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Journal of Neuro-Oncology

, Volume 133, Issue 2, pp 315–320 | Cite as

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

  • Caroline HouillierEmail author
  • Hervé Ghesquières
  • Cécile Chabrot
  • Carole Soussain
  • Guido Ahle
  • Sylvain Choquet
  • Emmanuelle Nicolas-Virelizier
  • Jacques-Olivier Bay
  • Jacques Vargaftig
  • Claude Gaultier
  • Valérie Touitou
  • Nadine Martin-Duverneuil
  • Nathalie Cassoux
  • Magali Le Garff-Tavernier
  • Myrto Costopoulos
  • Pierre Faurie
  • Khê Hoang-Xuan
Clinical Study

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.

Keywords

Primary CNS lymphoma Elderly patients Chemotherapy Methotrexate Cytarabine Rituximab Consolidation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

For this type of study, formal consent is not required.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Caroline Houillier
    • 1
    Email author
  • Hervé Ghesquières
    • 2
  • Cécile Chabrot
    • 3
  • Carole Soussain
    • 4
  • Guido Ahle
    • 5
  • Sylvain Choquet
    • 6
  • Emmanuelle Nicolas-Virelizier
    • 2
  • Jacques-Olivier Bay
    • 3
  • Jacques Vargaftig
    • 4
  • Claude Gaultier
    • 5
  • Valérie Touitou
    • 7
  • Nadine Martin-Duverneuil
    • 8
  • Nathalie Cassoux
    • 9
  • Magali Le Garff-Tavernier
    • 10
  • Myrto Costopoulos
    • 10
  • Pierre Faurie
    • 2
  • Khê Hoang-Xuan
    • 1
  1. 1.Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-SalpêtrièreAPHP, Sorbonne Universités UPMC Universités Paris VI, IHU, ICMParis Cedex 13France
  2. 2.Service d’hématologieCentre Léon BérardLyonFrance
  3. 3.Service d’hématologieCHU EstaingClermont-FerrandFrance
  4. 4.Service d’hématologieHôpital René Huguenin-Institut CurieSaint CloudFrance
  5. 5.Service de neurologieHôpitaux Civils de ColmarColmar CedexFrance
  6. 6.Service d’hématologieGroupe Hospitalier Pitié-SalpêtrièreParis Cedex 13France
  7. 7.Service d’ophtalmologieGroupe Hospitalier Pitié-SalpêtrièreParis Cedex 13France
  8. 8.Service de neuroradiologieGroupe Hospitalier Pitié-SalpêtrièreParis Cedex 13France
  9. 9.Service d’ophtalmologie, Institut CurieUniversité Paris VParisFrance
  10. 10.Service d’hématologie biologiqueGroupe Hospitalier Pitié-SalpêtrièreParis Cedex 13France

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