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Published in: International Journal of Hematology 3/2023

01-07-2023 | Methotrexate | Original Article

Treatment of new-onset primary central nervous system lymphoma in elderly patients using RMPV chemotherapy: a single-institution experience

Authors: Michiharu Yoshida, Takeharu Kato, Takeshi Hiu, Yoshitaka Imaizumi, Simpei Morimoto, Daisuke Niino, Susumu Yamaguchi, Shiro Baba, Kenta Ujifuku, Koichi Yoshida, Ayaka Matsuo, Yoichi Morofuji, Tsuyoshi Izumo, Shinji Okano, Yasushi Miyazaki, Takayuki Matsuo

Published in: International Journal of Hematology | Issue 3/2023

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Abstract

The prognosis of primary central nervous system lymphoma (PCNSL) in the elderly remains poor. We aimed to evaluate the outcome of rituximab, methotrexate, procarbazine, and vincristine (RMPV) chemotherapy in elderly patients with new-onset PCNSL. Twenty-eight patients aged ≥ 70 years treated for PCNSL between 2010 and 2020 were examined retrospectively. Nineteen patients received RMPV and nine did not qualify. Patients received five to seven cycles of RMPV plus response-adapted whole-brain radiotherapy (WBRT) and cytarabine. Ten of the 19 patients who received RMPV (52.6%) completed the induction, but only four patients (21.1%) completed RMPV chemotherapy, WBRT 23.4 Gy, and cytarabine. Median progression-free survival (PFS) and overall survival (OS) in the RMPV group was 54.4 and 85.0 months, respectively. Both PFS and OS were significantly longer in patients who received RMPV chemotherapy than in those who did not, and in patients who started but did not complete RMPV than in those who did not receive RMPV. Patients who received incomplete RMPV tended to have a favorable prognosis. Initial treatment with RMPV chemotherapy was effective in elderly patients with PCNSL. Adjusting the number of courses of RMPV may improve the prognosis of elderly patients with PCNSL, but further verification is necessary.
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Literature
1.
go back to reference van der Meulen M, et al. Improved survival in primary central nervous system lymphoma up to age 70 only: a population-based study on incidence, primary treatment and survival in the Netherlands, 1989–2015. Leukemia. 2017;31(8):1822–5.CrossRefPubMed van der Meulen M, et al. Improved survival in primary central nervous system lymphoma up to age 70 only: a population-based study on incidence, primary treatment and survival in the Netherlands, 1989–2015. Leukemia. 2017;31(8):1822–5.CrossRefPubMed
2.
3.
go back to reference Eloranta S, et al. Increasing incidence of primary central nervous system lymphoma but no improvement in survival in Sweden 2000–2013. Eur J Haematol. 2018;100(1):61–8.CrossRefPubMed Eloranta S, et al. Increasing incidence of primary central nervous system lymphoma but no improvement in survival in Sweden 2000–2013. Eur J Haematol. 2018;100(1):61–8.CrossRefPubMed
4.
go back to reference Kasenda B, et al. First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)–a systematic review and individual patient data meta-analysis. Ann Oncol. 2015;26(7):1305–13.CrossRefPubMedPubMedCentral Kasenda B, et al. First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)–a systematic review and individual patient data meta-analysis. Ann Oncol. 2015;26(7):1305–13.CrossRefPubMedPubMedCentral
5.
go back to reference Mendez JS, et al. The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades. Neuro Oncol. 2018;20(5):687–94.CrossRefPubMed Mendez JS, et al. The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades. Neuro Oncol. 2018;20(5):687–94.CrossRefPubMed
6.
go back to reference van der Meulen M, et al. Primary therapy and survival in patients aged over 70-years-old with primary central nervous system lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Haematologica. 2021;106(2):597–600.CrossRefPubMed van der Meulen M, et al. Primary therapy and survival in patients aged over 70-years-old with primary central nervous system lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Haematologica. 2021;106(2):597–600.CrossRefPubMed
7.
go back to reference Morris PG, et al. Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome. J Clin Oncol. 2013;31(31):3971–9.CrossRefPubMedPubMedCentral Morris PG, et al. Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome. J Clin Oncol. 2013;31(31):3971–9.CrossRefPubMedPubMedCentral
8.
go back to reference Shah GD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol. 2007;25(30):4730–5.CrossRefPubMed Shah GD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol. 2007;25(30):4730–5.CrossRefPubMed
9.
go back to reference Abrey LE, 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 Abrey LE, 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
10.
go back to reference Abrey LE, et al. Primary central nervous system lymphoma: the Memorial Sloan-Kettering Cancer Center prognostic model. J Clin Oncol. 2006;24(36):5711–5.CrossRefPubMed Abrey LE, et al. Primary central nervous system lymphoma: the Memorial Sloan-Kettering Cancer Center prognostic model. J Clin Oncol. 2006;24(36):5711–5.CrossRefPubMed
