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Outcome of patients with newly diagnosed primary CNS lymphoma after high-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine: an 8-year cohort study
International Journal of Clinical Oncology ( IF 3.3 ) Pub Date : 2021-07-08 , DOI: 10.1007/s10147-021-01982-0
Pokpong Piriyakhuntorn 1 , Thanawat Rattanathammethee 1 , Sasinee Hantrakool 1 , Chatree Chai-Adisaksopha 1 , Ekarat Rattarittamrong 1 , Adisak Tantiworawit 1 , Lalita Norasetthada 1
Affiliation  

Background

Addition of cytarabine to high-dose methotrexate (HD-MTX) chemotherapy improves outcome of primary CNS lymphoma (PCNSL); however, the combination therapy increases toxicity. Sequential chemotherapy and cranial radiation may decrease toxicity without altering efficacy.

Methods

This was a single-center, retrospective cohort study of consecutive newly diagnosed immunocompetent PCNSL patients treated with HD-MTX (5 cycles of 3 g/m2 every 2 weeks) followed by consolidation whole-brain radiotherapy (WBRT) and cytarabine (2 cycles of 3 g/m2/d for 2 days every 3 weeks) from January 2013 to December 2020. Initial WBRT before HD-MTX was allowed in patients with significant disability or brain edema at presentation. Primary outcome was progression-free survival (PFS). Key secondary outcomes were response rate, treatment-related toxicity, and overall survival (OS).

Results

Of 41 patients, 25 patients had a complete response (CR) and ten patients had a partial response, inferring an overall response rate (ORR) of 85.4% and a CR rate of 60.9%. More than 90% of patients were able to tolerate and complete the HD-MTX. The incidence of ≥ grade 3 hematologic and non-hematologic toxicities were 4.8% and 17.1%, respectively. Treatment-related mortality rate was 2.4%. There was no difference in toxicity between patients with age < 60 and ≥ 60 years. At the median follow-up duration of 39.8 months, the median PFS was 35.2 months (95% CI 12.4–69.3) and median OS was 46.5 months (95% CI 21.8–NR).

Conclusion

High-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine has acceptable efficacy, great tolerability, and low toxicity in newly diagnosed PCNSL patients.



中文翻译:

新诊断的原发性中枢神经系统淋巴瘤患者接受大剂量甲氨蝶呤联合全脑放疗和阿糖胞苷联合治疗后的结果:一项为期 8 年的队列研究

背景

在大剂量甲氨蝶呤 (HD-MTX) 化疗中加入阿糖胞苷可改善原发性中枢神经系统淋巴瘤 (PCNSL) 的预后;然而,联合治疗会增加毒性。序贯化疗和颅脑放疗可在不改变疗效的情况下降低毒性。

方法

这是一项单中心、回顾性队列研究,连续新诊断的免疫功能正常的 PCNSL 患者接受 HD-MTX(5 个周期,每 2 周一次,每次3 g/m 2),随后进行巩固全脑放疗 (WBRT) 和阿糖胞苷(2 个周期)从 2013 年 1 月到 2020 年 12 月,每 3 周一次,每次3 g/m 2 /d,连续 2 天。对于出现严重残疾或脑水肿的患者,允许在 HD-MTX 之前进行初始 WBRT。主要结果是无进展生存期(PFS)。关键的次要结果是反应率、治疗相关毒性和总生存期 (OS)。

结果

在 41 名患者中,25 名患者完全缓解 (CR),10 名患者部分缓解,推断总缓解率 (ORR) 为 85.4%,CR 率为 60.9%。超过 90% 的患者能够耐受并完成 HD-MTX。≥ 3 级血液学和非血液学毒性的发生率分别为 4.8% 和 17.1%。治疗相关死亡率为 2.4%。年龄< 60 岁和≥ 60 岁的患者之间的毒性没有差异。中位随访时间为 39.8 个月,中位 PFS 为 35.2 个月(95% CI 12.4-69.3),中位 OS 为 46.5 个月(95% CI 21.8-NR)。

结论

大剂量甲氨蝶呤联合全脑放疗联合阿糖胞苷对初诊 PCNSL 患者具有可接受的疗效、良好的耐受性和低毒性。

更新日期:2021-07-08
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