Article
Author: Dierickx, Daan ; Doorduijn, Jeanette K. ; Bohmer, Lara H. ; Veelken, Hendrik ; de Haan, Lorraine M ; Koens, Lianne ; van Rooij, Sjo L M ; Doorduijn, Jeanette K ; de Haan, Lorraine M. ; de Groot, Fleur A ; van den Brand, Michiel ; Terpstra, Valeska ; Jansen, Patty M ; Lam, King H ; Durian, Marc F ; Neelis, Karen J. ; Oostvogels, Rimke S. ; Beeker, Aart ; Bohmer, Lara H ; Sijs-Szabo, Aniko ; Jansen, Patty M. ; Kersten, Marie José ; Oudshoorn, Mirjam A ; Woei-A-Jin, F J Sherida H ; Dekker, Tim J A ; Lam, King H. ; Bromberg, Jacoline C.E. ; Zijlstra, Josée M. ; Zijlstra, Josée M ; Oudshoorn, Mirjam A. ; Nijland, Marcel ; Posthuma, Eduardus F.M. ; Vermaat, Joost S P ; Bromberg, Jacoline C E ; Hamid, Myrurgia Abdul ; de Groot, Fleur A. ; Chamuleau, Martine E D ; Stevens, Wendy B C ; de Groen, Ruben A.L. ; Diepstra, Arjan ; te Boome, Liane C.J. ; Stavast, Jeroen ; Nicolae, Alina ; Durian, Marc F. ; de Weerdt, Okke ; Neelis, Karen J ; de Groen, Ruben A L ; Posthuma, Eduardus F M ; Stevens, Wendy B.C. ; Chamuleau, Martine E.D. ; Tousseyn, Thomas ; Noordenbos, Troy ; van der Poel, Marjolein W M ; Vermaat, Joost S.P. ; van Rooij, Sjo L.M. ; Mühlebner, Angelika ; Dekker, Tim J.A. ; Brink, Mirian ; Te Boome, Liane C J ; Woei-A-Jin, F.J. Sherida H. ; van der Poel, Marjolein W.M. ; Oostvogels, Rimke S ; Böhringer, Stefan
Given the rarity of primary central nervous system lymphoma (PCNSL), evaluations of different high-dose methotrexate-(HD-MTX)-based treatment regimens is sparse. This retrospective, multicenter study evaluates clinical characteristics and outcomes (progression-free, overall and disease-specific survival) after five HD-MTX-based polychemotherapeutic regimens and two consolidation therapies. 346 patients with histologically confirmed PCNSL, treated with ≥ 1 cycle HD-MTX-based strategies (≥3g/m2/cycle) were included. The regimens included MATRIX (HD-MTX, HD-AraC, thiotepa, and rituximab), (R)MBVP±HD-AraC (HD-MTX, teniposide/etoposide, carmustine, prednisolone, ± HD-AraC, ± rituximab), (R)MP (HD-MTX, procarbazine, ± rituximab), and a combination of HD-MTX and HD-AraC. The overall response rate after induction was 69 %, 28 % complete remission and progressive disease was observed in 100 (29 %) patients. 126 (36 %) patients received consolidation, including high-dose-BCNU-thiotepa with autologous stem cell transplantation (HD-BCNU-TT/ASCT, n = 59 (17 %)) or whole brain radiotherapy (WBRT, n = 67 (19 %)). Clinical characteristics associated with adverse mortality risk by multivariable prognostication contained age > 60 years (HR 1.61, p = 0.011), elevated LDH (HR 1.75, p = 0.004) and WHO status ≥ 2 (HR 1.56, p = 0.010). Independently, induction regimens containing HD-AraC demonstrated survival benefit compared to induction regimens without HD-AraC (HR 0.59, p = 0.002). Without preference for HD-BCNU-TT/ASCT or WBRT, a favorable effect of consolidation (HR 0.44 and HR 0.42, p < 0.001) was confirmed, also with consolidation as time-dependent variable. Competing risk analysis showed similar low incidence of lymphoma-unrelated deaths in consolidated and unconsolidated patients. This study confirms that age, elevated LDH and WHO status increase the mortality risk. HD-AraC containing treatment regimens and consolidation with HD-BCU-TT/ASCT or WBRT were associated with superior survival, including a favorable low incidence of lymphoma-unrelated deaths.