Clinical characteristics and survival outcomes of patients with primary central nervous system lymphoma treated with high-dose methotrexate-based polychemotherapy and consolidation therapies

被引：1

作者：

de Groot, Fleur A. ^{[1
]}

Dekker, Tim J. A. ^{[2
]}

Doorduijn, Jeanette K. ^{[3
]}

Bohringer, Stefan ^{[5
,34
]}

Brink, Mirian ^{[4
]}

de Groen, Ruben A. L. ^{[1
]}

de Haan, Lorraine M. ^{[6
]}

Woei-A-Jin, F. J. Sherida H. ^{[7
]}

Noordenbos, Troy ^{[6
]}

Sijs-Szabo, Aniko ^{[1
]}

Oudshoorn, Mirjam A. ^{[1
]}

Lam, King H. ^{[8
]}

Diepstra, Arjan ^{[9
]}

te Boome, Liane C. J. ^{[10
]}

Terpstra, Valeska ^{[11
]}

Bohmer, Lara H. ^{[12
]}

Nicolae, Alina ^{[13
]}

Posthuma, Eduardus F. M. ^{[14
]}

Koens, Lianne

Durian, Marc F. ^{[15
,16
]}

Stavast, Jeroen ^{[17
]}

van der Poel, Marjolein W. M. ^{[18
]}

Hamid, Myrurgia Abdul ^{[19
]}

Stevens, Wendy B. C. ^{[20
]}

van Rooij, Sjo L. M. ^{[21
]}

Oostvogels, Rimke S. ^{[22
]}

Muhlebner, Angelika ^{[23
]}

Neelis, Karen J. ^{[24
]}

van den Brand, Michiel ^{[25
]}

Tousseyn, Thomas ^{[26
]}

Dierickx, Daan ^{[27
]}

de Weerdt, Okke ^{[28
]}

Beeker, Aart ^{[29
]}

Jansen, Patty M. ^{[6
]}

Kersten, Marie Jose ^{[30
,31
]}

Zijlstra, Josee M. ^{[30
,31
]}

Chamuleau, Martine E. D. ^{[30
,31
]}

Veelken, Hendrik ^{[1
]}

Bromberg, Jacoline C. E. ^{[32
]}

Nijland, Marcel ^{[33
]}

Vermaat, Joost S. P. ^{[1
]}

机构：

[1] Leiden Univ, Dept Hematol, Med Ctr, POB 9600, NL-2300 RC Leiden, Netherlands

[2] Leiden Univ, Med Ctr, Dept Internal Med, Leiden, Netherlands

[3] Univ Med Ctr Rotterdam, Erasmus MC Canc Inst, Dept Hematol, Rotterdam, Netherlands

[4] Netherlands Comprehens Canc Org IKNL, Dept Res & Dev, Utrecht, Netherlands

[5] Leiden Univ, Med Ctr, Dept Biomed Data Sci, Leiden, Netherlands

[6] Leiden Univ, Med Ctr, Dept Pathol, Leiden, Netherlands

[7] Univ Hosp Leuven, Dept Gen Med Oncol, Leuven, Belgium

[8] Erasmus MC, Dept Pathol, Rotterdam, Netherlands

[9] Univ Groningen, Univ Med Ctr Groningen, Dept Pathol & Med Biol, Groningen, Netherlands

[10] Haaglanden Med Ctr, Dept Hematol, The Hague, Netherlands

[11] Haaglanden Med Ctr, Dept Pathol, The Hague, Netherlands

[12] Haga Teaching Hosp, Dept Biostat, The Hague, Netherlands

[13] Haga Teaching Hosp, Dept Neurol, The Hague, Netherlands

[14] Reinier de Graaf Gasthuis, Dept Internal Med, Delt, Netherlands

[15] Univ Amsterdam, Amsterdam Univ Med Ctr, Med Ctr, Amsterdam, Netherlands

[16] Elisabeth TweeSteden Ziekenhuis Tilburg, Dept Hematol, Tilburg, Netherlands

[17] Elisabeth TweeSteden Ziekenhuis Tilburg, Dept Pathol, Tilburg, Netherlands

[18] Maastricht Univ, GROW Sch Oncol & Dev Biol, Dept Internal Med, Div Hematol,Med Ctr, Maastricht, Netherlands

