title: CHOD/BVAM chemotherapy and whole-brain radiotherapy for newly diagnosed primary central nervous system lymphoma.
abstract: OBJECTIVE
  To assess the efficacy and toxicity of chemotherapy consisting of cyclophosphamide, doxorubicin (Adriamycin), vincristine, and dexamethasone (CHOD) plus bis-chloronitrosourea (BCNU), cytosine arabinoside, and methotrexate (BVAM) followed by whole-brain irradiation (WBRT) for patients with primary central nervous system lymphoma (PCNSL).
  
  
  METHODS
  Patients 70 years old and younger with newly diagnosed, biopsy-proven PCNSL received one cycle of CHOD followed by two cycles of BVAM. Patients then received WBRT, 30.6 Gy, if a complete response was evoked, or 50.4 Gy if the response was less than complete; both doses were given in 1.8-Gy daily fractions. The primary efficacy endpoint was 1-year survival.
  
  
  RESULTS
  Thirty-six patients (19 men, 17 women) enrolled between 1995 and 2000. Median age was 60.5 years (range, 34 to 69 years). Thirty (83%) patients had baseline Eastern Cooperative Oncology Group performance scores of 0 to 1. All 36 patients were eligible for survival and response evaluations. Median time to progression was 12.3 months, and median survival was 18.5 months. The percentages of patients alive at 1, 2, and 3 years were 64%, 36%, and 33%, respectively. The best response was complete response in 10 patients and immediate progression in 7 patients. Ten (28%) patients had at least one grade 3 or higher neurologic toxicity.
  
  
  CONCLUSIONS
  This regimen did improve the survival of PCNSL patients but also caused substantial toxicity. The improvement in survival is less than that reported with high-dose methotrexate-based therapies.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Laack
authors.forename: Brian Patrick
authors.initials: BP
authors.lastname: O'Neill
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.forename: Judith Rich
authors.initials: JR
authors.lastname: O'Fallon
authors.forename: Xiomara W
authors.initials: XW
authors.lastname: Carrero
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kurtin
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Scheithauer
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Colgan
authors.forename: Mark R
authors.initials: MR
authors.lastname: Gilbert
authors.forename: Roland B
authors.initials: RB
authors.lastname: Hawkins
authors.forename: Roscoe F
authors.initials: RF
authors.lastname: Morton
authors.forename: Harry E
authors.initials: HE
authors.lastname: Windschitl
authors.forename: Tom R
authors.initials: TR
authors.lastname: Fitch
authors.forename: Eduardo R
authors.initials: ER
authors.lastname: Pajon
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D002330:Carmustine; D008727:Methotrexate
references.citation: J Clin Oncol. 2003 Jan 15;21(2):266-72
references.pmid: 12525518
references.citation: J Clin Oncol. 2006 Oct 1;24(28):4570-4
references.pmid: 17008697
references.citation: Neurology. 2004 Feb 24;62(4):548-55
references.pmid: 14981169
references.citation: Cancer. 2008 Apr 15;112(8):1812-20
references.pmid: 18318432
references.citation: Clin Oncol (R Coll Radiol). 2005 May;17(3):185-91
references.pmid: 15901003
references.citation: Neurology. 1994 Sep;44(9):1721-7
references.pmid: 7936304
references.citation: Int J Radiat Oncol Biol Phys. 2006 Feb 1;64(2):408-13
references.pmid: 16198065
references.citation: J Clin Oncol. 2000 Sep;18(17):3144-50
references.pmid: 10963643
references.citation: Neurology. 2004 Feb 24;62(4):544-7
references.pmid: 14981168
references.citation: Leuk Lymphoma. 2006 Dec;47(12):2449-52
references.pmid: 17169791
references.citation: J Clin Oncol. 1998 Apr;16(4):1561-7
references.pmid: 9552066
references.citation: J Clin Oncol. 2003 Mar 15;21(6):1044-9
references.pmid: 12637469
references.citation: Neuro Oncol. 1999 Jul;1(3):196-203
references.pmid: 11554388
references.citation: Expert Rev Anticancer Ther. 2001 Oct;1(3):382-94
references.pmid: 12113105
references.citation: J Clin Oncol. 1998 Mar;16(3):859-63
references.pmid: 9508166
references.citation: J Clin Oncol. 2002 Dec 15;20(24):4643-8
references.pmid: 12488408
references.citation: J Clin Oncol. 2002 Jan 1;20(1):231-6
references.pmid: 11773174
references.citation: J Clin Oncol. 2003 Dec 15;21(24):4483-8
references.pmid: 14597741
references.citation: Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1429-39
references.pmid: 16863926
references.citation: Clin Cancer Res. 2002 Jun;8(6):1702-9
references.pmid: 12060607
references.citation: Int J Radiat Oncol Biol Phys. 1992;23(1):9-17
references.pmid: 1572835
references.citation: JAMA. 1993 May 12;269(18):2386-91
references.pmid: 8479064
references.citation: Arch Neurol. 2003 Apr;60(4):563-8
references.pmid: 12707070
references.citation: Neurology. 2002 May 28;58(10):1513-20
references.pmid: 12034789
references.citation: Biometrics. 1982 Mar;38(1):143-51
references.pmid: 7082756
references.citation: Semin Oncol. 2004 Oct;31(5):684-92
references.pmid: 15497122
references.citation: Cancer. 2002 Oct 1;95(7):1504-10
references.pmid: 12237919
references.citation: Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):559-63
references.pmid: 10078637
references.citation: J Clin Oncol. 2003 Nov 15;21(22):4151-6
references.pmid: 14615443
references.citation: Int J Radiat Oncol Biol Phys. 2001 Jun 1;50(2):457-64
references.pmid: 11380234