of leukoencephalopathy. Therefore, it is recommended that clinicians monitor the KPS score among outpatients with PCNSL. QOL examination for older patients

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“…Not only is this unusual in patients with NK/T cell lymphoma, particularly one with HIV/AIDS, but is also surprising as our patient presented with other poor prognostic indicators including intestinal involvement, disseminated disease, high level of EBV DNA in the CSF, and a low CD4 count [3,13,14]. Although therapy for NK/T cell lymphoma has focused on anthracycline-based chemotherapy with or without radiation [13], because of the need to treat her CNS disease, a regimen utilizing methotrexate every 14 days was used [15]. Furthermore, as she presented with disseminated disease, radiation was thought to be most likely of little benefit.…”

Section: Discussionmentioning

confidence: 99%

NK/T cell non-Hodgkin lymphoma in a HIV-positive patient

et al. 2010

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NK/T lymphomas have rarely been reported in HIV/AIDS patients. Here we report a case of a 37-year-old woman, with AIDS and a recent diagnosis of Kaposi sarcoma in a mesenteric lymph node, who presented with extra-ocular nerve palsies and gastrointestinal bleeding. A small intestine resection specimen revealed an extra-nodal NK/T cell lymphoma, nasal type. The unique presentation of this rare and aggressive lymphoma in the setting of AIDS and Kaposi sarcoma underscores the importance of maintaining a broad differential diagnosis when evaluating a malignant neoplasm from a HIV-positive patient.

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Treatment for Primary CNS Lymphoma: The Next Step

Cited by 560 publications

References 15 publications

Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study

Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study

Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy

NK/T cell non-Hodgkin lymphoma in a HIV-positive patient

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