Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study.

Abstract

BACKGROUND:

A systemic and intraventricular polychemotherapy regimen (the Bonn protocol) without radiotherapy resulted in durable responses in 75% of patients <60 years with primary CNS lymphoma (PCNSL), but was complicated by a high rate of Ommaya reservoir infections. Here, the efficacy and toxicity of this regimen without intraventricular treatment was evaluated in PCNSL.

PATIENTS AND METHODS:

From August 2003 to November 2005, 18 patients with PCNSL <60 years (median age, 53 years) were treated in a phase II trial with a high-dose methotrexate (MTX; cycles 1, 2, 4 and 5) and cytarabine (Ara-C; cycles 3 and 6) based systemic therapy including dexamethasone, vinca-alkaloids, ifosfamide and cyclophosphamide.

RESULTS:

Study accrual was prematurely stopped in November 2005 due to a high rate of early relapses. Seventeen of 18 patients were assessable for response: nine (53%) achieved complete response (CR), two (12%) complete response/unconfirmed (CRu) and two (12%) partial response (PR); four (24%) showed progressive disease (PD). One treatment was stopped due to toxicity. Median follow-up was 23 months, median response duration was only 10 months in responding patients, and median time to treatment failure (TTF) was 8 months in the whole group. Median overall survival (OS) has not been reached. Systemic toxicity was mainly hematologic.

CONCLUSIONS:

In PCNSL patients <60 years, polychemotherapy without intraventricular treatment results in a high response rate, but is associated with early relapses in the majority of cases. This is in contrast to the results achieved with the same protocol but with intraventricular treatment.

• Authors: Hendrik Pels, Annika Juergens, Axel Glasmacher, Holger Schulz, Andreas Engert, Michael Linnebank, Gabriele Schackert, Heinz Reichmann, Frank Kroschinsky, Marlies Vogt-Schaden, Gerlinde Egerer, Udo Bode, Carlo Schaller, Monika Lamprecht, Peter Hau, Martina Deckert, Rolf Fimmers, Christopher Bangard, Ingo G H Schmidt-Wolf, Uwe Schlegel
• Journal: Journal of neuro-oncology (J Neurooncol) Vol. 91 Issue 3 Pg. 299-305 (Feb 2009) ISSN: 1573-7373 [Electronic] United States
• PMID: 18931887 (Publication Type: Clinical Trial, Phase II, Journal Article)

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Antineoplastic Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Central Nervous System Neoplasms (drug therapy)
• Drug Administration Routes
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Karnofsky Performance Status
• Lymphoma (drug therapy)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Retrospective Studies