Journal of Neuro-Oncology

, Volume 80, Issue 2, pp 159–165 | Cite as

Relapse of primary central nervous system lymphoma: clinical features, outcome and prognostic factors

  • Kristoph Jahnke
  • Eckhard Thiel
  • Peter Martus
  • Ulrich Herrlinger
  • Michael Weller
  • Lars Fischer
  • Agnieszka Korfel
  • on behalf of the German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG)
Clinical–Patient Studies

Abstract

Data on relapsed primary central nervous system lymphoma (PCNSL) are limited. We have evaluated the clinical characteristics and outcome of relapsed PCNSL patients from two German trials.

Patients with relapsed disease after primary treatment were studied. Primary therapy consisted of high-dose methotrexate-based chemotherapy in all patients. Treatment for relapse was not predetermined.

After a median follow-up of 22.5 months, 52 (36%) patients with relapse were identified among 143 patients with complete remission (CR) after primary treatment. The median disease-free survival was 10.25 (3–47.5) months. The median age at relapse was 59 years. Forty-four of 51 evaluable patients relapsed within the CNS, 6 systemically and one both cerebrally and systemically. The median survival time after first relapse was 4.5 (0.5–40.5) months. Karnofsky performance status (KPS) at relapse (P = 0.004), site of relapse (isolated systemic versus other, P = 0.049) and treatment for relapse (versus no treatment, P = 0.001) were independent prognostic factors for survival after relapse in multivariate analysis.

Survival of patients with relapsed PCNSL is poor despite high response rates to salvage therapy. Good KPS, isolated systemic relapse and treatment for relapse were significantly associated with longer survival.

