The treatment of primary central nervous system lymphoma in 122 immunocompetent patients

Abstract

BACKGROUND The objective of this study was to evaluate the clinical outcome of a population‐based cohort of immunocompetent patients with primary central nervous system lymphoma (PCNSL) treated with 3 different strategies over 13 years. METHODS One hundred twenty‐two consecutive patients (median age, 66 years) with PCNSL were identified. Three treatment strategies were employed: 1) whole‐brain irradiation with (from January, 1990, to June, 1991) or without (from April, 1995, to December, 1999) cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)‐type chemotherapy (n = 50 patients); 2) combined‐modality therapy, including 1 g/m² methotrexate plus whole‐brain irradiation (from July, 1991, to March, 1995; n = 34 patients); and 3) 8 g/m² methotrexate alone (from January, 2000, to March, 2003) with whole‐brain irradiation reserved for those with progressive disease (n = 38 patients). Treatment failure was defined as progressive disease, disease recurrence, death from toxicity or lymphoma, or toxicity that necessitated a change in primary treatment. RESULTS The median failure‐free survival was 7 months, and the median overall survival (OS) was 17 months. The median OS was similar in all 3 eras. In this population‐based analysis, one‐third of patients did not receive the treatment strategy of the era. Therefore, the data also were analyzed by treatment received. On multivariate analysis (including era of treatment), 3 factors—age > 60 years, lactate dehydrogenase > normal, and omission of methotrexate—were associated significantly with poorer OS (hazard ratio: 2.3, 2.2, and 2.3, respectively). CONCLUSIONS Outcomes for a general population with PCNSL remained constant despite different treatment strategies over three eras. For the two‐thirds of patients who could receive potentially curative treatment, age, lactate dehydrogenase level, and receipt of ≥ 1 g/m² methotrexate appeared to be important determinants of OS. Cancer 2005. © 2005 American Cancer Society.