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
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.
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页数:9
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