[19] Maastricht Univ, Dept Pathol, Med Ctr, Maastricht, Netherlands

[20] Radboud Univ Nijmegen, Dept Hematol, Med Ctr, Nijmegen, Netherlands

[21] Univ Med Ctr Utrecht, Dept Neurol, Utrecht, Netherlands

[22] Univ Med Ctr Utrecht, Dept Hematol, Utrecht, Netherlands

[23] Univ Med Ctr Utrecht, Dept Pathol, Utrecht, Netherlands

[24] Leiden Univ, Med Ctr, Dept Radiotherapy, Leiden, Netherlands

[25] Radboud Univ Nijmegen, Dept Pathol, Med Ctr, Nijmegen, Netherlands

[26] Univ Hosp Leuven, Dept Pathol, Leuven, Belgium

[27] Univ Hosp Leuven, Dept Hematol, Leuven, Belgium

[28] St Antonius Hosp, Dept Internal Med, Nieuwegein, Netherlands

[29] Spaarne Gasthuis, Dept Internal Med, Haarlem, Netherlands

[30] Univ Amsterdam, Dept Hematol, Canc Ctr Amsterdam, Med Ctr, Amsterdam, Netherlands

[31] LYMMCARE, Amsterdam, Netherlands

[32] Erasmus Univ, Med Ctr, Dept Neurol, Rotterdam, Netherlands

[33] Univ Groningen, Univ Med Ctr Groningen, Dept Hematol, Groningen, Netherlands

[34] Leiden Univ, Med Ctr, Med Ctr, Leiden, Netherlands

来源：

EUROPEAN JOURNAL OF CANCER | 2024年 / 213卷

关键词：

PCNSL; Clinical characteristics; Survival outcomes; High-dose methotrexate; Induction; Polychemotherapy; Consolidation; PRIMARY CNS LYMPHOMA; INTERNATIONAL EXTRANODAL LYMPHOMA; HEALTH-ORGANIZATION CLASSIFICATION; STEM-CELL TRANSPLANTATION; CHEMOTHERAPY; RADIOTHERAPY; CHEMOIMMUNOTHERAPY; RANDOMIZATION; RITUXIMAB;

D O I：

10.1016/j.ejca.2024.115068

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Given the rarity of primary central nervous system lymphoma (PCNSL), evaluations of different high-dose methotrexate-(HD-MTX)-based treatment regimens is sparse. This retrospective, multicenter study evaluates clinical characteristics and outcomes (progression-free, overall and disease-specific survival) after five HD-MTX-based polychemotherapeutic regimens and two consolidation therapies. 346 patients with histologically confirmed PCNSL, treated with >= 1 cycle HD-MTX-based strategies (>= 3g/m(2)/cycle) were included. The regimens included MATRIX (HD-MTX, HD-AraC, thiotepa, and rituximab), (R)MBVP +/- HD-AraC (HD-MTX, teniposide/etoposide, carmustine, prednisolone, +/- HD-AraC, +/- rituximab), (R)MP (HD-MTX, procarbazine, +/- rituximab), and a combination of HD-MTX and HD-AraC. The overall response rate after induction was 69 %, 28 % complete remission and progressive disease was observed in 100 (29 %) patients. 126 (36 %) patients received consolidation, including high-dose-BCNU-thiotepa with autologous stem cell transplantation (HD-BCNU-TT/ASCT, n = 59 (17 %)) or whole brain radiotherapy (WBRT, n = 67 (19 %)). Clinical characteristics associated with adverse mortality risk by multivariable prognostication contained age > 60 years (HR 1.61, p = 0.011), elevated LDH (HR 1.75, p = 0.004) and WHO status >= 2 (HR 1.56, p = 0.010). Independently, induction regimens containing HD-AraC demonstrated survival benefit compared to induction regimens without HD-AraC (HR 0.59, p = 0.002). Without preference for HD-BCNU-TT/ASCT or WBRT, a favorable effect of consolidation (HR 0.44 and HR 0.42, p < 0.001) was confirmed, also with consolidation as time-dependent variable. Competing risk analysis showed similar low incidence of lymphoma-unrelated deaths in consolidated and unconsolidated patients. This study confirms that age, elevated LDH and WHO status increase the mortality risk. HD-AraC containing treatment regimens and consolidation with HD-BCU-TT/ASCT or WBRT were associated with superior survival, including a favorable low incidence of lymphoma-unrelated deaths.

引用

页数：9

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