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Primary Central Nervous System Lymphoma: Long-Term Treatment Outcomes and Cost-Analysis from a Retrospective Study of High-Dose Methotrexate Based Chemoimmunotherapy and Reduced Dose Radiation Therapy Approach

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Abstract

Standard treatment of primary central nervous system lymphoma (PCNSL) in countries with limited resources remains conventional chemotherapy, with or without whole brain radiotherapy (WBRT). To evaluate the treatment outcomes, prognostic factors and costs in patients with PCNSL treated with high-dose Methotrexate, vincristine and procarbazine, plus Rituximab (MVP-R) followed by consolidation with reduced dose (rd) WBRT and Cytarabine chemotherapy. We conducted an institutional audit of the first line treatment of patients with PCNSL, who were treated with MVP-R regimen, WBRT, or both between September 2011 and January 2020. Long term neuro-cognitive toxicity was recorded on follow up. The 5-year overall survival (OS) was the primary end point. Of 54 patients, 42 were evaluable [median age: 54 years (19–73 years)]. The commonest subtype was activated B-cell subtype (90%). At presentation, multiple and deep brain lesions were reported in 38 and 73% patients, respectively. Combined chemoimmunotherapy was given to 41 patients and WBRT to 29 patients. 27 patients (65%) achieved a complete response, and 22 received rdWBRT. 7 patients with partial response received conventional dose WBRT. Among tested prognostic factors, response to treatment was the single most significant determinant. At a median follow-up of 58 months, the 5-year progression free survival was 42%, and 5-year OS was 60%. The median direct hospital costs incurred by most patients for investigations and treatment were $1976.45 and $12,078.49, respectively. MVP-R is a well-tolerated regimen with substantial long term outcomes. Among all prognostic factors, response to therapy is the most significant.

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Authors and Affiliations

  1. Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160, India

    Radhakrishnan VS, Podder D, Mukherjee H, Mandal P, Nag A, Kumar J, Javed R, Bhave SJ, Chandy M & Nair R

  2. Department of Radiation Oncology, Tata Medical Center, Newtown, Kolkata, 700160, India

    Achari R

  3. Department of Radiology, Tata Medical Center, Newtown, Kolkata, 700160, India

    Sen S

  4. Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160, India

    Dey D, Arun I, Latif Z, Arora N, Parihar M & Mishra DK

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Contributions

Concept and design: RN, VSR, Literature search: DP, HM, RN, VSR, Clinical studies: DP, HM, VSR, SJB, JK, RA, RN, MC, Laboratory and Imaging studies: DD, LZ, IA, DKM, NA, MP, SS, Data acquisition, data analysis: DP, HM, PM, RN, VSR, Manuscript preparation: DP, HM, VSR, RN, Manuscript editing: RN, VSR, Manuscript review: RN, VSR, RA, SS, DD, LZ, IA, Guarantors: MC, RN.

Corresponding author

Correspondence to Nair R.

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Conflicts of Interest

Prof Nair R has received research grants, advisory board fees as well as Speaker fee from Cipla, Freisenius Kabi, Johnson and Johnson, Mylan, Novartis, and Dr Reddy’s Laboratory. Dr. RADHAKRISHNAN V reports advisory fees (institutional) and non-financial Institutional support from PFIZER, Institutional grants and non-financial support from INTAS Pharmaceuticals, Institutional grants from NATCO Pharmaceuticals, Institutional grants from ROCHE, Institutional grants from BMS, Institutional grants and non-financial support from CIPLA Pharmaceuticals, Institutional grants from EMCURE, personal fees (institutional) from ASTRA ZENECA, non-financial institutional support from Dr. REDDY’s Laboratories, outside the submitted work. Other authors declare no relevant conflicts of interest with respect to the submitted work.

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Institutional Review Board (Ethics Committee) waiver number; EC/WV/TMC/58/20. Retrospective study with no patient personal identifiers.

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VS, R., D, P., H, M. et al. Primary Central Nervous System Lymphoma: Long-Term Treatment Outcomes and Cost-Analysis from a Retrospective Study of High-Dose Methotrexate Based Chemoimmunotherapy and Reduced Dose Radiation Therapy Approach. Indian J Hematol Blood Transfus 38, 223–234 (2022). https://doi.org/10.1007/s12288-021-01444-7

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