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01-11-2010 | Original Article

A nonradiation-containing, intermediate-dose methotrexate regimen for elderly patients with primary central nervous system lymphoma

Authors: Kennichi Taoka, Yasushi Okoshi, Noriaki Sakamoto, Shingo Takano, Akira Matsumura, Yuichi Hasegawa, Shigeru Chiba

Published in: International Journal of Hematology | Issue 4/2010

Abstract

To assess the efficacy, acute toxicity, and delayed neurotoxicity of intermediate-dose methotrexate (MTX)-containing chemotherapy without whole-brain radiotherapy in the treatment of elderly patients with primary central nervous system lymphoma (PCNSL), we conducted a retrospective analysis of elderly patients (N = 17; median age 67) with newly diagnosed PCNSL who were treated with chemotherapy alone at Tsukuba University Hospital from January 2005 to December 2009. Induction therapy consisted of intravenous intermediate-dose MTX (1 g/m²), ranimustine, procarbazine, methylprednisolone, and intrathecal MTX and cytarabine. Patients who achieved complete response (CR) or partial response (PR) received 5 cycles of maintenance therapy every 6 weeks. All patients in this study achieved CR or PR and received maintenance therapy. Overall survival (OS) and progression-free survival (PFS) were 100 and 80% at 1 year, and 61 and 43% at 2 years, respectively. The median OS and PFS were 36 and 20 months, respectively. Delayed neurotoxicity did not develop in any patient before lymphoma progression. In terms of response rate, OS, and PFS, the nonradiation-containing, intermediate-dose MTX-containing protocol used in elderly Japanese patients was comparable to previous protocols that consisted of more intensive chemotherapy. Acute and delayed toxicities were manageable and quality of life was maintained until progression.

Hochberg FH, Baehring JM, Hochberg EP. Primary CNS lymphoma. Nat Clin Pract Neurol. 2007;3(1):24–35.CrossRefPubMed

Nelson DF, Martz KL, Bonner H, Nelson JS, Newall J, Kerman HD, et al. Non-Hodgkin’s lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys. 1992;23(1):9–17.PubMed

Reni M, Ferreri AJ, Guha-Thakurta N, Blay JY, Dell’Oro S, Biron P, et al. Clinical relevance of consolidation radiotherapy and other main therapeutic issues in primary central nervous system lymphomas treated with upfront high-dose methotrexate. Int J Radiat Oncol Biol Phys. 2001;51(2):419–25.PubMed

Bessell EM, Graus F, Lopez-Guillermo A, Villa S, Verger E, Petit J, et al. CHOD/BVAM regimen plus radiotherapy in patients with primary CNS non-Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys. 2001;50(2):457–64.CrossRefPubMed

Abrey LE, Yahalom J, DeAngelis LM. Treatment for primary CNS lymphoma: the next step. J Clin Oncol. 2000;18(17):3144–50.PubMed

DeAngelis LM, Seiferheld W, Schold SC, Fisher B, Schultz CJ. Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93–10. J Clin Oncol. 2002;20(24):4643–8.CrossRefPubMed

Braaten KM, Betensky RA, de Leval L, Okada Y, Hochberg FH, Louis DN, et al. BCL-6 expression predicts improved survival in patients with primary central nervous system lymphoma. Clin Cancer Res. 2003;9(3):1063–9.PubMed

Herrlinger U, Schabet M, Clemens M, Kortmann RD, Petersen D, Will BE, et al. Clinical presentation and therapeutic outcome in 26 patients with primary CNS lymphoma. Acta Neurol Scand. 1998;97(4):257–64.CrossRefPubMed

Fine HA, Mayer RJ. Primary central nervous system lymphoma. Ann Intern Med. 1993;119(11):1093–104.PubMed

10.

Miller DC, Hochberg FH, Harris NL, Gruber ML, Louis DN, Cohen H. Pathology with clinical correlations of primary central nervous system non-Hodgkin’s lymphoma. The Massachusetts General Hospital experience 1958–1989. Cancer. 1994;74(4):1383–97.CrossRefPubMed

11.