11.
go back to reference Laack NN, et al. Whole-brain radiotherapy and high-dose methylprednisolone for elderly patients with primary central nervous system lymphoma: Results of North Central Cancer Treatment Group (NCCTG) 96–73-51. Int J Radiat Oncol Biol Phys. 2006;65(5):1429–39.CrossRefPubMed Laack NN, et al. Whole-brain radiotherapy and high-dose methylprednisolone for elderly patients with primary central nervous system lymphoma: Results of North Central Cancer Treatment Group (NCCTG) 96–73-51. Int J Radiat Oncol Biol Phys. 2006;65(5):1429–39.CrossRefPubMed
13.
go back to reference Roth P, et al. Outcome of elderly patients with primary CNS lymphoma in the G-PCNSL-SG-1 trial. Neurology. 2012;79(9):890–6.CrossRefPubMed Roth P, et al. Outcome of elderly patients with primary CNS lymphoma in the G-PCNSL-SG-1 trial. Neurology. 2012;79(9):890–6.CrossRefPubMed
14.
go back to reference Schmitt AM, et al. Rituximab in primary central nervous system lymphoma-A systematic review and meta-analysis. Hematol Oncol. 2019;37(5):548–57.CrossRefPubMed Schmitt AM, et al. Rituximab in primary central nervous system lymphoma-A systematic review and meta-analysis. Hematol Oncol. 2019;37(5):548–57.CrossRefPubMed
15.
go back to reference Fritsch K, et al. Immunochemotherapy with rituximab, methotrexate, procarbazine, and lomustine for primary CNS lymphoma (PCNSL) in the elderly. Ann Oncol. 2011;22(9):2080–5.CrossRefPubMed Fritsch K, et al. Immunochemotherapy with rituximab, methotrexate, procarbazine, and lomustine for primary CNS lymphoma (PCNSL) in the elderly. Ann Oncol. 2011;22(9):2080–5.CrossRefPubMed
16.
17.
go back to reference Houillier C, et al. Rituximab, methotrexate, procarbazine, vincristine and intensified cytarabine consolidation for primary central nervous system lymphoma (PCNSL) in the elderly: a LOC network study. J Neurooncol. 2017;133(2):315–20.CrossRefPubMed Houillier C, et al. Rituximab, methotrexate, procarbazine, vincristine and intensified cytarabine consolidation for primary central nervous system lymphoma (PCNSL) in the elderly: a LOC network study. J Neurooncol. 2017;133(2):315–20.CrossRefPubMed
18.
go back to reference Makino K, et al. Prognostic impact of completion of initial high-dose methotrexate therapy on primary central nervous system lymphoma: a single institution experience. Int J Clin Oncol. 2015;20(1):29–34.CrossRefPubMed Makino K, et al. Prognostic impact of completion of initial high-dose methotrexate therapy on primary central nervous system lymphoma: a single institution experience. Int J Clin Oncol. 2015;20(1):29–34.CrossRefPubMed
19.
go back to reference Schorb E, et al. High-dose chemotherapy and autologous stem cell transplant in elderly patients with primary CNS lymphoma: a pilot study. Blood Adv. 2020;4(14):3378–81.CrossRefPubMedPubMedCentral Schorb E, et al. High-dose chemotherapy and autologous stem cell transplant in elderly patients with primary CNS lymphoma: a pilot study. Blood Adv. 2020;4(14):3378–81.CrossRefPubMedPubMedCentral
20.
go back to reference Bairey O, Siegal T. The possible role of maintenance treatment for primary central nervous system lymphoma. Blood Rev. 2018;32(5):378–86.CrossRefPubMed Bairey O, Siegal T. The possible role of maintenance treatment for primary central nervous system lymphoma. Blood Rev. 2018;32(5):378–86.CrossRefPubMed
21.
go back to reference Vu K, et al. Low-dose lenalidomide maintenance after induction therapy in older patients with primary central nervous system lymphoma. Br J Haematol. 2019;186(1):180–3.CrossRefPubMedPubMedCentral Vu K, et al. Low-dose lenalidomide maintenance after induction therapy in older patients with primary central nervous system lymphoma. Br J Haematol. 2019;186(1):180–3.CrossRefPubMedPubMedCentral
22.
go back to reference Grommes C, et al. Introduction of novel agents in the treatment of primary CNS lymphoma. Neuro Oncol. 2019;21(3):306–13.CrossRefPubMed Grommes C, et al. Introduction of novel agents in the treatment of primary CNS lymphoma. Neuro Oncol. 2019;21(3):306–13.CrossRefPubMed
23.
go back to reference Narita, Y., et al., Phase 1/2 Study of Tirabrutinib, a Second-Generation Bruton's Tyrosine Kinase Inhibitor, in Relapsed/Refractory Primary Central Nervous System Lymphoma. Neuro Oncol, 2020. Narita, Y., et al., Phase 1/2 Study of Tirabrutinib, a Second-Generation Bruton's Tyrosine Kinase Inhibitor, in Relapsed/Refractory Primary Central Nervous System Lymphoma. Neuro Oncol, 2020.
Metadata
Title
Treatment of new-onset primary central nervous system lymphoma in elderly patients using RMPV chemotherapy: a single-institution experience
Authors
Michiharu Yoshida
Takeharu Kato
Takeshi Hiu
Yoshitaka Imaizumi
Simpei Morimoto
Daisuke Niino
Susumu Yamaguchi
Shiro Baba
Kenta Ujifuku
Koichi Yoshida
Ayaka Matsuo
Yoichi Morofuji
Tsuyoshi Izumo
Shinji Okano
Yasushi Miyazaki
Takayuki Matsuo
Publication date
01-07-2023
Publisher
Springer Nature Singapore
Published in
International Journal of Hematology / Issue 3/2023
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-023-03632-9

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