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Impact of contemporary regimens on the outcomes and toxicity of primary CNS lymphoma: a single-center retrospective analysis of 73 patients

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Abstract

Introduction

Primary central nervous system lymphoma (PCNSL) is a rare disease with a dismal prognosis compared to its systemic large B-cell lymphoma counterpart. Real world data are limited, when considering a uniform backbone treatment.

Methods

A retrospective study of all adult patients treated sequentially with a high-dose methotrexate (HD MTX)-based regimen in a single tertiary medical center between 2003 and 2019.

Results

The 2015–2019 period differed from its predecessor in that most patients were treated with an HD MTX-based polychemotherapy regimen as opposed to HD MTX monotherapy (81% vs. 13%, P < .001), rituximab was given as standard of care (100% vs. 56%, P < .01), and most induction-responsive patients received consolidation treatment (70% vs. 18%, P = .01). The median progression-free and overall survival (OS) for the entire cohort (n = 73, mean age 64 years) was 9.9 and 29.8 months, respectively. Patients diagnosed between 2015 and 2019 had superior OS (P = .03) compared to those treated earlier. An interim partial response (PR) state, documented after two cycles of chemotherapy, was associated with increased incidence of progression, with only 33% of those patients achieving end-of-induction complete response. Twenty-three percent of patients developed thrombotic events and 44% developed grade 3–4 infections. HD MTX-based polychemotherapy induction was associated with both increase in thrombotic and infection incidence.

Conclusions

Contemporary HD MTX-based combination therapies suggestively improved the outcomes for PCNSL, but at a cost of increased incidence of toxicity. Patients who achieve an interim PR status are at a high risk for treatment failure.

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Authors and Affiliations

  1. Department of Hematology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel

    Nadav Sarid, Lili Gibstein, Irit Avivi, Chava Perry & Ron Ram

  2. Division of Oncology, Neuro-Oncology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Felix Bokstein & Deborah T. Blumenthal

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nadav Sarid, Felix Bokstein, Deborah T. Blumenthal, Lili Gibstein, Irit Avivi, Chava Perry & Ron Ram

  4. Clinical Operation Research and Quality Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Ahuva Weiss-Meilik

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  1. Nadav Sarid
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Correspondence to Nadav Sarid.

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Sarid, N., Bokstein, F., Blumenthal, D.T. et al. Impact of contemporary regimens on the outcomes and toxicity of primary CNS lymphoma: a single-center retrospective analysis of 73 patients. J Neurooncol 151, 211–220 (2021). https://doi.org/10.1007/s11060-020-03654-x

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  • DOI: https://doi.org/10.1007/s11060-020-03654-x

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