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Long term outcomes in older patients with primary central nervous system lymphoma: an analysis of the Texas Cancer Registry

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Abstract

Primary central nervous system lymphoma (PCNSL) is an aggressive subtype of non-Hodgkin lymphoma that carries a poor prognosis in the elderly. The aim of this study is to investigate treatment patterns and survival trends in patients ≥ 65 years with PCNSL through data provided by the Texas Cancer Registry. Adults ≥ 65 years diagnosed with PCNSL and followed between 1995–2017 were identified and separated into three eras: 1995–2003, 2004–2012, and 2013–2017. Baseline covariates compared included patient demographics and treatments administered. Pearson’s chi-squared test and Cox proportional hazard models compared covariates; overall survival (OS) and disease-specific survival (DSS) were assessed via Kaplan–Meier methodology. There were 375 patients; 104 (27.7%) in 1995–2003, 146 (38.9%) in 2004–2012, and 125 (33.3%) in 2013–2017. There were 50 (48.1%), 55 (37.7%), and 31 (24.8%) in 1995–2003, 2004–2012, and 2013–2017, respectively, that did not receive treatment. At last follow up, 101 (97.1%), 130 (89.0%), and 94 (75.2%) in each era died, of which 89 (85.6%), 112 (76.7%), and 70 (56.0%) were attributed to PCNSL. Median OS per era was eight (95% confidence interval [CI] 5.06–10.93), six (95% CI, 2.30–9.69), and five months (95% CI, 2.26–7.73) (p = 0.638). DSS per era was nine (95% CI: 0.00, 26.53), 10 (95% CI: 5.14, 14.86), and 19 (95% CI, 0.00–45.49) (p = 0.931) months. Spinal cord as primary disease site (HR: 0.668 [95% CI, 0.45–0.99], p = 0.049), and chemotherapy (HR 0.532 [95% CI, 0.42–0.673], p =  < 0.001) or chemotherapy + radiation (HR, 0.233 [95% CI, 0.11–0.48] p < 0.001) had better outcomes compared to no therapy or radiation therapy alone. Survival in older patients ≥ 65 with PCNSL has not improved per our analysis of the TCR from 1995–2017 despite increasing trends of treatment utilization. Strategies to augment recruitment of older individuals in trials are needed in order to determine who would derive treatment benefit and minimize treatment toxicities.

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Abbreviations

PCNSL:

Primary central nervous system lymphoma

OS:

Overall survival

DSS:

Disease specific survival

CI:

Confidence interval

NHL:

Non-Hodgkin Lymphoma

CNS:

Central nervous system

US:

United States

WBRT:

Whole brain radiation therapy

Auto-HCT:

Autologous hematopoietic stem cell transplantation

HD-MTX:

High dose methotrexate

TCR:

Texas Cancer Registry

SEER:

Surveillance, Epidemiology, and End Results

NPCR:

National Program of Cancer registries

NOS:

Not otherwise specified

SPC:

Second primary cancer

COPD:

Chronic obstructive pulmonary disease

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Authors and Affiliations

  1. Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main Street, Outpatient Center, 24Th Floor, Houston, TX, 77030, USA

    Ethan A. Burns, Cesar Gentille Sanchez, Sunil Mathur, Carlo Guerrero, Shilpan S. Shah, Siddhartha Ganguly & Sai Ravi Kiran Pingali

  2. Department of Medicine, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA

    Ibrahim N. Muhsen & Humaira Sarfraz

  3. Center for Translational Research in Hematologic Malignancies, Neal Cancer Center, Houston Methodist Research Institute, 6550 Fannin St., Houston, TX, 77030, USA

    Chih-Chi Andrew Hu & Chih-Hang Anthony Tang

  4. Department of Neurosurgery and Neuro-Oncology, Houston Methodist Hospital, 6445 Main Street, Outpatient Center, 24Th Floor, Houston, TX, 77030, USA

    Ivo W. Tremont

  5. Department of Radiation Oncology, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA

    Bin Teh

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  1. Ethan A. Burns
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Contributions

Ethan Burns: Conceptualization, methodology, data curation, investigation, original draft preparation, data visualization, reviewing and editing; Cesar Gentille Sanchez: Conceptualization, methodology, reviewing and editing; Sunil Mathur: Methodology, Validation, formal analysis, reviewing and editing; Carlo Guerrero, Ibrahim N. Muhsen, Humaira Sarfraz, Chih-Chi Andrew Hu, Chih-Hang Anthony Tang, Shilpan S. Shah, Ivo W. Tremont, Bin Teh, and Siddhartha Ganguly: Conceptualization, methodology, Reviewing and editing; Sai Ravi Kiran Pingali: Conceptualization, methodology, reviewing and editing, supervision.

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Correspondence to Sai Ravi Kiran Pingali.

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The authors have no competing or financial interests to disclose.

Ethical approval

Since this was a retrospective database study with data provided by the Texas Cancer Registry, informed consent was not obtained by individual subjects. All data was released as an aggregate of de-identified data by the Texas Cancer Registry following approval of a written protocol in order to protect patient confidentiality.

Conflicts of interest

EAB declares that he has no conflict of interest. CGS declares that he has no conflict of interest. SM declares that he has no conflict of interest. CG declares that he has no conflict of interest. INM declares that he has no conflict of interest. HS declares that she has no conflict of interest. CCAH declares that he has no conflict of interest. CHAT declares that he has no conflict of interest. SSS declares that he has no conflict of interest. IWT declares that he has no conflict of interest. BT declares that he has no conflicts of interest. SG declares that he has no conflict of interest. SRP declares that he has no conflict of interest.

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Burns, E.A., Sanchez, C.G., Mathur, S. et al. Long term outcomes in older patients with primary central nervous system lymphoma: an analysis of the Texas Cancer Registry. Ann Hematol 102, 1111–1120 (2023). https://doi.org/10.1007/s00277-023-05140-6

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