Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy.
OBJECTIVE
To evaluate response rate, response duration, overall survival (OS), and toxicity in primary CNS lymphoma (PCNSL) after systemic and intraventricular chemotherapy with deferred radiotherapy.


METHODS
From September 1995 to July 2001, 65 consecutive patients with PCNSL (median age, 62 years) were enrolled onto a pilot and phase II study evaluating chemotherapy without radiotherapy. 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) was combined with intraventricular MTX, prednisolone, and ARA-C.


RESULTS
Sixty-one of 65 patients were assessable for response. Of these, 37 patients (61%) achieved complete response, six (10%) achieved partial response, and 12 (19%) progressed under therapy. Six (9%) of 65 patients died because of treatment-related complications. Follow-up is 0 to 87 months (median, 26 months). The Kaplan-Meier estimates for median time to treatment failure (TTF) and median OS were 21 months and 50 months, respectively. For patients older than 60 years, median survival was 34 months, and the median TTF was 15 months. In patients younger than 61 years, median survival and median TTF have not been reached yet; the 5-year survival fraction is 75%. Systemic toxicity was mainly hematologic. Ommaya reservoir infection occurred in 12 patients (19%), and permanent cognitive dysfunction possibly as a result of treatment occurred in only two patients (3%).


CONCLUSIONS
Primary chemotherapy based on high-dose MTX and ARA-C is highly efficient in PCNSL. Response rate and response duration in this series are comparable to the response rates and durations reported after combined radiotherapy and chemotherapy. Neurotoxicity was infrequent.
Department of Neurology, University of Bonn, Germany.
Hendrik
H
Pels
Ingo G H
IG
Schmidt-Wolf
Axel
A
Glasmacher
Holger
H
Schulz
Andreas
A
Engert
Volker
V
Diehl
Anton
A
Zellner
Gabriele
G
Schackert
Heinz
H
Reichmann
Frank
F
Kroschinsky
Marlies
M
Vogt-Schaden
Gerlinde
G
Egerer
Udo
U
Bode
Carlo
C
Schaller
Martina
M
Deckert
Rolf
R
Fimmers
Christoph
C
Helmstaedter
Aslihan
A
Atasoy
Thomas
T
Klockgether
Uwe
U
Schlegel
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D010865:Pilot Projects; D011239:Prednisolone / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome
D003561:Cytarabine; D003907:Dexamethasone; D003520:Cyclophosphamide; D011239:Prednisolone; D007069:Ifosfamide; D008727:Methotrexate