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Rituximab, methotrexate, procarbazine, vincristine and intensified cytarabine consolidation for primary central nervous system lymphoma (PCNSL) in the elderly: a LOC network study

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Abstract

Primary CNS lymphoma (PCNSL) is chemosensitive to high-dose methotrexate-based chemotherapy. However, responses in the elderly are short-lasting and outcome is poor. Given that radiotherapy and intensive chemotherapy expose elderly to severe toxicities, alternative consolidation approaches need to be evaluated. In this multicenter study, we retrospectively analyzed consecutive patients with newly-diagnosed PCNSL, aged >60, treated with a (R)-MPV-AAA regimen. The regimen consisted of three 28-day cycles of methotrexate (3.5 g/m2 D1, D15), procarbazine, vincristine, followed by three 28-day cycles of cytarabine consolidation (3 g/m2 D1-2). Addition of rituximab (375 mg/m2 D1) was optional. The results were compared with the historical MPV-A regimen. Ninety patients received the (R)-MPV-AAA regimen with (n = 39) or without (n = 51) rituximab. Median age was 68 and median KPS 60. 55% of patients achieved a complete response, 8% a partial response and 37% progressed. The median PFS was 10 months, the median OS 28.1 months. Toxicity was mainly hematological, with 54 and 51% of grade III-IV neutropenia and thrombopenia. The response rate was higher in patients receiving rituximab (77 vs. 53%; p = 0.03), whereas no difference was observed in terms of PFS or OS. When comparing the results to the historical MPV-A, there was no difference in terms of response rate, PFS or OS, but a higher rate of hematotoxicity. This study suggests that extending cytarabine consolidation after methotrexate-based chemotherapy does not improve the MPV-A efficacy but increases toxicity in the elderly. The addition of rituximab may improve the response rate, but its impact on final outcome remains unclear.

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Authors and Affiliations

  1. Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités UPMC Universités Paris VI, IHU, ICM, 47–83 boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Caroline Houillier & Khê Hoang-Xuan

  2. Service d’hématologie, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France

    Hervé Ghesquières, Emmanuelle Nicolas-Virelizier & Pierre Faurie

  3. Service d’hématologie, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63100, Clermont-Ferrand, France

    Cécile Chabrot & Jacques-Olivier Bay

  4. Service d’hématologie, Hôpital René Huguenin-Institut Curie, 35 rue Dailly, 92210, Saint Cloud, France

    Carole Soussain & Jacques Vargaftig

  5. Service de neurologie, Hôpitaux Civils de Colmar, 39 avenue de la Liberté, 68024, Colmar Cedex, France

    Guido Ahle & Claude Gaultier

  6. Service d’hématologie, Groupe Hospitalier Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Sylvain Choquet

  7. Service d’ophtalmologie, Groupe Hospitalier Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Valérie Touitou

  8. Service de neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Nadine Martin-Duverneuil

  9. Service d’ophtalmologie, Institut Curie, Université Paris V, 26 rue d’Ulm, 75005, Paris, France

    Nathalie Cassoux

  10. Service d’hématologie biologique, Groupe Hospitalier Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Magali Le Garff-Tavernier & Myrto Costopoulos

Authors
  1. Caroline Houillier
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  2. Hervé Ghesquières
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  3. Cécile Chabrot
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  4. Carole Soussain
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  6. Sylvain Choquet
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  7. Emmanuelle Nicolas-Virelizier
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  8. Jacques-Olivier Bay
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  9. Jacques Vargaftig
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  10. Claude Gaultier
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  11. Valérie Touitou
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  12. Nadine Martin-Duverneuil
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  13. Nathalie Cassoux
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  14. Magali Le Garff-Tavernier
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  15. Myrto Costopoulos
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  16. Pierre Faurie
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  17. Khê Hoang-Xuan
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Corresponding author

Correspondence to Caroline Houillier.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Houillier, C., Ghesquières, H., Chabrot, C. et al. Rituximab, methotrexate, procarbazine, vincristine and intensified cytarabine consolidation for primary central nervous system lymphoma (PCNSL) in the elderly: a LOC network study. J Neurooncol 133, 315–320 (2017). https://doi.org/10.1007/s11060-017-2435-7

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  • DOI: https://doi.org/10.1007/s11060-017-2435-7

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