Author(s): Lim Y.J.; Smith J.
Source: Haematologica; Jun 2017; vol. 102 ; p. 699
Publication Date: Jun 2017
Publication Type(s): Conference Abstract
Available in full text at Haematologica – from Highwire Press
Available in full text at Haematologica [Haematologica] NLMUID: 0417435 – from EBSCOhost
Available in full text at Haematologica – from Directory of Open Access Journals
Available in full text at Haematologica – from National Library of Medicine
Abstract:Background: Combination chemotherapy incorporating high dose methotrexate (HD-Mtx) and high dose cytarabine (Ara-C) is the standard chemotherapeutic approach for newly diagnosed primary CNS lymphoma (PCNSL). However, patients >60 years old account for 50% of cases and combining HD-Mtx with Ara-C can be associated with high toxicity and early mortality. The management of secondary CNS lymphoma (SCNSL) is less clear, but is often based upon a similar approach. Aims: We present a tertiary centre experience in management of primary (PCNSL) and secondary CNS lymphoma (SCNSL), with therapy based on comorbidities and performance status. Methods: We performed a retrospective analysis of patients with a diagnosis of CNS lymphoma seen at our centre between 2011 and 2016. These were categorized into 3 groups, Group 1: treatment of newly diagnosed PCNSL prior to September 2014 where majority of patients received HD-Mtx & Ara-C combination chemotherapy, Group 2: treatment of PCNSL after September 2014 where patients were selected based on co-morbidities to receive Mtx with or without Ara-C, Group 3: treatment of newly diagnosed SCNSL. The median survival for each group was estimated using the Kaplan-Meier method and logranked test. Overall response rates, 30 day and 90 day survival between groups 1 & 2 were compared using unpaired t test. Results: 60 pts with a median age of 65 years old were recruited. 40 pts were diagnosed to have PCNSL at presentation, while 20 patients had SCNSL. 5 pts were excluded from this study as they did not receive any treatment. In group 1, 21 pts (84%) received combination chemotherapy incorporating HDMTX and Ara-C, 3 pts (12%) received HD-MTX monotherapy and 1 pt (4%) received radiotherapy only. In group 2, 7 pts (53.8%) received HD-MTX and Ara-C as part of MATRix protocol or with single agent rituximab, 3 pts (23%) received HD-MTX as part of RMP protocol or with single agent rituximab, 1 pt (7.7%) received a single alkylating agent and 1 pt (7.7%) received radiotherapy only. In group 3 15 pts (88.3%) received chemotherapy incorporating HD-MTX and Ara-C, 2 pt (11.8%) received HD-MTX without Ara-C. 30 day mortality was 7 (28%) in group 1 and 0 in group 2 (0%) (p=0.03). 90 day mortality was 7 (28%) in group 1 and 2 in group 2 (15.4%) (p=0.39). Overall response rate was 9 (36%) in group 1 and 8 (61.5%) in group 2 (p= 0.13). A Kaplan Meier curve of all 3 groups is illustrated in Figure 1 below. (Figure presented). Summary/Conclusions: This single centre study demonstrated that patient selection, based upon comorbidities and performance status, for high dose combination chemotherapy in the treatment of PCNSL improves 30 day mortality, often associated with death from myelosuppression due to chemotherapy. The overall response rate, with appropriate selection of combination chemotherapy regimens, was improved. This also applies to patients with SCNSL in subgroup analysis. Longer follow up of patients will be needed to further demonstrate an overall survival benefit.