Keywords

Chemotherapy Primary central nervous system lymphoma Radiotherapy Relapse Survival 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Oȁ9Neill BP, Oȁ9Fallon JR, Earle JD, Colgan JP, Brown LD, Krigel RL (1995) Primary central nervous system non-Hodgkinȁ9s lymphoma: survival advantages with combined initial therapy? Int J Radiat Oncol Biol Phys 33:663–673CrossRefGoogle Scholar
  2. 2.
    Blay JY, Conroy T, Chevreau C, Thyss A, Quesnel N, Eghbali H, Bouabdallah R, Coiffier B, Wagner JP, Le Mevel A, Dramais-Marcel D, Baumelou E, Chauvin F, Biron P (1998) High-dose methotrexate for the treatment of primary cerebral lymphomas: analysis of survival and late neurologic toxicity in a retrospective series. J Clin Oncol 16:864–871PubMedGoogle Scholar
  3. 3.
    Abrey LE, DeAngelis LM, Yahalom J (1998) Long-term survival in primary CNS lymphoma. J Clin Oncol 16:859–863PubMedGoogle Scholar
  4. 4.
    Oȁ9Brien P, Roos D, Pratt G, Liew K, Barton M, Poulsen M, Olver I, Trotter G (2000) Phase II multicenter study of brief single-agent methotrexate followed by irradiation in primary CNS lymphoma. J Clin Oncol 18:519–526Google Scholar
  5. 5.
    Brada M, Hjiyiannakis D, Hines F, Traish D, Ashley S (1998) Short intensive primary chemotherapy and radiotherapy in sporadic primary CNS lymphoma (PCL). Int J Radiat Oncol Biol Phys 40:1157–1162PubMedCrossRefGoogle Scholar
  6. 6.
    Reni M, Ferreri AJM (2001) Therapeutic management of refractory or relapsed primary central nervous system lymphomas. Ann Hematol 80:B113–B117PubMedCrossRefGoogle Scholar
  7. 7.
    Glass J, Shustik C, Hochberg FH, Cher L, Gruber ML (1996) Therapy of primary central nervous system lymphoma with pre-irradiation methotrexate, cyclophosphamide, doxorubicin, vincristine, and dexamethasone (MCHOD). J Neurooncol 30:257–265PubMedCrossRefGoogle Scholar
  8. 8.
    Soussain C, Merle-Beral H, Reux I, Sutton L, Fardeau C, Gerber S, Ben Othman T, Binet JL, Lehoang P, Leblond V (1996) A single-center study of 11 patients with intraocular lymphoma treated with conventional chemotherapy followed by high-dose chemotherapy and autologous bone marrow transplantation in 5 cases. Leuk Lymphoma 23:339–345PubMedGoogle Scholar
  9. 9.
    Fine HA, Mayer RJ (1993) Primary central nervous system lymphoma. Ann Intern Med 119:1093–1104PubMedGoogle Scholar
  10. 10.
    DeAngelis LM (1999) Primary CNS lymphoma: treatment with combined chemotherapy and radiotherapy. J Neurooncol 43:249–257PubMedCrossRefGoogle Scholar
  11. 11.
    Reni M, Ferreri AJ, Villa E (1999) Second-line treatment for primary central nervous system lymphoma. Br J Cancer 79:530–534PubMedCrossRefGoogle Scholar
  12. 12.
    Jahnke K, Korfel A, Martus P, Weller M, Herrlinger U, Schmittel A, Fischer L, Thiel E (2005) on the behalf of the German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG): high-dose methotrexate toxicity in elderly patients with primary central nervous system lymphoma. Ann Oncol 16:445–449PubMedCrossRefGoogle Scholar
  13. 13.
    Korfel A, Martus P, Nowrousian MR, Hossfeld DK, Kirchen H, Brücher J, Stelljes M, Birkmann J, Peschel C, Pasold R, Fischer L, Jahnke K, Thiel E (2005) on behalf of the German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG): response to chemotherapy and treating institution predict survival in primary central nervous system lymphoma. Br J Haematol 128:177–183PubMedCrossRefGoogle Scholar
  14. 14.
    Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280PubMedGoogle Scholar
  15. 15.
    Abrey LE, Moskowitz CH, Mason WP, Crump M, Stewart D, Forsyth P, Paleologos N, Correa DD, Anderson ND, Caron D, Zelenetz A, Nimer SD, DeAngelis LM (2003) Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: an intent-to-treat analysis. J Clin Oncol 21:4151–4156PubMedCrossRefGoogle Scholar
  16. 16.
    Batchelor T, Carson K, Oȁ9Neill A, Grossman SA, Alavi J, New P, Hochberg F, Priet R (2003) Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol 21:1044–1049PubMedCrossRefGoogle Scholar
  17. 17.
    Herrlinger U, Schabet M, Brugger W, Kortmann RD, Kuker␣W, Deckert M, Engel C, Schmeck-Lindenau HJ, Mergenthaler HG, Krauseneck P, Benohr C, Meisner C, Wiestler OD, Dichgans J, Kanz L, Bamberg M, Weller M (2002) German Cancer Society Neuro-Oncology Working Group NOA-03 multi-center trial of single-agent high-dose methotrexate for primary CNS lymphoma. Ann Neurol 51:247–252PubMedCrossRefGoogle Scholar
  18. 18.
    Poortmans PM, Kluin-Nelemans HC, Haaxma-Reiche H, Vanȁ9t Veer M, Hansen M, Soubeyran P, Taphoorn M, Thomas J, Van den Bent M, Fickers M, Van Imhoff G, Rozewicz C, Teodorovic I, van Glabbeke M (2003) European Organization for Research and Treatment of Cancer Lymphoma Group: high-dose methotrexate-based chemotherapy followed by consolidating radiotherapy in non-AIDS-related primary central nervous system lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase II Trial 20962. J Clin Oncol 21:4483–4488PubMedCrossRefGoogle Scholar
  19. 19.
    Sanz L, Lopez-Guillermo A, Martinez C, Bosch F, Esteve J, Cobo F, Montoto S, Perales M, Blade J, Cervantes F, Nomdedeu B, Campo E, Montserrat E (1998) Risk of relapse and clinico-pathological features in 103 patients with diffuse large-cell lymphoma in complete response after first-line treatment. Eur J Haematol 61:59–64PubMedCrossRefGoogle Scholar
  20. 20.
    DeAngelis LM, Seiferheld W, Schold SC, Fisher B, Schultz CJ (2002) Radiation Therapy Oncology Group Study 93-10: combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93-10. J Clin Oncol 20:4643–4648PubMedCrossRefGoogle Scholar
  21. 21.
    Abrey LE, Batchelor TT, Ferreri AJ, Gospodarowicz M, Pulczynski EJ, Zucca E, Smith JR, Korfel A, Soussain C, DeAngelis LM, Neuwelt EA, Oȁ9Neill BP, Thiel E, Shenkier T, Graus F, van den Bent M, Seymour JF, Poortmans P, Armitage JO, Cavalli F (2005) International Primary CNS Lymphoma Collaborative Group: report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol 23:5034–5043PubMedCrossRefGoogle Scholar
  22. 22.
    Zucca E, Conconi A, Mughal TI, Sarris AH, Seymour JF, Vitolo U, Klasa R, Ozsahin M, Mead GM, Gianni MA, Cortelazzo S, Ferreri AJ, Ambrosetti A, Martelli M, Thieblemont C, Moreno HG, Pinotti G, Martinelli G, Mozzana R, Grisanti S, Provencio M, Balzarotti M, Laveder F, Oltean G, Callea V, Roy P, Cavalli F, Gospodarowicz MK (2003) International Extranodal Lymphoma Study Group: patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol 21:20–27PubMedCrossRefGoogle Scholar
  23. 23.
    Oȁ9Neill BP, Dinapoli RP, Kurtin PJ, Habermann TM (1995) Occult systemic non-Hodgkinȁ9s lymphoma (NHL) in patients initially diagnosed as primary central nervous system lymphoma (PCNSL): how much staging is enough? J Neurooncol 25:67–71CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Kristoph Jahnke
    • 1
  • Eckhard Thiel
    • 1
  • Peter Martus
    • 2
  • Ulrich Herrlinger
    • 3
  • Michael Weller
    • 3
  • Lars Fischer
    • 1
  • Agnieszka Korfel
    • 1
  • on behalf of the German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG)
  1. 1.Department of Hematology, Oncology and Transfusion MedicineCharité-Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of Biostatistics and Clinical EpidemiologyCharité-Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of General Neurology, Center for NeurologyUniversity of TübingenTübingenGermany

Personalised recommendations