Data on older patients with primary central nervous system lymphoma (PCNSL) are scarce. Comorbidities and performance status frequently compromise outcomes in this group. Medical records for consecutive patients ≥65 years (n  = 244) with PCNSL diagnosed 2012–2017 from 14 UK centres were retrospectively reviewed. Of these 192 patients received methotrexate (MTX)‐based treatment. Patients were categorised based on clinician's treatment choice into ‘palliative’ (n  = 52), ‘less intensive: MTX ± rituximab ± alkylators’ (n  = 74) and ‘intensive: MTX/cytarabine combinations’ (n  = 118) groups. Complete remission (CR) rate, two‐year progression‐free survival (PFS) and overall survival (OS) rates were 49%, 11% and 24% for the less intensive and 69%, 40% and 50% for the intensive groups. Treatment‐related mortality (TRM) was 6·8% for MTX‐treated patients. Median MTX cumulative dose was 8·8 g/m² (range 1·5–21) over a median of three cycles. Higher relative dose intensity of MTX (MTX‐RDI) was associated with improved PFS and OS in both groups adjusting for age, Eastern cooperative oncology group (ECOG) score and baseline parameters. Two‐year PFS and OS for patients receiving four or more induction cycles followed by consolidation (n  = 36) were 65% and 70% respectively. Older patients completing MTX‐based induction and consolidation had clinical outcomes similar to those in younger cohorts. These retrospective data suggest that maximising MTX‐RDI and delivering consolidation in a subgroup of older patients may improve clinical outcomes.

中文翻译：

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在英国的常规临床实践中治疗的患有原发性中枢神经系统淋巴瘤的老年患者的结局：甲氨蝶呤的剂量强度与反应和生存率相关。

关于老年原发性中枢神经系统淋巴瘤（PCNSL）患者的数据很少。合并症和表现状态经常损害该组的结果。 回顾性分析了来自英国14个中心的2012年至2017年诊断为PCNSL的连续≥65岁患者（n = 244）的病历。在这192名患者中，接受了甲氨蝶呤（MTX）治疗。患者被归类基于临床医生的治疗选择成“姑息”（ñ  = 52），“较不密集：MTX±利妥昔单抗±烷化剂”（ñ  = 74）和“密集：MTX /阿糖胞苷组合”（Ñ = 118）组。完全缓解（CR）率，两年无进展生存率（PFS）和总体生存率（OS）分别为低强度人群49％，11％和24％，高强度人群69％，40％和50％ 。经MTX治疗的患者的治疗相关死亡率（TRM）为6·8％。在三个周期的中位数中值，MTX累积剂量中位数为8·8 g / m ²（范围为1·5-21）。调整年龄，东部合作肿瘤学组（ECOG）评分和基线参数后，两组中较高的MTX相对剂量强度（MTX-RDI）与PFS和OS改善有关。为期两年的PFS和OS用于接收四个或更多的感应周期的患者，然后合并（ñ = 36）分别为65％和70％。完成基于MTX的诱导和巩固的老年患者的临床结局与年轻人群相似。这些回顾性数据表明，在部分老年患者中最大化MTX-RDI并实现巩固治疗可以改善临床疗效。