Panageas KS, Elkin EB, DeAngelis LM, Ben-Porat L, Abrey LE. Trends in survival from primary central nervous system lymphoma, 1975–1999: a population-based analysis. Cancer. 2005;104(11):2466–72.CrossRefPubMed

12.

Hoang-Xuan K, Taillandier L, Chinot O, Soubeyran P, Bogdhan U, Hildebrand J, et al. Chemotherapy alone as initial treatment for primary CNS lymphoma in patients older than 60 years: a multicenter phase II study (26952) of the European Organization for Research and Treatment of Cancer Brain Tumor Group. J Clin Oncol. 2003;21(14):2726–31.CrossRefPubMed

13.

Hider SL, Bruce IN, Thomson W. The pharmacogenetics of methotrexate. Rheumatology (Oxford). 2007;46(10):1520–4.CrossRef

14.

Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J. 1965;14:61–5.PubMed

15.

Pact V, Sirotkin-Roses M, Beatus J. The muscle testing handbook. Boston: Little Brown; 1984.

16.

Abrey LE, Batchelor TT, Ferreri AJ, Gospodarowicz M, Pulczynski EJ, Zucca E, et al. Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol. 2005;23(22):5034–43.CrossRefPubMed

17.

Correa DD, DeAngelis LM, Shi W, Thaler H, Glass A, Abrey LE. Cognitive functions in survivors of primary central nervous system lymphoma. Neurology. 2004;62(4):548–55.PubMed

18.

Omuro AM, Ben-Porat LS, Panageas KS, Kim AK, Correa DD, Yahalom J, et al. Delayed neurotoxicity in primary central nervous system lymphoma. Arch Neurol. 2005;62(10):1595–600.CrossRefPubMed

19.

Abrey LE, DeAngelis LM, Yahalom J. Long-term survival in primary CNS lymphoma. J Clin Oncol. 1998;16(3):859–63.PubMed

20.

Shah GD, Yahalom J, Correa DD, Lai RK, Raizer JJ, Schiff D, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol. 2007;25(30):4730–5.CrossRefPubMed

21.

Yilmaz M, Erkutlu I, Kilciksiz S, Pehlivan M, Okan V, Alptekin M, et al. Modified IDARAM chemotherapy regimen for primary central nervous system lymphoma: experience of three cases. Hematology. 2008;13(2):107–13.CrossRefPubMed

22.

Freilich RJ, Delattre JY, Monjour A, DeAngelis LM. Chemotherapy without radiation therapy as initial treatment for primary CNS lymphoma in older patients. Neurology. 1996;46(2):435–9.PubMed

23.

Ng S, Rosenthal MA, Ashley D, Cher L. High-dose methotrexate for primary CNS lymphoma in the elderly. Neuro Oncol. 2000;2(1):40–4.PubMed

24.

McAllister LD, Doolittle ND, Guastadisegni PE, Kraemer DF, Lacy CA, Crossen JR et al. Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma. Neurosurgery. 2000;46(1):51–60 (discussion 60–1).

25.

Illerhaus G, Marks R, Muller F, Ihorst G, Feuerhake F, Deckert M, et al. High-dose methotrexate combined with procarbazine and CCNU for primary CNS lymphoma in the elderly: results of a prospective pilot and phase II study. Ann Oncol. 2009;20(2):319–25.CrossRefPubMed

Title: A nonradiation-containing, intermediate-dose methotrexate regimen for elderly patients with primary central nervous system lymphoma
Authors: Kennichi Taoka
Yasushi Okoshi
Noriaki Sakamoto
Shingo Takano
Akira Matsumura
Yuichi Hasegawa
Shigeru Chiba
Publication date: 01-11-2010
Publisher: Springer Japan
Published in: International Journal of Hematology / Issue 4/2010
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI: https://doi.org/10.1007/s12185-010-0703-9

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