Resultsof a large population-based study of patients with primary CNS lymphoma diagnosedbetween 2011 and 2016 showed a higher proportion of patients 60 years and oldercompared with reports from studies conducted 1 to 2 decades earlier. The findings from this study were published inNeurology.

PrimaryCNS lymphoma is a rare, aggressive form of non-Hodgkin lymphoma that caninvolve the brain, spine, leptomeninges, and eyes. It is characterized by theabsence of systemic disease, and a poor prognosis.

Anumber of advances in the treatment of patients with this disease have beenmade over the past 3 decades. These have included replacement of conventional whole-brainradiotherapy (WBRT) alone with combined modality therapy including high-dosemethotrexate-based chemotherapy followed by WBRT consolidation, which was shownto prolong time to recurrence in these patients. Alternatively, the use of first-line,high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) consolidationis an approach designed to circumvent WBRT-associated toxicity.

Inaddition, studies of the safety and efficacy of combining first-line high-dosemethotrexate with other drugs, such as high-dose cytarabine or rituximab, haveshown promising results, although concerns related to toxicity, particularly inolder patients, remain with some of these approaches.

Thisretrospective study included patient-, disease-, and treatment-related data forall adult, HIV-negative patients with primary CNS lymphoma diagnosed between2011 and 2016 who were included in the French oculo-cerebral lymphoma network,a prospective, nationwide database.

Ofthe 1002 patients included in this analysis, the median patient age was 68years (range, 18-91 years), and the median Karnofsky Performance Status (KPS) was60. Patients at least 60 years old and at least 70 years old comprised 72% and43% of the study population, respectively.

Thesedata are in line with epidemiologic studies reporting a continuouslyincreasing rate in the elderly over the last decades, the study authorscommented.

Morethan 90% of patients were treated with high-dose methotrexate chemotherapy,including more than 80% of patients aged 80 years or older, although the dosewas more likely to be lower in the latter population.

Consolidationtherapy with WBRT or ASCT was received by 15% and 6% of patients, respectively,although the majority of these patients were younger than 60, with only 11% ofpatients aged 60 years or older receiving consolidation therapy.

Theobjective response rate (ORR) to first-line treatment was significantly higherin younger patients compared with older patients (73% vs 54%; P <.001), and ORRs for the overallpopulation and the population treated with consolidation therapy were 59% and92%, respectively.

Ata median follow-up of 44.4 months, the median overall survival (OS) for theoverall population was 25.3 months. Although the rates of 1-, 2-, and 5-year OSfor the overall population were 62%, 51%, and 38%, the 5-year OS rate for thosetreated with first-line high-dose chemotherapy followed by ASCT was 76%.

One-quarterof patients included in the study died within 6 months of primary CNS lymphomadiagnosis, and these patients were more likely to be older (P <.001) and to have a worse KPS atdiagnosis (P <.001). Cause ofdeath in this group was determined to be multifactorial in 44% of cases, andincluded impaired neurologic status due to lymphoma, complications (eg,infections), and/or treatment-related side effects.

MedianOS in patients 60 years or older at diagnosis of primary CNS lymphoma was 15.4months compared with 28.4 months in those younger than 60 years (P <.001).

Onmultivariate analysis, prognostic factors associated with longer OS includedage younger than 60 years (P <.001),KPS of 70 or higher at diagnosis (P<.001), female sex (P =.03), andresponse to first-line induction chemotherapy (P <.001).

Thefinding that age represents not only the strongest prognostic factor of thedisease, but also a major risk factor for severe treatment-relatedneurotoxicity, prompted the study authors to conclude that these resultsshould stimulate specific studies devoted to the elderly [with primary CNSlymphoma] to optimize the therapeutic management of this growing vulnerablepopulation.

Reference

Houillier C, Soussain C, Ghesquires H, et al. Management and outcome of primary CNS lymphoma in the modern era: an LOC network study [published online January 6, 2020]. Neurology. doi:10.1212/WNL.0000000000008900

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Younger Age, Consolidation Therapy With Autologous SCT Associated With Improved OS in Patients With Primary CNS Lymphoma - Oncology Nurse Advisor