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A single-center retrospective analysis of outcome measures and consolidation strategies for relapsed and refractory primary CNS lymphoma

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Abstract

Background

Relapsed or refractory primary CNS lymphoma (rrPCNSL) is a rare and challenging malignancy for which better evidence is needed to guide management.

Methods

We present a retrospective cohort of 66 consecutive patients with rrPCNSL treated at the University of Washington between 2000 and 2020. Immunosuppressed and secondary CNS lymphoma patients were excluded.

Results

During a median follow-up of 40.5 months from initial diagnosis, median OS for relapsed disease was 14.1 (0.2–88.5) months and median PFS was 11.0 (0.2–73.9) months. At diagnosis (r2 = 0.85, p < 0.001), first relapse (r2 = 0.69, p < 0.001), multiple relapses (r2 = 0.97, p < 0.001) PFS was highly correlated with OS. In contrast, there was no correlation between the duration of subsequent progression-free intervals. No difference in PFS or OS was seen between CSF or intraocular relapse and parenchymal relapse. Patients reinduced with high-dose methotrexate-based (HD-MTX) regimens had an overall response rate (ORR) of 86.7%. Consolidation with autologous stem cell transplant (ASCT) was associated with longer PFS compared to either no consolidation (p = 0.01) and trended to longer PFS when compared to other consolidation strategies (p = 0.06). OS was similarly improved in patients consolidated with ASCT compared with no consolidation (p = 0.04), but not compared with other consolidation (p = 0.22). Although patients receiving ASCT were younger, KPS, sex, and number of recurrences were similar between consolidation groups. A multivariate analysis confirmed an independent effect of consolidation group on PFS (p = 0.01), but not OS.

Conclusions

PFS may be a useful surrogate endpoint which predicts OS in PCNSL. Consolidation with ASCT was associated with improved PFS in rrPCNSL.

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Funding

This study was supported in part by NINDS NS079200 (AVB).

Author information

Authors and Affiliations

  1. Department of Neurology, University of Washington, Seattle, WA, USA

    Alipi V. Bonm

  2. Medical Scientist Training Program, University of Washington, Seattle, WA, USA

    Alec W. Gibson

  3. Departments of Neurology and Neurosurgery, Alvord Brain Tumor Center, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Tresa McGranahan, Lynne P. Taylor & Jerome J. Graber

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Leona A. Holmberg & Marco Mielcarek

  5. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Leona A. Holmberg & Marco Mielcarek

Authors
  1. Alipi V. Bonm
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  2. Alec W. Gibson
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  3. Leona A. Holmberg
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  4. Marco Mielcarek
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  5. Tresa McGranahan
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  6. Lynne P. Taylor
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  7. Jerome J. Graber
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Correspondence to Jerome J. Graber.

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This study was approved by the institutional review board (STUDY00006927).

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Bonm, A.V., Gibson, A.W., Holmberg, L.A. et al. A single-center retrospective analysis of outcome measures and consolidation strategies for relapsed and refractory primary CNS lymphoma. J Neurooncol 151, 193–200 (2021). https://doi.org/10.1007/s11060-020-03648-9

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  • DOI: https://doi.org/10.1007/s11060-020-03648-9

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