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Abstract
Objective Real-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL.
Methods The French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed.
Results We identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients <60 years of age received consolidation treatment in 77% of cases, consisting of whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) (23%). Among patients >60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (<60 years: not reached [NR], 70%, and 61%; >60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis.
Conclusions Our study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.
Glossary
- CI=
- confidence interval;
- CR=
- complete response;
- CRu=
- unconfirmed complete response;
- HCT-ASCT=
- high-dose chemotherapy with autologous stem cell transplantation;
- HD-MTX-CT=
- high-dose methotrexate-based chemotherapy;
- IELSG=
- International Extranodal Lymphoma Study Group;
- KPS=
- Karnofsky Performance Status;
- LDH=
- lactate dehydrogenase;
- LOC=
- French oculo-cerebral lymphoma network;
- MSKCC=
- Memorial Sloan Kettering Cancer Center;
- ORR=
- objective response rate;
- OS=
- overall survival;
- PCNSL=
- primary CNS lymphoma;
- PFS=
- progression-free survival;
- PR=
- partial response;
- WBRT=
- whole-brain radiotherapy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received April 12, 2019.
- Accepted in final form September 5, 2019.
- © 2020 American Academy of Neurology
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