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28-06-2022 | Lymphoma | Research

Consolidation regimens in primary central nervous system lymphoma: a single-center retrospective cohort evaluating survival outcomes and cost–benefit analysis

Authors: Savannah Gelhard, Amiee Maxwell, Howard Colman, Adam L. Cohen, Joe S. Mendez

Published in: Journal of Neuro-Oncology | Issue 2/2022

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Abstract

Purpose

Optimal treatment for primary central nervous system lymphoma (PCNSL) comprises polychemotherapy induction with high-dose methotrexate followed by consolidation therapy, but there is no standard treatment regimen because of a lack of comparative trials examining efficacy or relative value. We performed a retrospective outcome and relative cost analysis on consolidation regimens to gain perspective on how cost and benefit can be weighed in medical decisions for patients with PCNSL.

Methods

Patients with newly diagnosed PCNSL who completed consolidation at our institution from July 1, 2012, to March 1, 2019, were included. Patients completed etoposide/cytarabine (EA), high-dose cytarabine (HIDAC), or high-dose chemotherapy with autologous stem-cell rescue (HDC-ASCR) as consolidation regimen. Data were collected from the electronic medical record and our institution’s Value Driven Outcomes tool. Survival was analyzed as date of diagnosis to last known date of survival.

Results

Of the 22 patients included in the study, 12 completed the EA regimen, 4 completed HDC-ASCR, and 6 completed HIDAC. Facility and pharmacy costs contributed most to the cost of each treatment. HDC-ASCR treatment was 50× the cost of the cheapest treatment, HIDAC. Outcomes were numerically superior with HDC-ASCR and HIDAC compared with EA (2-year progression-free survival 100% vs. 100% vs. 63.6%, respectively, p = 0.1915).

Conclusion

This small retrospective cost–benefit analysis provides evidence that HDC-ASCR may be a superior treatment for PCNSL but at a higher cost than other consolidation regimens. HIDAC may increase value for patients, including elderly patients, who are not appropriate candidates for HDC-ASCR when compared with EA.
Literature
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go back to reference Ferreri AJM, Cwynarski K, Pulczynski E et al (2017) Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal L. Lancet Haematol 4:e510–e523. https://doi.org/10.1016/S2352-3026(17)30174-6CrossRefPubMed Ferreri AJM, Cwynarski K, Pulczynski E et al (2017) Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal L. Lancet Haematol 4:e510–e523. https://​doi.​org/​10.​1016/​S2352-3026(17)30174-6CrossRefPubMed
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Metadata
Title
Consolidation regimens in primary central nervous system lymphoma: a single-center retrospective cohort evaluating survival outcomes and cost–benefit analysis
Authors
Savannah Gelhard
Amiee Maxwell
Howard Colman
Adam L. Cohen
Joe S. Mendez
Publication date
28-06-2022
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 2/2022
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-022-04064-x

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