Outcome of patients with newly diagnosed primary CNS lymphoma after high-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine: an 8-year cohort study.

Abstract

BACKGROUND:

Addition of cytarabine to high-dose methotrexate (HD-MTX) chemotherapy improves outcome of primary CNS lymphoma (PCNSL); however, the combination therapy increases toxicity. Sequential chemotherapy and cranial radiation may decrease toxicity without altering efficacy.

METHODS:

This was a single-center, retrospective cohort study of consecutive newly diagnosed immunocompetent PCNSL patients treated with HD-MTX (5 cycles of 3 g/m2 every 2 weeks) followed by consolidation whole-brain radiotherapy (WBRT) and cytarabine (2 cycles of 3 g/m2/d for 2 days every 3 weeks) from January 2013 to December 2020. Initial WBRT before HD-MTX was allowed in patients with significant disability or brain edema at presentation. Primary outcome was progression-free survival (PFS). Key secondary outcomes were response rate, treatment-related toxicity, and overall survival (OS).

RESULTS:

Of 41 patients, 25 patients had a complete response (CR) and ten patients had a partial response, inferring an overall response rate (ORR) of 85.4% and a CR rate of 60.9%. More than 90% of patients were able to tolerate and complete the HD-MTX. The incidence of ≥ grade 3 hematologic and non-hematologic toxicities were 4.8% and 17.1%, respectively. Treatment-related mortality rate was 2.4%. There was no difference in toxicity between patients with age < 60 and ≥ 60 years. At the median follow-up duration of 39.8 months, the median PFS was 35.2 months (95% CI 12.4-69.3) and median OS was 46.5 months (95% CI 21.8-NR).

CONCLUSION:

High-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine has acceptable efficacy, great tolerability, and low toxicity in newly diagnosed PCNSL patients.

• Authors: Pokpong Piriyakhuntorn, Thanawat Rattanathammethee, Sasinee Hantrakool, Chatree Chai-Adisaksopha, Ekarat Rattarittamrong, Adisak Tantiworawit, Lalita Norasetthada
• Journal: International journal of clinical oncology (Int J Clin Oncol) Vol. 26 Issue 10 Pg. 1805-1811 (Oct 2021) ISSN: 1437-7772 [Electronic] Japan
• PMID: 34236556 (Publication Type: Journal Article)
• Copyright: © 2021. Japan Society of Clinical Oncology.

Chemical References

• Cytarabine
• Methotrexate

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Brain
• Central Nervous System Neoplasms (drug therapy, radiotherapy)
• Cohort Studies
• Cytarabine (adverse effects)
• Humans
• Lymphoma (drug therapy, radiotherapy)
• Methotrexate (adverse effects)
• Middle Aged
• Retrospective Studies
• Treatment Outcome