title: Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: an intent-to-treat analysis.
abstract: OBJECTIVE
  To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL).
  
  
  METHODS
  Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m2) and cytarabine (3 g/m2 daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue.
  
  
  RESULTS
  The objective response rate to the induction-phase chemotherapy was 57%, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43%) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity.
  
  
  CONCLUSIONS
  This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted.
authors: Departments of Neurology and Medicine and the Office of Clinical Research, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. abreyl@mskcc.org
authors: Lauren E
authors: LE
authors: Abrey
authors: Craig H
authors: CH
authors: Moskowitz
authors: Warren P
authors: WP
authors: Mason
authors: Michael
authors: M
authors: Crump
authors: Douglas
authors: D
authors: Stewart
authors: Peter
authors: P
authors: Forsyth
authors: Nina
authors: N
authors: Paleologos
authors: Denise D
authors: DD
authors: Correa
authors: Nicole D
authors: ND
authors: Anderson
authors: Dawn
authors: D
authors: Caron
authors: Andrew
authors: A
authors: Zelenetz
authors: Stephen D
authors: SD
authors: Nimer
authors: Lisa M
authors: LM
authors: DeAngelis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D011446:Prospective Studies; D012074:Remission Induction; D012449:Safety; D016879:Salvage Therapy; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D005047:Etoposide; D008558:Melphalan; D002330:Carmustine; D008727:Methotrexate